Instruction: Generate impression based on findings.

Input: Female, 68 years old, with bilateral upper extremity pain and difficulty ambulating. Spinal alignment is grossly anatomic. Vertebral body heights are preserved. Extensive degenerative endplate marrow signal change is seen, however no evidence of significant marrow edema is detected.T2 hyperintensity is seen within the spinal cord at the C4-5 level in the context of spinal canal stenosis, as discussed below. Elsewhere, the cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.The spinal canal is congenitally slender. Additional superimposed degenerative findings are as follows:C2-3: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation with mild spinal canal narrowing and very slight deformation of the spinal cord. Mild left foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation with moderate to severe spinal canal narrowing and flattening of the spinal cord with spinal cord signal abnormality. Mild right and moderate left foraminal narrowing. C5-6: Loss of disc height without significant disc osteophyte formation or spinal canal stenosis. No significant foraminal narrowing. C6-7: Loss of disc height without significant posterior disc-osteophyte complex formation. No spinal canal stenosis. No significant foraminal narrowing. C7-T1: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing.

Output: Multilevel disc degeneration is evident. C4-5 is the most severely affected level where a disc osteophyte complex along with a congenitally slender spinal canal produces moderate to severe canal stenosis, cord deformation and abnormal cord signal which may represent either edema or myelomalacia.


Instruction: Generate impression based on findings.

Input: Per EPIC, 21year-old female with Chiari status post multiple surgeries (first in 11/'07, last in 06/'09), ED, fibromyalgia with recurrent Chiari symptoms including headache, clumsiness, and dysphagia status post re-do Chiari decompression on 6/9/2015. BRAIN: There are postoperative findings related to revision of Chiari decompression with release as well as prior suboccipital craniectomy and resection of the posterior arch of C1. There is mild focal expansion of the thecal sac at the level of surgery. The previously seen lobule of pseudomeningocele just below the level of the neo-foramen magnum is no longer visualized. There is persistent dorsal tenting of the cervicomedullary junction but increased CSF space at the dorsal aspect of the cervical cord at the C2 level. The rounded cerebellar tonsils again extend to the approximate level of the upper margin of C2.CSF flow is not visualized and may be due to technical limitations. The ventricles and sulci are unchanged in size and morphology. The basal cisterns remain patent. There is no midline shift or mass effect. There are new foci of susceptibility in the right greater than left ambient cisterns, likely related to pneumocephalus. Susceptibility with associated FLAIR hyperintensity is seen in a linear fashion in the right frontal lobe, which may relate to previous catheter tract. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is a left maxillary sinus mucosal retention cyst.Normal flow-voids are demonstrated in the major intracranial vascular structures.CERVICAL SPINE: 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. There is stable small spinal cord syrinx from T3 extending inferiorly.There is no significant disc bulge, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Postoperative findings related to revision of Chiari decompression and probable lysis of adhesions as well as repair of pseudomeningocele with slight increased CSF space posterior to the proximal cervical spinal cord. CSF flow study is technically limited. Repeat CSF flow may be obtained as clinically warranted.2. Stable appearance of partially visualized tiny thoracic spinal cord syrinx.


Instruction: Generate impression based on findings.

Input: Diagnosis: Pneumonia due to methicillin resistant Staphylococcus aureusClinical question: eval cavernous sinus thrombosisSigns and Symptoms: infection MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchyma.The left sigmoid sinus flow void is absent. This was also the case on the prior examMany of the pulse sequences are degraded due to patient motion. Susceptibility weighted imaging is severely degraded due to patient motion. To extent of visualization no significant hemorrhages appreciated intracranially.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the maxillary sinuses and mucosal thickening in the sphenoid sinuses. The visualized portions of the mastoid air cells demonstrate opacification of the mastoid air cells and middle ears. The patient is intubated. The visualized portions of the orbits are intact.MRI neck:MRI of the neck is severely degraded due to patient motion. There is signal hyperintensity within the left jugular vein. This was also present on the prior exam. Previously noted T2 signal hyperintensity within the perivertebral soft tissues appears to persist.

Output: 1.Findings suggest persistent left jugular vein and left sigmoid sinus thrombosis. No associated evidence for cerebral congestion is appreciated. Due to significant motion artifact subtle abnormalities readily overlooked. The previously noted epidural collection is not adequately assessed on this exam due to patient motion.2.There is no convincing evidence for cavernous sinus thrombosis or intracranial mass on the basis of this MRI of the brain. However, the exam is limited due to patient motion which may obscure more subtle abnormalities.3.MRI of the neck is severely degraded due to patient motion despite use of sedation. As a result no meaningful interpretation can be provided. The previously noted inflammatory change within the perivertebral soft tissues does not appear to have significantly changed when compared to the prior exam to the extent of visualization possible. Due to significant rotation of the images if clinically appropriate, alternatives may include use of general anesthesia or performing CT exam instead.


Instruction: Generate impression based on findings.

Input: Reason: Pt with know h/o Pancreatic Divisum and multiple bouts of pancreatitis requiring several ERCPS with stents. Need SECRETIN Stimulating MRCP to evaluate. History: Chronic abdominal pain ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma demonstrates normal signal intensity. There is a subcentimeter T2 hyperintense focus within segment 6 (series 4, image 16) which demonstrates persistent enhancement and is compatible with a hemangioma. There are several additional peripheral wedge-shaped areas of arterial enhancement without washout which are compatible with transient hepatic intensity differences. No suspicious focal hepatic lesions are identified. The gallbladder is surgically absent. There is no intra or extrahepatic biliary ductal dilatation. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates diffusely decreased T1 signal as well as diffuse mild atrophy compatible with chronic pancreatitis. The pancreatic duct is mildly irregular with scattered strictures and is mildly prominent in caliber measuring up to 5 mm at the level of the pancreatic head. The main pancreatic duct empties into the minor papilla compatible with pancreatic divisum. There appear to be several small connections between the main pancreatic duct and the distal common bile duct. No pancreatic duct stones are identified. Post secretin images demonstrate a blunted/poor response to secretin possibly due to pancreatic duct stricturing.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.Pancreas divisum. 2.Findings compatible with chronic pancreatitis including mild prominence, irregularity, and stricturing of the main pancreatic duct. No evidence of acute pancreatitis.3.Blunted/poor response to secretin possibly due to pancreatic duct stricturing.


Instruction: Generate impression based on findings.

Input: Female 32 years old Reason: infertility History: infertility Scout AP film of the pelvis was unremarkable. Opacification of the uterine cavity revealed an arcuate/bicornuate uterus without mucosal irregularity or filling defects in the uterine cavity, further characterization with MRI may be obtained if clinically warranted. Upon contrast administration, right hydrosalpinx without significant free spillage was noted. The left fallopian tube freely opacified with free spillage into the left pelvis and subsequent spread into the right pelvis, indicating left tubal patency.TOTAL FLUOROSCOPY TIME: 1:39 minutesDOSE AREA PRODUCT: 1322 uGy*m^2

Output: Right hydrosalpinx without significant free spillage. Patent left fallopian tube. MRI/ultrasound to further evaluate arcuate/bicornuate uterus as above.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:11/14/1952)Reason: chronic infarcts or focus for seizure? History: repeated episodes of transient R-sided weaknessPROVIDER/ATTENDING NAME: NAOUM P ISSA NAOUM P ISSA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 demonstrate partial opacification of the left mastoid air cells.. The visualized portions of the orbits are intact.A well-circumscribed 18 x 11 mm axial dimension lesion is present in subcutaneous tissues the left occipital scalp most likely representing a sebaceous cyst.

Output: No evidence for acute ischemic cerebral infarction.No evidence for intracranial mass lesionThere are several periventricular and subcortical white matter lesions which are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Shoulder pain and numbness to left arm Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.There is mild narrowing of the mid cervical spinal canal on a congenital basis. Minimal superimposed degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is small left foraminal disc protrusion and mild uncovertebral hypertrophy with resulting mild left foraminal stenosis. No significant compromise to the spinal canal or right neural foramen.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: Minimal narrowing of the left neural foramen. Otherwise no significant spinal canal or neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Minimal degenerative changes in the cervical spine as detailed above with mild left C3-C4 and minimal left C6-C7 neural foraminal narrowing. No significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Low back pain with radicular symptoms. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There is loss of intravertebral disk height at the L1-L2 level with edematous marrow signal changes involving the adjacent vertebral bodies. Small Schmorl's nodes are noted at the superior endplates of L3 and L4. Small Tarlov cyst is present at the left S2 level. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Loss of intervertebral disk space and mild disk bulge, eccentric to the right. There is mild right neural foraminal narrowing. No significant spinal canal or left 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: There is disk desiccation and small dorsal annular fissure. No spinal canal or neural foraminal stenosis.L5-S1: There is disk desiccation and small dorsal annular fissure. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.There is atrophy involving the left psoas muscle.

Output: 1. Degenerative changes in the lumbar spine particularly at the L1-L2 intervertebral disk level. There is mild right L1-L2 neural foraminal narrowing. Otherwise no significant spinal canal or neural foraminal stenosis is seen at any level. 2. Atrophy involving the left psoas muscle which may be related to advanced osteoarthritis involving the left hip joint.


Instruction: Generate impression based on findings.

Input: Status post cervical laminoplasty. Evaluate healing of hinge of the lamina. History of breast cancer and stenosis. Reformatted images of the cervical spine demonstrates extensive degenerative changes of cervical spine with slight reversal cervical lordosis. There is no definitive evidence of any destructive bony lesion. However irregular and sclerotic lesion within the right aspect of vertebral body of T3 which also involves the right pedicle, a sclerotic and lytic changes of the right aspect of vertebral body of T1 and sclerotic changes of the right aspect of C6 are noted. There are no prior CT examinations of the cervical spine or an MRI examination of cervical spine for comparison.Considering the provided clinical date of possibility of a sclerotic met cannot be ruled out. Some of these lesions have the appearance of a capillary skeletal hemangioma.Foramina magnum. Examination of this level is unremarkable.C2 -- C3.Degenerative changes are noted in mild compromise of left neural foramina is suspected. Broad-based bulging of disk material is in contact with ventral aspect of the cord and borderline central spinal stenosis is suspected.C3 -- C4.Degenerative disk disease and slight bulge of disk material is noted. There is evidence of left sided laminectomy with no evidence of laminoplasty. Left neural foramina appears widely compromise secondary to degenerative changes. A very small metallic density is noted within the right inferior articulating facet. C4 -- C5.Left-sided laminectomy of C5 with no evidence of laminoplasty. Small metallic density within the inferior facet of C5 on the right is also noted.C5 -- C6.Left-sided laminectomy but no evidence of laminoplasty. A small metallic fragment within the inferior facet of C6 on the right. Degenerative changes are noted.C6 -- C7.Exam of the stomach is unremarkable. No evidence of any fixating devices or bony graft is detected.

Output: 1.Extensive areas of sclerotic bony changes as detailed above. Concerning for metastases lesions or treated metastatic lesion. No prior MRI of cervical spine or CT of cervical spine for comparison.2.Multi-level laminectomies on the left with no areas of laminoplasty.3.Small metallic densities within the inferior facets of C4, C5 and C6. Correlate with prior surgical intervention.


Instruction: Generate impression based on findings.

Input: Cervical spine: There has been anterior fusion of the cervical spine from C4 through C6. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. There is no focal bone marrow signal abnormality to suggest neoplasm. There is no abnormal leptomeningeal enhancement. There are mild posterior disc osteophyte complexes at throughout the cervical spine. There is mild spinal canal stenosis at C3-C4 with slight flattening of the ventral spinal cord. There is no abnormal spinal cord signal. There is multilevel bilateral facet arthropathy and uncovertebral hypertrophy. There is multilevel neural foraminal stenoses, up to a moderate degree bilaterally at C3-C4, on the left at C5, and bilaterally at C5-C6.Thoracic spine: There is a small syrinx beginning at the level of T2-T3, which extends caudally to the T12-L1 level. The syrinx measures up to 4 mm in greatest axial dimension at T11. There is mild resultant expansion of the spinal cord. The thoracic spine is in normal alignment. The vertebral body heights are well-maintained. There is mild loss of intervertebral disc height at multiple levels. There are mild disc bulges and ligamentum flavum hypertrophy at multiple levels throughout the thoracic spine without significant spinal canal or neural foraminal stenosis. Small foci of increased T1 and T2 signal are present in the vertebral bodies of T1 and T12, compatible with intraosseous hemangiomas or focal fatty marrow. Otherwise, there is no focal bone marrow signal abnormality to suggest neoplasm. There is no abnormal leptomeningeal enhancement. There are multiple pulmonary nodules bilaterally, as well as a small left pleural effusion.Lumbar spine: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. Foci of increased T1 and T2 signal are demonstrated in the L1 vertebral body, compatible with an intraosseous hemangioma or focal fatty marrow. There are bone marrow signal abnormalities of the endplates of the L3, L4, and L5 vertebral bodies compatible with degenerative endplate changes. Likewise, there is enhancement surrounding multiple bilateral lower lumbar facet joints, which is likely degenerative in nature. The conus medullaris and cauda equina nerve roots within normal limits. There are small disc bulges at L1-L2, L2-L3, and L5-S1. There are also disc bulges at L3-L4 and L4-L5. There is multilevel facet arthropathy/ligamentum flavum hypertrophy. There is multilevel resultant spinal canal stenoses, which is mild at L2-L3 and L4-L5, and moderate at L3-L4. There is neural foraminal narrowing at multiple levels, which is moderate on the left and severe on the right at L3-L4 and L4-L5. There appears to be impingement on the examining right L4 nerve root. There are multiple nonenhancing round lesions in the kidneys up to 14 mm, some of which demonstrate increased T1 signal, likely representing renal cysts.

Output: 1. No evidence of metastatic disease involving the vertebrae or spinal canal.2. Multilevel cervical spondylosis with mild spinal canal stenosis at C3-C4.3. Long segment syrinx in the thoracic cord, which measures up to 4 mm in width, without associated mass or spinal cord compression in the thoracic spine.4. Multilevel lumbar spondylosis, which is most pronounced at L4-L5. 5. Multiple pulmonary metastases ar better depicted on the prior chest CT.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 are no areas of abnormal parenchymal signal. 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 unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: No evidence of acute infarction, intracranial mass, or 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: 68 year old male with history of hyperlipidemia and anginal symptoms who presents for cardiac MRI to evaluate for ischemiaMEDICATIONS: aspirin, Lipitor, metoprolol First Pass PerfusionDuring hyperemia, there is a severe, large sized defect in the basal to mid inferior and inferoseptum and the apical inferior and septal walls. Additionally, there is a mild perfusion defect involving all of the other segments in the mid ventricle and and the apical anterior wall. Viability/ Myocardial ScarThere is a small subendocardial basal inferior late gadolinium enhancement involving approximately 25-50% of the wall thickness, suggesting prior non-transmural myocardial infarction. This segment has an intermediate probability of viability. The remainder of the myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 71%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 139 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 39 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 114 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe ascending aorta is mildly dilated (39x41mm). There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large, severe perfusion defect in the territory of the right coronary artery. There are additionally mild perfusion defects noted in the usual territory of the mid LAD and mid LCx arteries.2. There is a small non-transmural myocardial infarction involving the basal inferior wall. This segment has an intermediate probability of viability. The remainder of the myocardium is viable. 3. Normal LV size and systolic function (LVEF 71%).4. Normal RV size and systolic function (RVEF 67%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 18-year-old female with pain and swelling MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema consistent with contusions within the anterior lateral femoral condyle, posterior lateral tibial condyles, and posterior medial tibial condyle. There is also a small contusion within the posterior medial femoral condyle.LIGAMENTS: The ACL is completely disrupted. The PCL is intact. The MCL and LCL complex are intact.EXTENSOR MECHANISM: Quadriceps and patella tendons are intact.ADDITIONAL

Output: 1. ACL tear with bone contusions as described above.2. Moderate joint effusion


Instruction: Generate impression based on findings.

Input: Reason: cause of 10/10 pain on knee flexion US negative for blood, has MS (not the cause) on coumadin History: ib id MENISCI: Lateral meniscus is intact. There is absence of a large portion of the body and anterior horn of medial meniscus. The medial meniscus is extruded medially into the lateral recess. There is also a possible additional tear at the medial meniscal root.ARTICULAR CARTILAGE AND BONE: There are large areas of full-thickness cartilage loss involving nearly the entire medial femoral condyle measuring at least 3 cm and medial tibial plateau. There is diffuse thinning in the lateral compartmentwithout a fluid-filled defect present. Patellar and trochlear cartilage is intact. Moderate tricompartmental osteophytes are present. There are scattered foci of increased T2 signal along the tibial plateau which likely represent reactive edema.LIGAMENTS: The lateral collateral ligament complex is intact. The medial collateral ligament is intact. There is a tear of the ACL. The PCL is increased T2 signal which may reflect tendinopathy.EXTENSOR MECHANISM: Extensor mechanism is intactADDITIONAL

Output: 1.ACL rupture.2.Absence of large portion of the medial meniscal body and anterior horn may reflect either prior partial meniscectomy or degenerative tearing.3.Severe full-thickness articular cartilage loss in the medial compartment.4.Multilobulated Baker's cyst.


Instruction: Generate impression based on findings.

Input: 16 year male with sarcomere mutation and family history of hypertrophic cardiomyopathy. He is referred for MRI as part of the VANISH trial. Left VentricleThe left ventricle is normal in size and systolic function. The interventricular septal thickness is normal (9mm). There are deep crypts/ recesses in the basal to mid inferior wall, these have been described to be present in family members of patients with hypertrophic cardiomyopathy. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 92 ml/m2 (normal range: 74+/-15), the LVEDV is 184 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 41 g/m2 (normal range 85+/-15), and the LV mass is 81 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 188 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 92 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 56 %) without evidence of regional wall thickness. Deep recesses and crypts are noted in the basal to mid inferior wall, which have been described in gene positive, phenotype negative hypertrophic cardiomyopathy patients.2. No evidence of underlying myocardial fibrosis, inflammation, or infiltration.3. Normal RV size and systolic function (RVEF 51 %).


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of kidney, except pelvis [189.0], Reason for Study: ^Reason: bladder CA (neuroendocrine pathology) History: bladder CA (neuroendocrine pathology) No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. . Minimal mucosal thickening on the left side of sphenoid sinus. Minimal fluid collections on the right mastoid air cell.

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


Instruction: Generate impression based on findings.

Input: 30 year old male with possible bicuspid valve morphology by ECHO. Cardiac MRI done to evaluate aortic valve morphology and aorta size. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 78 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 84 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. No evidence of atrial septal defect. Right VentricleThe right ventricle is upper limits of normal size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 189 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and is bicuspid in morphology with nearly complete fusion of the right and left coronary cusps. There is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. No evidence of aortic coarctation. Sinotubular junction: 25x28mmSinus of Valsalva: 36x33x34mmAscending Aorta: 28x28mmTransverse Aorta: 24 mm x 23 mmDescending Aorta: 20 mm x 20 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (56%) without underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is upper limits of normal size with normal systolic function (50%)3. Bicuspid aortic valve with trivial aortic regurgitation4. Normal aortic root without evidence of aortic coarctation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Other ill-defined conditions(799.89) [799.89] / Lack of coordination [781.3], Reason for Study: ^Reason: eval for Wernicke's enceph or cerebellar lesion History: ataxia, EtOH abuse Significant motion artifact on post gadolinium enhanced scan especially axial post contrast enhanced scan is nondiagnostic.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Scattered high signal intensity foci on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.Focal high signal intensity on the left globus pallidus could represent focal chronic lacunar infarct.Gadolinium-enhanced sagittal scan shows no evidence of abnormal enhancement. However, axial post gadolinium enhanced scan was nondiagnostic.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. 2. Given limited examination, no definitive evidence of abnormal enhancement on the scan either.3. Nonspecific small vessel ischemic disease, minimal as described above.4. Small lacunar infarct on the left globus pallidus.


Instruction: Generate impression based on findings.

Input: MRI Pituitary: There is minimal heterogeneous enhancement of the pituitary gland, but no discrete lesion is apparent. The pituitary gland is not enlarged. The pituitary stalk lies in the midline. The posterior pituitary bright spot is intact. The cavernous sinuses and optic apparatus are unremarkable.MRI Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is minimal nonspecific diffuse periventricular white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a right cerebellar hemisphere developmental venous anomaly. There is mucosal thickening in the left maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. The pituitary gland is mildly heterogeneous, but no discrete lesion is apparent.2. Right cerebellar hemisphere developmental venous anomaly.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Melanoma with new brain metastases on CT scan. There is a medial left cerebellar enhancing lesion that measures up to 18 mm, a left lateral cerebellar enhancing lesion that measures up to 10 mm, a left middle frontal gyrus enhancing lesion that measures up to 9 mm, a left superior frontal gyrus lesion that measures up to 6 mm, a left hippocampal tail enhancing lesion that measures up to 4 mm, and a right medial cerebellum enhancing lesion that measures up to 4 mm. There is confluent T2 hyperintensity surrounding the lesions. There is no evidence of intracranial hemorrhage or acute infarct. There is partial effacement of the fourth ventricle. The third and lateral ventricles are not particularly enlarged. There is no midline shift or herniation. There is mild scattered subcortical and confluent periventricular white matter T2 hyperintensity without associated enhancement. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a subcentimeter exophytic cystic lesion in the skin along the left lateral eyelid region, which may represent a hidrocystoma. There is an apical scalp lipoma that measures 7 mm in thickness. There are small bilateral maxillary sinus retention cysts.

Output: Multiple supratentorial and infratentorial metastases with vasogenic edema, but no midline shift or herniation.


Instruction: Generate impression based on findings.

Input: Clinical question: status post craniotomy. Signs and symptoms: Same Nonenhanced head CT:Extensive postoperative changes of a left frontal -- temporal craniotomy is again identified. There is no definite evidence of any interval change.Small area of low-attenuation along the anterior aspect of the left temporal lobe is better visualized than prior study. This finding may represent widened left sylvian fissure due to recent surgical intervention. Possibility of focal cortical edema cannot be entirely ruled out. Please correlate with exam and if there is clinical concern for ischemic change recommend an MRI study.There is no evidence of interval hemorrhage since prior study. No evidence of hydrocephalus. Minimal midline shift to the right of approximately 3 mm is again noted with no change. Expected postoperative changes of intracranial air and small epidural blood/fluid collection under the craniotomy flap is again noted.

Output: No definitive interval change since prior study. Please see above comments.


Instruction: Generate impression based on findings.

Input: 46 years Male (DOB:9/26/1970)Reason: seizure eval History: seizure-like eventsPROVIDER/ATTENDING NAME: NAOUM ISSA NAOUM ISSA No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The cerebellum is relatively small and atrophic. There is a lesion at the junction of the right cerebellar hemisphere in the middle cerebellar peduncle measuring 9 x 5 mm which follows spinal fluid on all pulse sequences.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 mucosal thickening in the maxillary sinuses - left more than right - and some mucosal thickening in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Cerebellar atrophy2.A small lesion at the junction of the right middle cerebellar peduncle and cerebellar hemisphere is likely related to a small focus of encephalomalacia or a perivascular space.3.There is no evidence for intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: Reason: please define the margins of the tumor History: woman with NF1 and largish plexiform neurofibroma of left hip/flank (just above or at the iliac crest) BONE MARROW: No fractures are identified. Bone marrow signal is within normal limits.SOFT TISSUES: There is a soft tissue mass mass in the left back centered just above the iliac crest (series 401, image 35) which measures approximately 6.5 x 11.1 cm in the axial plane and 4.5 cm in the craniocaudal dimension. The lesion is somewhat heterogeneous and demonstrates increased T2 signal and decreased T1 signal compared to the adjacent fat. The deep margin of the lesion is somewhat indistinct and blends with the underlying fat. The lesion appears separate from the adjacent deep paraspinal and gluteal muscles; the intervening fat planes appear intact. Additional scattered round targetoid T2 hyperintense lesions are present throughout the soft tissues of the abdomen, pelvis and bilateral lower extremities compatible with neurofibromas. An example lesion in the anterior musculature of the right thigh (image 401, image 4) measures approximately 1.3 x 1.8 cm. JOINTS: No significant abnormality noted.ADDITIONAL

Output: 1.Soft tissue mass in the left back centered just above the iliac crest measuring 6.5 x 11.1 x 4.5 with features somewhat atypical for classic neurofibroma and which could represent a malignant peripheral nerve sheath tumor. 2.Additional smaller neurofibromas scattered throughout the soft tissues of the abdomen, pelvis and bilateral lower extremities.


Instruction: Generate impression based on findings.

Input: Reason: further charaterization of renal mass described on recent chest CT; avoiding iodine/gadolinium given CKD History: incidental renal mass ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensity in the left hepatic lobe (4/16) is incompletely characterized without intravenous contrast. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 6.3 x 5.0 cm left upper quadrant lesion seen on CT appears to arise from the left adrenal gland and not the kidney (6/92). On the prior CT, this lesion had regions of fat density. These regions are hyperintense on T1-weighted images, consistent with macroscopic fat. There is loss of signal on out of phase images suggesting microscopic fat. Overall, these imaging characteristics are suggestive of an adrenal myelolipoma.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: Lesion described on prior CT likely represents a left adrenal myelolipoma.


Instruction: Generate impression based on findings.

Input: History of lytic lesion in the left iliac bone seen on recent CT. We see no discrete lesion on this study corresponding to the lucency in the left iliac bone seen on recent CT scan. The lucency seen on CT probably represents an area of fatty marrow of no clinical significance. There is an ovoid focus of low signal intensity within the right femoral neck representing a benign bone island. Otherwise bone marrow signal is within normal limits. We see no abnormal enhancement in the left hip. Please note that this study is not protocoled for evaluation of acetabular labrum, but we see no gross labral abnormality. No joint effusion is present. The sacroiliac joints are within normal limits. The visualized musculature is within normal limits. A small amount of pelvic free fluid is present which may be physiologic.

Output: No discrete lesions seen on this study. Lucent lesion seen on prior CT likely represents a benign focus of relatively fatty marrow.


Instruction: Generate impression based on findings.

Input: 72-year-old male with complex left renal lesion seen on outside hospital MRI examination. Needs dedicated renal imaging to evaluate for RCC. ABDOMEN:LUNG BASES: No significant abnormality noted. There is coronary artery calcification.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality noted. There is a splenule at the splenic hilum.PANCREAS: No significant abnormality notedADRENAL GLANDS: There is mild eccentric thickening of the left adrenal that measures 1 cm in greatest dimension.KIDNEYS, URETERS: The right kidney is normal. No hydronephrosis. There are two left renal cysts, including a mid pole region cortical cyst and a more inferior exophytic cyst. The cortical cyst measures approximately 1.5 x 1.8 cm and demonstrates no significant contrast enhancement on immediate and delayed sequences. The exophytic cyst measures 2.7 x 3.3 cm with attenuation value of 2 Hounsfield units prior to contrast, and 4 - 6 Hounsfield units after contrast and approximately 2 Hounsfield units on delay. The renal cortical cyst is uniloculated and compatible with a benign simple cyst. The wall of the larger exophytic cyst appears eccentrically thickened at axial image 56/172 of the axial postcontrast series 9. This Bosniak II category cyst should be followed in 4 to 6 months. Alternatively, comparison can be made with the patient's outside MRI examination, if available.RETROPERITONEUM, LYMPH NODES: There is an enlarged aortocaval periportal lymph node at axial image 43/172 which measures 2 x 2.7 cm. Several additional enlarged lymph nodes are seen in the celiac region.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: There are degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted

Output: Two left renal cysts, but no significant enhancement with contrast administration. The larger exophytic left mid pole cyst has a eccentrically thickened wall and should be followed. Comparison with outside MRI examination may be helpful, if available. No solid renal mass was found. Enlarged periportal & celiac lymph nodes. See above.


Instruction: Generate impression based on findings.

Input: 53-year-old woman with strong family history of breast cancer presents for screening. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified nature of brainClinical question: h/o right brain tumor; preop planning for resectionSigns and Symptoms: preop planning for resection There is an extra-axial enhancing parafalcine mass measuring 59 x 40 mm axial dimensions which compresses the adjacent right precuneus, right paracentral lobule and right parietal lobe associated with multiple flow voids. It extends to the adjacent superior sagittal sinus were no flow void is appreciated along the length of this extra-axial mass. There is associated signal hyperintensity on T2 imaging within the adjacent white matter compatible with vasogenic edema.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.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.Large extra-axial parafalcine mass centered adjacent to the right parietal lobe associated with suspected occlusion or near occlusion of the adjacent superior sagittal sinus most likely represents a meningioma. There is adjacent vasogenic edema and mass effect.2.Please note that this examination is limited for the purposes of stereotactic guidance during surgery.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: r/o bleed History: s/p fall None infused head CT:There is no intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Bilateral extra-axial CSF density collections in frontal and anterior parietal regions are concerning for old subdural hematomas. Recommend follow-up with an MRI examination. The collection on the left at the level of frontal horn of lateral ventricle measures approximately 9 mm in size and results in very minimal flattening of the cortex. The smaller right-sided subdural measures approximately 6.4 mm. Minimal patchy foci of periventricular white matter is concerning for mild small vessel disease of indeterminate age.

Output: 1.No evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.2.Small bilateral frontal CSF density subdural collections (left greater than right) with very subtle mass effect on the brain parenchyma.3.Mild small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Splenic mass. Pelvic pain. Consultation with Dr. Peabody reveals an additional history of prior breast cancer.IMAGE ACQUISITIONS: Nonenhanced computed tomography of the pelvis with transverse, coronal, and sagittal reformatted images provided. There is sclerosis of the left ischium and supraacetabular left ilium that appears similar to prior studies and corresponds to abnormal signal intensity seen on an outside MRI examination. Subtle abnormal density of the L5 vertebral body is also noted, but the corresponding lesion is better visualized on the prior lumbar spine MRI examination. There are also chronic fractures of the superior ramus and body of the left pubic bone. A fracture of the left sacral wing is new when compared to prior studies. Moderate osteoarthritis affects both hip joints. Severe degenerative disk disease affects the visualized lower lumbar spine.There is atherosclerotic calcification of the distal abdominal aorta and common iliac arteries. The pelvic viscera are unremarkable given the limitation imposed by lack of intravenous or enteric contrast.

Output: 1. Sclerotic lesions in the left ischium and supra-acetabular ilium as described above which correspond to areas of abnormal signal intensity on MRI. Given the patient's history of breast cancer, metastases cannot be excluded.2. Fractures and degenerative arthritis as described above.


Instruction: Generate impression based on findings.

Input: Evaluate for aneurysm, angio architecture. Left occipital cavernoma/venous anomaly. Aneurysm, attention communicating arteries. Headaches/possible seizure.TECHNICAL:Enhanced CTA of intracranial vasculature is performed.Utilizing an independent workstation reformatted images were acquired and utilized in interpretation of the exam.65 cc of Omnipaque 350 was administered for this study.A nonenhanced head CT was also performed. CTA of intracranial circulation:Patent and unremarkable bilateral intracranial vertebral arteries (dominant left vertebral) is noted. Bilateral pica branches are visualized and unremarkable. Basilar artery and all of its branches are within normal limits. Right vertebral artery is patent and within normal limits across the skull base and in its supraclinoid portion. Right ophthalmic artery is visualized and unremarkable. There is absence of posterior communicating artery on this side (anatomical variation). There is also anatomical variation off hypoplastic right A1. Right middle cerebral artery and its branches are unremarkable and without evidence of an aneurysm.Left internal carotid artery is larger than right and likely secondary to hypoplastic right A1.The left internal carotid artery is patent across the skull base and in its supraclinoid portion. The left ophthalmic artery is visualized and unremarkable.There is a prominent left posterior communicating artery however without evidence of an aneurysm as clinically is questioned. A dominant left A1 is present with filling of bilateral anterior cerebral arteries.There is a vascular fenestration of the distal portion of the left A1. The anterior communicating artery is unremarkable. The bilateral anterior cerebral arteries beyond the anterior communicating artery are unremarkable. The previously noted left occipital lobe cavernoma is not identified on this study. A developmental venous anomaly in the left occipital lobe over his present. This multi-branch developmental venous anomaly appears to traverse the left occipital lobe and in the vein terminating into the left perimesencephalic vein. On the outside MRI examination the left occipital developmental venous anomaly extends into the occipital horn of left lateral ventricle.Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact.Visualized paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable. A

Output: 1.Negative CTA of intracranial circulation for aneurysm. There are normal anatomical variations of hypoplastic right A1, absence of right posterior communicating artery and a prominent left posterior communicating artery, a small vascular fenestration of distal dominant left A1, developmental venous anomaly of left occipital lobe which appears to communicate with left perimesencephalic vein.2.Negative nonfused head CT.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of other parts of brainClinical question: Eval for growth of glioma.Signs and Symptoms: low grade glioma. The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right parietal craniotomy. The patient status post surgery along the right precuneus. There is signal change within the brain tissue surrounding the surgical site some of which extends and involves both gray and white matter at the right precuneus. When compared to the previous exam there is no interval change. There are punctate foci of susceptibility effect along the surgical site which were also present on the prior exam and have not changed to any significant degree. There is no associated contrast enhancement. On the perfusion scan there is a elevated rCBV on the non corrected scans within the resection cavity. There is redemonstration of an 8 mm FLAIR hyperintense lesion present along the left superior frontal gyrus along its medial aspect which remains stable compared to the prior exam. There is no associated contrast enhancement or susceptibility effectNormal 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.Status post right parietal lobe surgery. There is no significant change in the appearance of the adjacent brain parenchyma compared to prior exams. Low grade oligodendrogliomas may have paradoxically elevated rCBV.2.A left superior frontal gyrus lesion is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Leg pain The marrow signal of the right tibia and fibula is normal with no evidence of stress fracture. Additionally, there is no evidence of abnormal marrow signal within the left lower extremity as seen on the limited coronal sequences.Slightly increased signal is noted within the distal gastrocnemius approximately 5 cm from Achilles insertion on the calcaneus. There is also a trace amount of signal surrounding the Achilles at this level although the Achilles tendon itself is normal in course, signal, and caliber.

Output: 1. No evidence of stress fracture within the right tibia or fibula.2. Mild edema of the distal gastrocnemius approximately 5 cm from the insertion upon the Achilles. Correlation with any physical exam findings is recommended as the clinical significance of this finding is uncertain.


Instruction: Generate impression based on findings.

Input: 16 year old female patient status post gastric sleeve procedure in Jordan, now with draining fistula and concern for pancreatic injury. Evaluate for pancreatic injury. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No intra- or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is non-dilated within the body and tail. The duct is poorly visualized, but non-dilated within the pancreatic head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are multiple prominent mesenteric lymph nodes.BOWEL, MESENTERY: Post-surgical changes of a gastric sleeve procedure with a multiloculated fluid collection within the upper abdomen adjacent to the proximal transverse colon, the gastric remnant, and the proximal duodenum. There appears to be at least one cutaneous fistula within the right abdominal wall (image 34, series 7). There is wall thickening and likely secondary inflammatory changes of the proximal transverse colon.BONES, SOFT TISSUES: There is a 3.6 x 5.4 cm fluid collection within the right anterior abdominal wall (image 40, series 7), which communicates with the likely enterocutaneous fistula as described above. There are surrounding inflammatory changes within the right ventral abdominal wall. OTHER: There are significant inflammatory changes within the upper abdomen.

Output: 1.Post-surgical changes to the stomach and a multiloculated fluid collection within the upper abdomen adjacent to the gastric remnant/proximal duodenum with fistulous connection to the right ventral abdominal wall, likely representing a complex enterocutaneous fistula. 2.Non-dilated pancreatic duct without specific evidence of pancreatic ductal injury.


Instruction: Generate impression based on findings.

Input: 54-year-old woman with history of painful nodule in the right lower pannus. PELVIS:UTERUS, ADNEXA: Multiple intramural and subserosal fibroids are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 29 x 23 mm stellate area of T2 hypointensity which enhances uniformly (7/32). This lesion appears to restrict diffusion. Punctate foci of signal loss indicate calcification. This area is contained within the superficial subcutaneous soft tissues of the right pannus. No viscera or bowel are involved.OTHER: No significant abnormality noted.

Output: Subcutaneous soft tissue lesion of the right pannus which is nonspecific in appearance but has morphology suspicious for malignant etiologies such as sarcomatous lesions or metastasis. This lesion abuts the skin surface, does not communicate with the viscera or bowel, and would be amenable to tissue sampling.


Instruction: Generate impression based on findings.

Input: Cervical spondylosis with arm pain, evaluate stability of spine. There is severe multilevel degenerative disc disease from C3 through C7. The upper cervical spine is slightly kyphotic. There are minimal retrolistheses of C4, C5, and C6, but I see no frank instability between the flexion, neutral, and extension views.

Output: Severe degenerative disc disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified exophthalmosClinical question: left orbital tumorSigns and Symptoms: left orbital proptosis and double vision There is unilateral enlargement and contrast enhancement of the left superior rectus muscle, the left medial rectus muscle and to a lesser degree the left lateral rectus muscle associated with some infiltration of the adjacent fat planes and a shaggy border along the involved muscles. The involved muscles are high signal on T2 and intermediate signal on T1. The sclera does not appear thickened. The extraocular muscle thickening appears to involve both the belly and the tendons. There is minimal infiltration along the left lacrimal gland The distance between the interzygomatic line and the cornea on the left side is 24 mm whereas on the right-side is17 mm.The left optic nerve sheath appear thickened and enhances.There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . The cavernous sinuses are symmetric and not enlarged.The left eyelid and preseptal space appear thickened.There is mild mucosal thickening in the ethmoid air cells.

Output: 1.Asymmetrically enlarged extraocular muscles associated with infiltration of the left orbit is suggestive of idiopathic orbital inflammatory disorder (pseudotumor) of the orbit. Please correlate with clinical symptoms of orbital pain. A lymphoproliferative lesion and less likely an atypical thyroid associated ophthalmopathy are differential considerations in the appropriate clinical setting. 2.Findings are suggestive of proptosis. Please correlate with clinical findings


Instruction: Generate impression based on findings.

Input: Left hip pain There is no evidence of fracture or avascular necrosis of the left hip. The marrow signal of the remaining pelvis is normal. A small amount of fluid is noted within the left hip joint.There is nonspecific increased signal within the vastus intermedius and medialis muscles, the extent of which is not fully included on the exam.

Output: 1. No osseous abnormality, specifically no evidence of fracture or avascular necrosis of the left hip.2. Nonspecific increased signal within the left vastus musculature, the extent of which is not fully included on this exam.


Instruction: Generate impression based on findings.

Input: Sacral decubitus ulcer There is decubitus ulceration overlying the sacrum with a small area of low T1/high T2 signal involving the distal coccyx consistent with a small focus of osteomyelitis. This is best appreciated on sagittal image 33/65 of series 9 and image 29/34 of series 3. There is soft tissue edema overlying the sacrum/coccyx but no discrete fluid collection identified. Scattered areas of heterogeneous marrow signal within the remaining sacrum may be reactive in nature.There is irregularity of the tendon of the left gluteus maximus with a large amount of increased signal surrounding the muscle suggestive of partial tear of the tendon and muscle. There is diffuse muscle atrophy. Deformity of the right hip/pelvis relates to Paget's as seen on prior CT.

Output: 1. Small focus of osteomyelitis involving the distal coccyx. This finding represents a discrepancy with initial preliminary report and was conveyed to Dr. P. Mehta of the admitting service at the time of dictation.2. Partial tear of the left gluteus maximus tendon/muscle.


Instruction: Generate impression based on findings.

Input: 39-year-old male patient with history of ALL with neutropenic fever and rectal pain. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The bladder is distended.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The rectum is unremarkable without wall thickening, perirectal inflammatory change, or abnormal enhancement.BONES, SOFT TISSUES: Edema type signal noted within the dependent soft tissues of the posterior lower pelvis.There is curvilinear T2 signal within the right femoral head with corresponding low T1 signal. However, there is no significant surrounding T2 signal within the marrow.OTHER: No abnormal intrapelvic fluid collection is identified.

Output: 1. No acute pelvic findings to account for the patient's symptoms.2. Findings concerning for early AVN in the right hip.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell carcinoma. Status post resection and radiation treatment. Assess brain metastasis. There are changes related to left frontal tumor resection and hematoma evacuation. The surgical bed has not changed, including changes of laminar necrosis as well as T1 shortening, susceptibility effect and focal diffusion restriction related to the presence of blood products. The adjacent parenchymal T2-hyperintensity is largely unchanged except for slight increased conspicuity of extension along the anterior limb of the left internal capsule, which may reflect differences in technique as today's examination was acquired on a 3 Tesla magnet. There is further decreased prominence of areas of nodularity and essentially resolved enhancement in the left frontal lobe resection cavity. This is favored to represent evolving postoperative change. There is no significant change in the other posttreatment findings and there is no new or suspicious contrast enhancement. Associated minimal volume loss is unchanged. The remainder of the brain is notable for unchanged punctate T2 hyperintensities in the cerebral white-matter that reflect chronic microvascular ischemia. There is no new brain abnormality. The ventricles and sulci remain unchanged, accounting for mild central volume loss. Major intracranial vascular flow voids are preserved.Mucosal thickening in the maxillary and ethmoid sinuses remains mild and not significantly changed.There are postoperative skull and scalp changes related to previous left frontal craniotomy. There is no destructive skull lesion.There is susceptibility effect related to the previous posterior C1-C2 surgery.

Output: 1.Further decreased prominence of nodularity and enhancement in the left frontal resection cavity suggesting evolving postoperative changes, without findings concerning for tumor recurrence.2.There is no new brain contrast-enhancing lesion.


Instruction: Generate impression based on findings.

Input: 6 years, Male, Chiari malformation. Yearly follow-up. The cerebellar tonsils are caudally displaced measuring up to 17 mm below the foramen magnum and demonstrate a peglike configuration. Tonsils terminate just inferior to the C1 posterior arch, previously extending to the mid C2 level. There is retroflexion of the dens which contributes to effacement of the ventral thecal sac. There is overall mild crowding at the foramen magnum, which is improved since prior. Sagittal midline CSF flow sequence demonstrates minimally diminished but otherwise preserved biphasic flow ventrally and dorsally through the foramen magnum, as well as into the fourth ventricle.Brain parenchyma is otherwise unremarkable. No evidence of infarct, hemorrhage, mass, or mass effect. Ventricles are normal in size. No extra-axial collections. Sulcation and myelination are unremarkable. Bone marrow signal and extracranial soft tissues are grossly unremarkable.Evaluation of the cervical spine demonstrates no cord signal abnormality or evidence of syrinx. Vertebral body heights and intervertebral discs are unremarkable. Bone marrow signal is unremarkable. No significant spinal canal or neural foraminal stenosis is seen. Paraspinous soft tissues are unremarkable.

Output: 1. Findings consistent with Chiari I malformation are again seen. Cerebellar tonsillar descent has improved since prior from 1/30/2015 as has the associated crowding at the foramen magnum. There is mild crowding on the current study and minimally diminished biphasic flow of CSF.2. No evidence of syrinx in the cervical cord.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with paresthesias. There is no significant interval change in the extent of cerebral white matter T2 hyperintense lesions. There is no evidence of 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There appear to be small effusions in the bilateral mastoid air cells.

Output: No significant interval change in the demyelinating brain lesions related to multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate AMS in transplant patient. Signs and symptoms: Confusion; no neurological deficit. Pre-and post-enhanced brain MRI:There is no detectable acute intracranial process and in particular no evidence of acute ischemic stroke present.Examination demonstrate multiple punctate foci of flair hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres. There is extensive similar signal changes within the pons present. Signal intensity are present parenchyma is otherwise unremarkable. Although the findings are nonspecific this appearance is often result of microvascular ischemic changes. There is a slight prominence of cortical sulci which may be at the upper limits of normal for age.Unremarkable ventricular system, CSF spaces and myelination of brain otherwise. The signal void of major intracranial arterial branches are identified.Anatomical variation of partially empty sella is identified. Post enhanced images are negative for abnormal enhancement of brain parenchyma, leptomeninges or the calvarium. Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: 1.No evidence of acute intracranial process.2.Finding suggestive of minimal chronic small vessel ischemic disease in the subcortical and periventricular white matter and more extensively of the pons as detailed.3.Anatomical variation of partially empty sella is identified.4.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 71-year-old female with muscle weakness of the right lower extremity. Unable to extend the right lower extremity. Evaluate for denervation. BONE MARROW: Note is made of increased signal abnormality and decreased linear signal abnormality traversing the right femur most consistent with a nondisplaced intertrochanteric insufficiency/stress fracture. No additional bone marrow signal abnormality is identified.SOFT TISSUES: There is heterogeneity and increased signal within the rectus femoris at the level of the myotendinous junction with fluid signal intensity internally suggesting an incomplete tear. Fibers of the rectus femoris can be traced distally to the level of the quadriceps tendon and proximally to the AIIS. There is a 4.5 x 1.3 x 10.0 cm foci of fluid collection adjacent to the rectus femoris which may represent hematoma formation. There is diffuse increased signal abnormality within the quadriceps musculature which is nonspecific and may be posttraumatic in etiology, although subacute denervation cannot be completely excluded and clinical correlation is indicated.There multiple foci of metallic susceptibility artifact along the anterior aspect of the thigh corresponding to surgical clips seen on prior radiographs. There is diffuse fatty infiltration of the imaged musculature.JOINTS: The femoral acetabular joint alignment is anatomic.ADDITIONAL

Output: 1. Nondisplaced intertrochanteric insufficiency/stress fracture of the right femur.2. Incomplete tear of the rectus femoris with adjacent fluid collection which is nonspecific but may represent hematoma formation as described above.3. Nonspecific edema type signal abnormality within the quadriceps musculature as described above.These findings were relayed to Luanne Shea by phone at 11:46 AM on 8/28/2015.


Instruction: Generate impression based on findings.

Input: Female, 87 years old, with fluent aphasia. Evaluate for stroke. Patchy restricted diffusion is seen within the left temporal lobe. A punctate focus of restricted diffusion is also seen in the right centrum semiovale.Patchy periventricular white matter and basal ganglia T2 hyperintensity is seen bilaterally. No evidence of significant generalized mass effect is observed.No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are slightly prominent which most likely represents parenchymal volume loss.

Output: 1.Patchy acute ischemia is seen within the left temporal lobe with a single punctate focus in the right centrum semiovale.2.Sequelae of fairly extensive chronic microvascular and lacunar ischemic disease is seen as well.3.No evidence of generalized mass effect is seen. No acute intracranial hemorrhage is detected.


Instruction: Generate impression based on findings.

Input: 53-year-old female. EtOH decompensated cirrhosis with probable pubic rami fracture x 2 weeks ago due to mechanical fall. Needs further imaging if intervention needed. ACETABULAR LABRUM: Intermediate signal intensity in the right anterosuperior labrum consistent with degeneration.ARTICULAR CARTILAGE AND BONE: Edema type signal in the right superior and inferior pubic rami as well as left superior pubic rami with T1 hypointense linear bands traversing the cortex consistent with nondisplaced fractures.Mild edema in the greater trochanter without evidence of a discrete fracture line. Mild osteoarthritis of the right hip with subchondral cysts and joint space narrowing. SOFT TISSUES: Diffuse subcutaneous edema. Edema in the right adductor muscles down to their insertion on the pubic tubercle, consistent with muscle strain.ADDITIONAL

Output: Nondisplaced right superior and inferior pubic rami fractures and left superior pubic ramus fracture.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with history of non-small cell lung cancer, outside hospital CT showing a small brain lesion. A lobular, partially enhancing lesion is present at the junction of the left parietal and temporal lobes which measures up to 10 mm in maximal diameter. The lesion contains bubbly areas of T1 and T2 hyperintensity internally, with a T2 hypointense rim and strong associated susceptibility artifact. The lesion correlates with one noted on the prior outside CT which demonstrates intrinsic hyperattenuation suggesting either mineralization or blood product. This lesion was not evident on older examinations from 2007 or 2009. MR spectroscopy of the lesion was not performed as the strong associated susceptibility effect prevents reliable assessment.The above-described lesion is associated with little if any edema and no significant mass effect. No additional enhancing lesions are seen. Note is made of numerous scattered T2 hyperintense lesions in the periventricular and subcortical white matter of the bilateral cerebral hemispheres. Note is also made of two additional foci of susceptibility, one in the left frontal lobe and one in the right frontal lobe, without edema or mass effect.No abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.

Output: A lesion is identified at the junction of the left parietal and temporal lobes with MRI and CT characteristics suggesting associated mineralization and/or blood product. Some of the features of this lesion are suggestive of a cavernous malformation, which is supported by the history of brain radiation and the presence of two additional susceptibility inducing foci. While enhancement is typically absent or minimal with cavernomas, recent hemorrhage could account for the somewhat greated than normal degree of enhancement seen on this exam. The possibility that this lesion represents either a hemorrhagic, or mineralized treated metastasis can also be considered. However, the lack of significant edema and mass effect would argue against active neoplastic disease.Due to the presence of strong susceptibility artifact, MRS is not a viable imaging modality for this lesion. Close interval follow-up should be considered, with brain PET as an additional diagnostic option for consideration.


Instruction: Generate impression based on findings.

Input: Right knee pain. History of Fulkerson procedure. Evaluate for chondromalacia of the patella, pes bursitis, medial meniscal tear. MENISCI: The menisci demonstrate normal signal characteristics and morphology without evidence of discrete tear.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial facet of the patella, with poorly defined increased signal intensity extending from the surface to the bone, indicating full thickness degeneration. There is degenerative edema-signal type abnormality in the subchondral bone at the median eminence of the patella. The articular cartilage of the lateral facet, trochlea, and medial and lateral femoral condyles is unremarkable. There are post operative changes compatible with stated history of Fulkerson procedure, with prominence of the anterior tibial tuberosity.LIGAMENTS: The anterior cruciate, posterior cruciate, medial collateral, lateral collateral, and popliteal ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Postoperative changes as described above.2.Full-thickness degeneration of the articular cartilage of the medial patellar facet.3.No evidence of meniscal tear or pes anserine bursitis.


Instruction: Generate impression based on findings.

Input: History of HCC status post TACE/RFA, follow-up. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates a cirrhotic morphology and loss of signal on in phase imaging compatible with iron deposition. Stigmata of portal hypertension are present including splenomegaly, gastroesophageal varices, and a recannulized periumbilical vein.In segment 3, there is a 2.7 x 1.6 cm post ablation halo (series 9, image 36) which demonstrates intrinsic T1 hyperintensity and which lacks residual arterial enhancement. Several scattered arterial enhancing foci become isointense on delayed imaging likely represent perfusional anomalies. No new suspicious arterially enhancing lesions which demonstrate washout are identified. Multiple simple hepatic cysts appear unchanged.The hepatic vessels appear patent. Portal vein is enlarged compatible with portal hypertension.There is cholelithiasis without evidence of cholecystitis. No biliary ductal dilatation.SPLEEN: Marked splenomegaly with spleen measuring 21 cm in the craniocaudal dimension, unchanged. Splenic hilar collateral vessels.PANCREAS: Multiple T2 hyperintense lesion within the pancreas most which appear to communicate with the main pancreatic duct and likely represent side branch IPMNs. The largest lesion is in the pancreatic body/tail (series 4, image 20) measuring 1.1 x 1.6 cm, unchanged compared to 8/21/2015 but slightly increased in size from 6/26/2014. The lesion lacks associated suspicious imaging features. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral small simple renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Persistent trace right pleural effusion and basilar atelectasis. Right lower lobe pulmonary nodule is more fully characterized on chest CT from same day.

Output: 1.Stable post ablation findings of segment 3 hepatic lesion without evidence of residual or recurrent disease. No new suspicious lesions.2.Cirrhosis with portal hypertension.3.Cystic pancreatic lesions likely representing side branch IPMNs stable since 8/7/2015 but slightly increased in size from 6/26/2014.


Instruction: Generate impression based on findings.

Input: Cervical radicular pain after whiplash. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. No evidence of ligamentous injury. No hematomas involving the spinal canal. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are present in the cervical spine with mild multilevel disc desiccation as well as mild ligamentum flavum thickening at the C4-C5, C5-C6, and C6-C7 levels. There are minimal disc bulges at C3-C4, C4-C5, and C5-C6 levels. There is a small corticated ossification involving the posterior aspect of the right C5-C6 facet joint which may be related to remote trauma and present on recent CT cervical spine from 1/6/2016. No associated edema. Tiny perineural cysts incidentally noted at the left C3-C4 level.Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: No evidence of ligamentous injury in the cervical spine. Minimal degenerative changes are seen without evidence of spinal canal or neural foraminal stenosis at any level in the cervical spine.


Instruction: Generate impression based on findings.

Input: Clinical question: History of meningioma. Evaluate residual for growth. Signs and symptoms: None surveillance imaging 3 months postop. Pre- and post enhanced brain MRI:Negative diffusion-weighted images.There is interval significant improvement of postoperative changes of a large bilateral anterior frontal craniotomy. There is resultant interval resolution of extra-axial fluid and air collection in bilateral anterior cranial fossa and complete resolution of bilateral frontal vasogenic edema.There is interval development of encephalomalacia of the bilateral anterior and inferior frontal lobes and with resultant ex vacuo dilatation of the frontal horns of lateral ventricles.There is evidence of uniformly enhancing mass along the planum sphenoidale measuring 19 mm in AP axis and 8 mm in height (sagittal post enhanced series 1/3/2001 image 13 which has decreased since prior MRI exam from 2-23-20 which measured 28 x 10 mm. Note should be made that MRI examination from 2-25-15 were dedicated study of the orbits and midline of the anterior cranial fossa where the tumor resides was not well-visualized.Additionally there is a mass in the midline extending from the planum sphenoidale in the superior anterior axis consistent with additional foci of residual tumor measuring at 23 x 11 mm measured on sagittal post enhanced series 1301 on image 13. Compared to prior exam from 2-23-15 30 significant interval decreased size of this lesion which measured at 29 x 22 mm.The anatomical morphology and signal intensity of brain remains within normal on all MRI sequences otherwise without change since prior exam.Extensive isointense to hypointense T1 and hyperintense T2/T2 FLAIR with enhancement in the bilateral frontal sinuses are believed to represent postoperative packing and enhancement. .

Output: 1.Examination is compared with prior dedicated brain MRI exam from 2-23-15 and cannot be properly evaluated compared to exam on 2-25-15 which was a dedicated orbital MRI exam.2.There is interval decreased size of residual meningioma along the planum sphenoidale measuring at 19 x 8 mm (sagittal post enhanced series) compared to prior dedicated brain MRI study measurement of 28 x 10 mm. Additional focus of residual tumor in the midline and extending from planum sphenoid superiorly measuring at 23 x 11 compared to prior study measurement of 29 x 22 mm.3.Significant interval resolution of postoperative changes and near complete resolution of bilateral anterior and inferior frontal lobes and development of significant bilateral frontal encephalomalacia.


Instruction: Generate impression based on findings.

Input: History of left thalamic anaplastic astrocytoma status post biopsy (5/7/14), RT/TMZ and now cycle #5 of TMZ. Redemonstrated is a left frontal burr hole with gliosis along the course of prior biopsy approach. There is a stable intrinsically T2 and T1 hyperintense lesion in the left thalamus measuring up to 17 mm, previously 17 mm. There is also stable size of a left periatrial enhancing lesion measuring 5 mm, but with decreased associated T2 signal. There is slight interval increase in the nonenhancing T2 signal abnormality in the left corona radiata. There is no acute intracranial hemorrhage or acute infarct. There are unchanged foci of susceptibility artifact in the right cerebellar hemisphere as well as the left thalamic and periatrial lesions. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Stable signal and size of the nonenhancing left thalamic lesion. 2. Stable size of enhancing left periatrial lesion, but with decreased associated T2 signal.3. Slight progression of ill defined non-specific white matter T2 hyperintensity in the left corona radiata.


Instruction: Generate impression based on findings.

Input: Unsteadiness on feet [R26.81], Reason for Study: ^Reason: 61 year old female with Ph+ ALL, neurological deficits, please complete MRI brain w/ contrast. History: neurologic sx There is no evidence of abnormal enhancement on this scan.High signal intensity lesions including one at the right corona radiata on FLAIR/T2 images do not show any evidence of contrast enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal.

Output: No MR evidence of abnormal enhancement on this scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for spinal lesion. Signs and symptoms: History of T1 lesion with worsening. Pre-and post-enhanced cervical MRI:Examination redemonstrates a intramedullary mass extending from lower C7 to lower T2 level similar to prior exam. This finding remains similar in size and extent to prior study demonstrate no surrounding edema. There is however faint T2 hyperintensity within the cord immediately superior to the tumor suggestive of hemosiderin deposition. The main bulk of tumor and measures approximately 22.8 mm in cranial cephalad and 8.6-mm in AP axis similar to prior study. The less defined inferior extension of tumor has mixed signal intensity and extend for approximately 20 mm further inferiorly and terminates at lower T2 level. There is no convincing evidence of enhancement however T1 hyperintensity signal of tumor can obscure enhancement. There is no evidence of cord edema. The finding is suggestive of a cavernoma however previously detailed multiple differential diagnosis of a spontaneous cord hemorrhage or hemorrhagic infarct cannot be entirely excluded however are considered less likely. This mass centrally located disk protrusion at C6 -- C7 demonstrates subtle interval increased size since prior exam. This finding results in very subtle indentation of ventral aspect of the cord and mild central spinal stenosis.Pre--and post enhanced thoracic MRI:Examination demonstrate normal signal intensity and caliber of thoracic cord inferior to the above detailed tumor. There is also no detectable abnormal enhancement of the cord or the leptomeninges.The signal intensity of vertebral column demonstrate changes related to degenerative disease and unremarkable otherwise.T5 -- T6 there is a central and right paramedian disk protrusion with resultant effacement of ventral subarachnoid space, slight flattening and posterior displacement of the cord however without convincing evidence of central spinal stenosis or neural foraminal compromise.A tiny left lateral disk protrusion at T6 the T7 is best appreciated on axial T2 series 1401 on image 33. No spinal stenosis or neural foraminal compromise.The small right paramedian hypertrophic spur at T7 -- T8 is noted without spinal stenosis or neural foraminal compromise.A tiny central disk protrusion at T8 -- T9 is noted. Hypertrophic changes of posterior elements at T9 -- T10 is also in moderate neural foraminal compromise on the right. Unremarkable images at other levels.Pre-and post enhanced lumbar MRI:Examination post right normal signal intensity and morphology the conus and the cauda equina with out detectable abnormal enhancement.The alignment of vertebral column is anatomical.T12 -- L1 demonstrate moderate disk disease and loss of disk height and unremarkable otherwise.L1 -- L2, L2 -- L3, L3 -- 4 levels are negative for spinal canal compromise or neural foraminal stenosis.L4 -- L5 demonstrate moderate disk disease and loss of disk height, broad based central and leftward disk protrusion without central spinal stenosis or neural foraminal compromise mild left lateral recess compromise however is present. Mild bilateral facet hypertrophy changes at this level also present.L5 -- S1 demonstrate moderate disk disease with loss of disk height and mild hypertrophic changes of posterior elements (left greater than right). There is a central and leftward shallow broad-based disk protrusion without central spinal stenosis or neural foraminal compromise. This finding however is in contact with the left S1 nerve root in the left lateral recess of the canal.

Output: 1.Pre-and post enhanced MRI of cervical spine demonstrate a stable intramedullary tumor extending from lower C7 to lower T2 level. The mass has a well demarcated superior component and an ill-defined component further inferiorly. Combination of two segments measures at 43-mm in cranial cephalad axis and a more well defined measures at 22.8-mm. There is suggestion of hemosiderin deposition superior to the tumor. Findings are more suggestive of a known cavernoma as detailed above. Other less likely differential diagnosis of a spontaneous cord hemorrhage or hemorrhagic infarct cannot be entirely excluded. New since prior exam is slight increase size of this protrusion at C6 -- C7 with result in mild central spinal stenosis.2.Pre-and post enhanced MRI of thoracic spine view demonstrates above detailed information any mass. The signal intensity and caliber of the cord otherwise is unremarkable and without abnormal enhancement. Disk protrusion at T5 -- T6 with subtle mass effect on the cord and without central spinal stenosis is noted. Additional small disk protrusions and hypertrophic spurs as detailed above. No central spinal stenosis at any level.3.Pre-and post enhanced MRI of one or spine demonstrate degenerative changes including disk protrusion at L4 -- L5 and L5 -- S1 levels without central spinal stenosis or neural foraminal compromise. Please see above comments.


Instruction: Generate impression based on findings.

Input: Left upper extremity sensory symptoms. Brain: 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.Cervical Spine: The spinal cord displays normal signal and morphology. There are minimal posterior disc-osteophyte complexes at C4-5 and C6-7 with minimal neural foraminal narrowing at these levels. However, there is no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, acute infarct, or demyelinating lesions. 2. No evidence of mass or demyelinating lesions in the cervical spine. 3. Minimal posterior disc-osteophyte complexes at C4-5 and C6-7 with minimal neural foraminal narrowing at these levels, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Lumbar pain, right buttock pain with fever, elevated CRP. Evaluate for abscess and osteomyelitis. There is prominent anterior epidural enhancement at L4-S1 that measures up to 8 mm in thickness with several punctate areas that do not enhance. There is associated narrowing of the spinal canal in conjunction with a disc bulge at L5-S1. There is also mild diffuse bone marrow T2 hyperintensity and enhancement at L5-S1, where there is endplate irregularity, but no enhancement of the disc. The vertebral body heights are preserved and the vertebral column alignment is anatomic. There appears to be patchy enhancement in the posterior subcutaneous tissues overlying the right sacrum, although this area is incompletely imaged.

Output: 1. Prominent anterior epidural enhancement at L4-S1 that measures up to 8 mm in thickness with several punctate areas that do not enhancement may represent phlegmon associated with spinal canal narrowing, but no evidence of osteomyelitis or discitis. Rather, there is degenerative spondylosis with what likely represents mild bone marrow reactive changes at L5-S1. 2. Apparent patchy enhancement in the posterior subcutaneous tissues overlying the right sacrum may represent cellulitis, although this area is incompletely imaged.


Instruction: Generate impression based on findings.

Input: A 51 year old female with hypertension, hyperlipidemia and overweight. Referred to stress cardiac MRI because of chest painMEDICATIONS: furosemide, hydralazine, lisinopril, lovastatin, metoprolol, spironolactone, amlodipine. First Pass PerfusionDuring hyperemia, there is a perfusion defect in the mid anterolateral and inferolateral wall. The overall ischemia score is 2 out of 32 and ~6% of the left ventricular mass is ischemic. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. There is mild concentric hypertrophy (IVSd=11mm). The overall LV ejection fraction is 67%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 138 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 32 g/m2, and the LV mass is 68 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. The interatrial septum deviates to the right suggesting increased left atrial pressure. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 67 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 mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a mild perfusion defect in the mid anterolateral and inferolateral walls involving ~6% of the myocardium. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 67%).4. Normal RV size and systolic function (RVEF 57%).5. Mild left atrial dilation with suggestion of increased left atrial pressure. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There are no T2/FLAIR abnormalities. There is normal ventricular size with no midline shift. Basal cisterns are patent. There are no diffusion or susceptibility abnormalities. Basal cisterns are patent.There is no evidence of hemorrhage, mass effect, or edema.There are multiple small signal voids in the inferior-anterior aspect of the vermis, most likely related to bilateral PICA flow related signal voids. However, dural arteriovenous fistula cannot be excluded.MRA BRAIN:The internal carotid arteries are patent. The anterior, middle, posterior cerebral arteries are patent with no evidence of significant stenosis or aneurysm. The basilar and vertebral arteries are patent.The anterior communicating artery and the bilateral posterior communicating arteries are patent.

Output: 1. Unremarkable MRI of the brain.2. There are small signal voids in the inferior-anterior aspect of the vermis, most likely related to bilateral PICA flow related signal voids. However, dural arteriovenous fistula cannot be excluded. Definitive diagnosis of dural arteriovenous fistula is done by angiogram; however, CTA would be recommended as a noninvasive procedure.3. Normal anterior and posterior cerebral circulation with no evidence of significant stenosis or aneurysm.