Instruction: Generate impression based on findings.

Input: Female, 70 years old, with low back pain on the right, radiating to the right hip, and decreased strength in right hip flexion. Apart from a mild scoliotic curvature at the thoracolumbar junction, spinal alignment is anatomic. Vertebral body heights are preserved. A STIR hyperintense, T1 hypointense and mildly T2 hyperintense lesion is seen within the L1 vertebral body. Minimal corresponding lucency is seen on prior CT and there is no FDG avidity on prior PET. Marrow signal characteristics are otherwise unremarkable allowing for minimal endplate degenerative signal.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected.L1-2: Mild facet hypertrophy. Otherwise unremarkable. L2-3: Mild facet hypertrophy. Otherwise unremarkable. L3-4: Mild facet hypertrophy. Minimal disc bulging. In combination with prominent dorsal epidural fat, the thecal sac is mildly narrowed but the nerve roots do not appear to be frankly compressed. Mild bilateral foraminal narrowing.L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. In combination with prominence of the dorsal epidural fat, the thecal sac is mildly narrowed but without frank nerve root compression. Mild bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy. Loss of disc height and disc bulging with a superimposed right subarticular and foraminal disc protrusion. The traversing right S1 nerve root is likely impinged by this process. In addition, the right neural foramen is severely narrowed with possible impingement of the exiting L5 nerve root. A mild generalized spinal canal stenosis is seen. The left neural foramen is moderately narrowed.

Output: 1.A disc herniation is evident in the right subarticular and foraminal regions at L5-S1. The traversing right S1 nerve root is likely impinged by this process. Furthermore, the disc herniation and facet hypertrophy contribute to severe narrowing of the right L5-S1 neural foramen which likely produces some impingement of the exiting L5 nerve root.2.Relatively mild degenerative findings are seen at the other lumbar vertebral levels.3.Signal abnormality within the L1 vertebral body is favored to represent a radiologically atypical benign hemangioma.


Instruction: Generate impression based on findings.

Input: Severe low back pain. The vertebral alignment is anatomic accounting for minimal straightening which may relate to position. The vertebral bodies are preserved in height. The vertebral bone marrow signal is unremarkable. There is mild degenerative lumbar spondylosis, including a left L2-L3 extraforaminal protrusion that seems to abut the exiting nerve roots. There is also a slight disc bulge at L5-S1, but no significant spinal canal or foraminal stenosis at any of the lumbar spine levels. There is partial loss of disc T2 signal at L2-L3, L5-S1 and to a lesser extent L3-L4. There is minimal disc height loss at L2-L3. The vertebral body heights are preserved. The tip of the conus medullaris is at the upper L2 level and appears to be unremarkable. There is a small amount of fat signal along the filum terminale at L4 and L5 levels. There are small T2 hypointense lesions within the uterus.

Output: 1. Mild degenerative lumbar spondylosis, including a left L2-L3 extraforaminal protrusion that seems to abut the exiting nerve roots, but no significant spinal canal or foraminal stenosis otherwise.2. Small filar fibrolipoma.3. Small probable uterine fibroids.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67 year old woman with known CAD and PCI to the LAD, LCx in 2015/2016, known chronic occlusion of the right coronary artery with ongoing angina, referred for cardiac MR stress to evaluate for ischemia and viability.MEDICATIONS: aspirin, rosuvastatin, enalapril, metoprolol, amlodipine First Pass PerfusionDuring hyperemia, no perfusion defects were present.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 hyperdynamic function. The overall LV ejection fraction is 75%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 117 ml (normal range 109+/-23), the LV end systolic volume index is 17 ml/m2 (normal range 18+/-5), the LVESV is 29 ml (normal range 31+/-10), the LV mass index is 48 g/m2, and the LV mass is 81 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 63%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 119 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 44 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 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.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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 75%).4. Normal RV size and systolic function (RVEF 63%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Atypical/anaplastic central neurocytoma. Status post resection. There is no significant change in size or morphology of the CSF filled resection cavity in the left parieto-occipital region. Again seen is slight mass effect on the trigone of the left lateral ventricle with associated slight prominence of the left temporal horn of the lateral ventricle, which appears similar to the prior study. Also unchanged is the pattern and extent of T2 hyperintensity within the surrounding parenchyma, consistent with gliosis. No new or suspicious enhancement is seen within or around the cavity. There is susceptibility artifact consistent with hemosiderin deposition along the walls of the surgical cavity. Unchanged additional scattered foci of susceptibility effect may be related to prior treatment.No pathologic enhancement is demonstrated elsewhere in the brain. No mass effect or parenchymal edema is suspected. A few scattered small nonspecific foci of T2 hyperintensity are evident in the cerebral hemispheres, not significantly changed. No intracranial hemorrhage or new extra-axial fluid collections are detected. The ventricles are stable in size and morphology.

Output: Stable appearance of the left parieto-occipital resection cavity and surrounding gliosis. No evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Vascular dementia without behavioral disturbance [F01.50], Reason for Study: ^Reason: r/o cva History: cognitive deficits No evidence of acute ischemic or hemorrhagic lesion on the scan. Minimal nonspecific small vessel ischemic disease.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: MS; follow-up progression. Signs and symptoms: Paresthesia. Nonenhanced brain MRI:There is significant technique difference between the 2 exams for comparison. Current study is performed utilizing dedicated MS protocol with 2 mm slice thickness and compared to prior study standard brain MRI with 5 mm slice thickness.Within this limitation examination demonstrate mild progression of disease since prior study which is most noticeable in the right frontal subcortical white matter.Extensive supratentorial findings are demyelinating disease of the periventricular and subcortical white matter as well as extensively of the corpus callosum and bilateral thalami are again noted. Diffuse FLAIR hyperintensity in the upper most visualized cervical cord is also again.Mild prominence of cortical sulci and ventricular system as well as cerebellar and vermian folia for patient of stated age is noted.Signal void of major intracranial arterial branches are identified.

Output: 1.Although difficult to compare with the prior exam due to significant technique difference there is suggestion of interval progression of disease and supratentorial brain since prior exam as detailed.2.Extensive findings of demyelinating disease in the supratentorial brain parenchyma and to a lesser degree in the posterior fossa is again noted. 3.Diffuse FLAIR hyperintensity of partially visualized upper cervical cord is again noted.4.Prominence of cerebral cortical sulci and cerebellar-vermian folia and minimally of the lateral ventricles for patient stated age of the tail.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis and intractable epilepsy with known SEGA. There is mild motion degradation. The large enhancing mass/SEGA at the left foramen of Monro is unchanged in size, measuring 16 x 14 x 17 mm (AP by TR by CC). The ventricles and sulci are stable. The known multiple small subependymal nodules appear stable. The lesion in the right lateral ventricular trigone again measures 6 mm. There are also multiple foci of increased T2 signal within the cortical and subcortical regions, which are unchanged from the prior study. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation.

Output: Stable appearance of stigmata of tuberous sclerosis, including presumed subependymal giant cell astrocytoma at the left foramen of Monro.


Instruction: Generate impression based on findings.

Input: 70 years Male (DOB:4/15/1946)Reason: Eval pineal parenchymal tumor of intermediate grade. S/p RT. S/p bx. Please compare past few MRIs. History: pineal parenchymal tumor.PROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS There is redemonstration of pineal region mass which infiltrates the thalami and is associated with heterogeneous contrast enhancement as well as punctate foci of susceptibility effect. On contrast enhanced imaging currently measures 31 x 27 mm axial dimensions and previously measured 27 x 24 mm axial dimensions. It involves more of the posterior aspect of the left thalamus in the medial aspect of the right thalamus. The tumor also involves the tectal plate and periaqueductal of gray with slightly greater involvement on the current versus the prior exam.There is redemonstration of a focus of encephalomalacia along the right occipital pole. The patient status post right occipital craniotomy.A ventriculostomy tube courses the right frontal lobe into the right lateral ventricle is in stable position. Biventricular diameter at the level of the foramen Monro on coronal imaging is currently 39 mm and was previously 36 mm. Third ventricular diameter is currently 10 mm intervals previously 6 mm. Temporal horns of the lateral ventricles are not substantially different.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 and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam, the patient's pineal region neoplasm has enlarged and infiltrated more into the thalami and periaqueductal gray.2.Status post ventriculostomy tube placement. The lateral and third ventricles are larger on the current exam when compared to the prior exam.3.Status post right occipital craniotomy.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Small focus of encephalomalacia is present along the right occipital pole.


Instruction: Generate impression based on findings.

Input: Medial knee pain after twisting injury. MENISCI: There is horizontal tear of the posterior horn of the lateral meniscus extending to the inferior surfact. There is mild undersurface fraying of the medial meniscus without discrete tear.ARTICULAR CARTILAGE AND BONE: There is extensive bone marrow edema type signal in the lateral femoral condyle with similar milder changes in the lateral tibial plateau.There is moderate tricompartmental cartilage degeneration, worst at the undersurface of the patella.LIGAMENTS: There is high T2 signal about the lateral collateral ligament complex with surrounding soft tissue edema and a partial LCL tear cannot be excluded. The MCL is intact. The cruciate ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Horizontal tear of the posterior horn of the lateral meniscus, as above.2. High T2 signal about the lateral collateral ligament complex, which may represent a partial tear of the LCL.3. Thickened medial retinaculum, suggestive of injury, without discrete tear.


Instruction: Generate impression based on findings.

Input: There is mild nonspecific prominence of the ventricles, especially the lateral ventricles. The sulci are within normal limits. The basal cisterns remain patent. There is no midline shift. There are few punctate and linear foci of T2/FLAIR hyperintensity left greater than right frontal white matter. The most conspicuous finding has a very linear in configuration on the coronal images. There is no diffusion abnormality. There is a small area of CSF signal intensity along the medial aspect of the left middle cranial fossa, with mild flattening of the adjacent temporal lobe parenchyma, likely representing an arachnoid cyst as there is no associated diffusion restriction. This measures 0.8 x 2.2 cm in greatest axial dimensions, x 1.5 cm CC. No pathologic extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is trace fluid within right mastoid air cells. There is no gross noncontrast abnormality involving the visualized portions of inner ear structures.

Output: 1.Dedicated IAC images were not obtained inadvertently as a separate order was not present. No gross noncontrast abnormality involving visualized portions of inner ear structures, although detailed evaluation of internal auditory canal contents and inner ear structures should be obtained with dedicated protocol. Follow-up separate order may be considered as clinically indicated.2.Scattered nonspecific punctate and linear foci of T2/FLAIR hyperintensity in the left greater than right frontal white matter. Some of the more linear areas may represent prominent perivascular spaces.3.Mild nonspecific prominence of the ventricles.4.Incidental small arachnoid cyst along the medial aspect of the left middle cranial fossa with mild localized mass effect on the mesial left temporal lobe.


Instruction: Generate impression based on findings.

Input: Female 73 years old with a recent intra operative biopsy negative for HCC and positive for cirrhosis. Assess for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with patchy T2 hyperintensity compatible with cirrhosis. There is no suspicious liver lesion. A mildly T1 hyperintense subcapsular segment 6 lesion has no internal enhancement on subtraction images and is consistent with a regenerative nodule . Splenorenal shunting is noted and there are paraesophageal varices.The hepatic vasculature is patent. Status post cholecystectomy with mild prominence of the biliary system, unchanged.SPLEEN: Splenorenal shunting is noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology. No suspicious hepatic lesion.2.Patent hepatic vasculature.3.Evidence of portal hypertension with paraesophageal varices and splenorenal shunting.


Instruction: Generate impression based on findings.

Input: 69 years, Male, metastatic lung cancer. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. No intracranial mass or mass-effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is mild degree of global parenchymal parenchymal volume loss which is slightly prominent for age. No hydrocephalus. No extra-axial collections.Sella and orbits are grossly within normal limits. Minimal paranasal sinus mucosal thickening is seen in the involving the anterior ethmoid air cells and sphenoid sinus. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Mild to moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Ms. Fan is a 59 year old female with personal history of bilateral breast cancer (right breast - DCIS/1997; left breast IDC/2011). She now has recurrence in the right breast with locoregional disease. Evaluate extent of disease prior to initiation of chemotherapy. Mild parenchymal enhancement is noted bilaterally.Right breast: There is extensive masslike enhancement identified throughout the entire superior right breast, spanning approximately 4.3 x 6.3 x 9.1 cm. A Hydromark clip is identified within the antero-superior portion of the abnormal area of enhancement. In addition, there is linear non-mass enhancement in the inferior right breast which spans approximately 2.5 cm, with similarly suspicious kinetics as the superior mass-like enhancement. This entire span of abnormal enhancement comes to within 1.4 cm of the nipple anteriorly and 1.0 cm of the pectoralis muscle posteriorly. Multiple enlarged right axillary lymph nodes are identified, the largest of which measures approximately 1.7 cm. A Hydromark clip is identified within one of these enlarged right axillary lymph nodes. Left breast: There are two foci identified within the left inferior breast, which were seen on prior MRI dated 5/10/2011 and are stable to slightly smaller in size. There is no new abnormal enhancement seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: (1) 9.1 cm span of abnormal mass-like enhancement in the superior right breast with extent detailed above. Enlarged right axillary lymph nodes. Additional non-mass enhancement in the inferior breast. (2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: Left-sided weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal patch periventricular white matter lesions on FLAIR imaging indicating mild to moderate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate irregularity of right proximal extracranial internal carotid artery about 1 cm above the bifurcation. The degree of stenosis of the right extracranial proximal internal carotid artery is about 50%.The left extracranial internal carotid artery at the level of carotid bulb also shows about 30% luminal stenosis.Normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Mild to moderate nonspecific small vessel ischemic disease.3. Normal intracranial MR angiogram. 4. About 50% of luminal stenosis and irregularity on the right extracranial internal carotid artery just above the bifurcation and 30 % luminal stenosis on the left extracranial internal carotid artery at the level of the carotid bulb. Precise evaluation of luminal stenosis with and NASCET criteria can be performed with CT angiogram of head and neck.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with headache, status post third ventriculocisternostomy, with pineal mass status post biopsy. Again seen are sequelae of right frontal burr hole access and endoscopic biopsy of a pineal region mass. A small amount of intracranial and intraventricular air is seen compatible with recent redo ventriculostomy. Without the benefit of IV contrast, the T2 hyperintense pineal mass shows no significant change in size or morphology relative to the prior MRI examination. As before, the lesion splays the thalami but otherwise exerts no significant generalized mass effect.High-resolution midline sagittal imaging does appear to show a small defect in the floor of the third ventricle just anterior to the mamillary bodies. Cine flow imaging demonstrates robust flow related signal along the ventral brainstem and basal cisterns which appears to cease abruptly at the floor of the third ventricle. Mild flow related signal is detected within the third ventricle, though it is difficult to ascertain if this arises from CSF pulsation through the foramina of Monro or through the third ventriculocisternostomy.The caliber of the ventricles has improved relative to recent prior CTs, and now appears equivalent to that seen on the postoperative MRI from 9/5/2015. Mild T2 hyperintense rimming of the ventricular system persists. No new areas of parenchymal signal abnormality are detected. No restricted diffusion is seen. Mucosal thickening is evident in the maxillary sinuses.

Output: 1.Expected immediate postoperative findings compatible with recent redo ventriculocisternostomy.2.A small defect appears to be present within the floor of the third ventricle just anterior to the mammillary bodies. On cine flow imaging, however, no large jet of CSF flow is seen to freely communicate between the basal cistern and third ventricle. Mild flow related signal in the third ventricle could reflect a small communication, or it could simply represent CSF pulsatility through the foramina of Monro.3.Nevertheless, the caliber of the ventricles has improved relative to recent prior CTs and appears similar to that seen on the immediate postoperative MRI.4.No significant interval change is identified in the size or morphology of the pineal lesion.


Instruction: Generate impression based on findings.

Input: Reason: structural brain lesion History: headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses and demonstrate mucus retention cysts in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Nivolumab treatment for glioblastoma. There has been marked interval increase in size of multiple enhancing intraparenchymal masses with elevated CBV. The heterogeneously enhancing soft tissue mass adjacent to the left temporal resection cavity measures 3.6 x 3.3 cm, previously approximately 3.2 x 2.6 cm. The mass in the inferior frontal lobe measures 3.0 x 2.7 cm, previously 0.9 x 0.7 cm, with mass effect on the left lateral ventricle near the foramen of Monro. While the foramina of Monro appear to be patent, the ventricular system appears to have increased in size diffusely. This inferior frontal mass extends laterally with heterogeneous enhancement extending to the left temporal resection cavity. This inferior frontal mass also abuts the prechiasmatic left optic nerve and surrounds the A1 segment of the left anterior cerebral artery. The left MCA is not clearly discernible, although distal MCA branches are appear to be patent. The heterogeneously enhancing mass along the left posterior temporal lobe has also increased in size, measuring 2.2 x 4.1 cm, previously 1.6 x 2.5 cm. Just medial to this lesion, there is a markedly increased thick heterogeneous rim enhancement mass that measures approximately 8.5 x 3.1 cm, previously approximately 1.5 x 1.0 cm. Associated with each of these growing lesions are numerous punctate and confluent foci of susceptibility artifact, compatible with punctate hemorrhage and/or angiogenesis. There is also extensive T2 abnormality throughout the white matter of the left cerebral hemisphere, corpus callosum, and periventricular white matter on the right, as well as Wallerian degenerative in the left brainstem. There is no evidence of acute brain parenchymal infarction. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Marked interval progression of the left hemisphere glioblastoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 48-year-old male with left elbow wound, assess for communication with elbow joint, history of steel pipe falling on arm There is a skin defect along the medial aspect of the elbow with herniation of the subcutaneous fat. Diffuse edema is present within the subcutaneous fat surrounding the elbow. Heterogeneous signal within the subcutaneous fat along the medial aspect of the elbow presumably represents hematoma. There is extensive edema within the distal aspect of the medial and long heads of the triceps muscle, compatible with the stated history of crush injury; the majority if not all of the triceps tendon appears to insert on the olecranon. There is edema within the common flexor tendon and adjacent musculature, but no fluid filled gap to indicate complete rupture. The anterior bundle of the ulnar collateral ligament is intact. The ulnar nerve is slightly medially subluxed from the cubital tunnel. There is a small amount of surrounding fluid as well as mild increased signal intensity within the nerve itself suggesting edema. There is no visible communication of the wound with the elbow joint space. A small amount of fluid is present in the joint without significant effusion. Edema is present within the proximal brachioradialis and extensor carpi radialis longus muscles. Foci of low signal within the extensor carpi radialis longus may represent blood product. There are additional foci of low signal within the subcutaneous fat and musculature along the posterolateral elbow which may likewise reflect blood products. The common extensor tendon and lateral collateral ligament appear intact. There is mild edema within the brachialis muscle, but the tendon of the brachialis and the tendon and muscle of the biceps appear intact. Mild osteoarthritis affects the joint with associated degenerative subchondral signal abnormality.

Output: Soft tissue findings consistent with the stated history of crush injury as described above. No findings to suggest communication of the wound with the elbow joint.


Instruction: Generate impression based on findings.

Input: Clinical question: Stenosis. Signs and symptoms: Sciatica. CT of lumbar spine:The alignment of the vertebral column is anatomical.T12 -- L1.Minimal degenerative changes and unremarkable otherwise.L1 -- 2.Minimal degenerative changes and unremarkable otherwise.L2 -- L3.Minimal degenerative changes and unremarkable otherwise.L3 -- L4.There is mild degenerative disk disease and minimal hypertrophic changes of posterior elements.There is asymmetric midline and leftward disk protrusion with resultant mass effect and posterior displacement of thecal sac. No convincing evidence of central trauma stenosis however mild lateral recess compromise bilaterally is noted. Minimal bilateral neural foraminal compromise is also present.L4 -- L5.Advanced degenerative disk disease with significant loss of disk height and mild hypertrophic changes of posterior elements are present. There is shallow broad based bulge of disk slightly more prominent on the right. No central spinal stenosis. Very minimal bilateral neural foramina (right greater than left) is present.L5 -- S1.Minimal degenerative changes. No central spinal stenosis. Minute bilateral neural foraminal compromise secondary to hypertrophied changes of ligamentum flavum present.

Output: 1.No convincing evidence of central spinal stenosis at any level.2.Broad base disk protrusion in the midline and to the left however at L3--L4 results in subtle mass effect on the thecal sac at this level.3.Advanced degenerative disk disease at L4 -- L5 level and mild disk disease at other levels.4.Minimal bilateral neural foraminal compromise at L3 -- L4, L4 -- L5 (right greater than left) and L5 -- S1 levels are present.


Instruction: Generate impression based on findings.

Input: PCNSL status post chemotherapy and autoSCT restage: Parkinson's. There is no significant interval change in the T2 hyperintense areas in the bilateral basal ganglia, left cerebellar hemisphere, as well as diffusely in the cerebral white matter. There is no significant interval change in the size and morphology of the ventricular system with unchanged coaptation of the right frontal horn. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or acute infarct. The skull, orbits, paranasal sinuses, and extracranial soft tissues are unchanged.

Output: Post-treatment findings in the brain without evidence of recurrent central nervous system lymphoma.


Instruction: Generate impression based on findings.

Input: Female 67 years old please evaluate atypical fibroid. PELVIS:UTERUS, ADNEXA: There are multiple T2 hypointense fibroids. The largest is a pedunculated anterior fibroid measuring 3.5 x 2.8 cm (series 4, image 17). A larger, well-defined right posterior myometrial mass measures 6.3 x 5.7 x 5.6 cm (series 4, image 21 and series 6, image 17). This mass is isointense to muscle on T1 and heterogeneous on T2-weighted images with areas of T2 bright signal. Heterogeneous enhancement is seen throughout the mass.Fluid and a polypoid endometrial lesion are seen within the endometrial canal.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Sigmoid colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large right myometrial mass most likely represents a degenerating fibroid. Multiple smaller fibroids are also seen.2.Fluid is seen within the endometrial canal which also contains a polypoid lesion.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with imbalance. Assess for myelopathy. Since the prior examination, anterior instrumented fusion has been performed from C3 through C5. The cervical lordosis is slightly exaggerated at C2-3, and straightened from C3 and below, though this could be at least in part due to positioning.Vertebral body heights are preserved. No evidence of any marrow signal abnormality or marrow edema is seen where the presence of orthopedic instruments do not interfere with the assessment.The visualized spinal cord demonstrates normal morphology and signal characteristics except as discussed below.C2-3: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. Improved from the prior examination where there was evidence of disc osteophyte disease and cord impingement. C3-4: Mild facet hypertrophy. Very mild persistent disc osteophyte complex formation, but significantly improved from the prior examination. There is no longer any evidence of cord impingement. A small focus of T2 hyperintensity within the right lateral aspect of the cord probably reflects chronic myelomalacia from cord impingement which was previously seen at this level. Mild to moderate bilateral foraminal narrowing, similar to prior. C4-5: Mild facet hypertrophy. Mild persistent disc osteophyte complex formation. Mild effacement of the ventral thecal sac with mild flattening of the ventral cord but no cord signal abnormality, stable or improved relative to prior. Mild to moderate bilateral foraminal narrowing, similar to prior. C5-6: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation but with substantial bilateral uncovertebral hypertrophy. No significant generalized spinal canal stenosis. Severe bilateral foraminal narrowing. No significant interval changes. C6-7: Facet hypertrophy. Mild posterior disc-osteophyte complex formation with bilateral uncovertebral hypertrophy. No significant generalized spinal canal stenosis. Severe bilateral foraminal narrowing. No significant interval changes.C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis. No significant interval changes.

Output: 1.Since the prior examination, anterior instrumented fusion has been performed spanning from C3 through C5. Significant disc osteophyte disease seen on the prior examination with cord impingement at these levels has significantly improved. No high-grade spinal canal stenosis is seen, though there remain small disc osteophyte complexes at several levels which slightly indent the ventral spinal cord.2.Below the fused levels, no significant interval changes are seen. Severe bilateral foraminal narrowing persists at C5-6 and C6-7, largely due to uncovertebral hypertrophy.


Instruction: Generate impression based on findings.

Input: 42-year-old with personal history of breast cancer status post left mastectomy. Patient plans for prophylactic right mastectomy this summer. There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast. The patient is status post left mastectomy. No suspicious chest wall enhancement. No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region. Post surgical change is noted in the left axilla.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Possible stroke, possible seizure. No restricted diffusion to suggest acute ischemia. Again seen are multiple areas of encephalomalacia in the brain, relatively largest in the left parietal lobe with additional areas including the bilateral left greater than right posterior temporal and occipital lobes. There is also prior infarct involving the right frontal lobe. These infarcts involve the cortex as well as the subcortical white matter. No intracranial mass or mass-effect. There is ex vacuo dilatation involving the atrium of the left lateral ventricle. There is no hydrocephalus. No extra-axial collections. There is global parenchymal volume loss, which is advanced for age. Small lacunar infarcts involving the bilateral cerebellar hemispheres also noted. Major flow-voids are preserved. Right globe staphyloma. Mild mucosal thickening involving the paranasal sinuses.

Output: 1. No evidence of acute ischemia. No intracranial mass or mass-effect.2. Multiple chronic bilateral cortical infarcts as detailed above which may be contributing to the seizures.


Instruction: Generate impression based on findings.

Input: 34-year-old female with history of fibromatosis. Evaluate for progression/regression. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a right rectus abdominus soft tissue mass which measures 8.2 x 3.7 x 4.0 cm (series 8, image 44), previously measuring 6.9 x 2.6 x 4.0 cm. Signal characteristics include T2 hypointensity with avid enhancement. The right inferior epigastric artery courses through this mass.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral adnexal T2 hyperintense subcentimeter foci most consistent with physiologic follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in size of the right rectus abdominis soft tissue mass most consistent with desmoid tumor. Of note, right inferior epigastric artery courses through this mass.


Instruction: Generate impression based on findings.

Input: 73-year-old female with history of left mastectomy in 2008 for IDC with extensive ductal carcinoma in situ. Patient is asymptomatic. No family history of breast cancer. Three standard views of the right breast were performed digitally, with additional right CC spot compression views, and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Redemonstrated right retroareolar dilated ducts, stable in appearance dating back to at least 2013.Scattered round calcifications within the lateral right breast.Oval circumscribed isodense mass within the right lower inner quadrant at mid depth, appears slightly enlarged as compared with mammogram of 2015. Finding not well visualized on the RML view.No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the right axilla.Targeted ultrasound of the right breast at the 4:00 position 3 cm from the nipple reveals an avascular circumscribed anechoic mass measuring 0.4 cm, compatible with a cyst. Targeted ultrasound of the right breast at the 2:00 position 3 cm from the nipple reveals an other 0.6 cm anechoic circumscribed avascular mass with posterior acoustic enhancement, also compatible with simple cyst. No other cystic or solid masses at the level of the finding on the CC view were seen, and one of these two cysts presumably represents the mammographic finding. Please note, multiple simple cysts were also present on previous breast MRI study of May 2008.

Output: Two simple cysts within the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Dementia. Assess for stroke or atrophy. The brain shows diffuse, fairly symmetric and proportionate expansion of the CSF-containing spaces reflecting mild cerebral and cerebellar volume loss. Volume loss in the mesial temporal lobes is proportionate as well. There is relatively minimal confluent periventricular cerebral white matter T2 hyperintensity that is most pronounced in the frontal and occipital lobes. In addition, there are scattered punctate foci of T2 hyperintensity in the frontal deep white matter. These findings are nonspecific but may reflect microvascular ischemia. There is a 7 mm left cerebellar white matter T1-hypointense, T2 hyperintense focus that may reflect a small chronic infarct. None of the lesions is associated with diffusion restriction. There is no intraparenchymal hemorrhage. Flow voids of the major vessels are preserved.There is a 1.5 cm extraaxial mass based on the right side of the anterior aspect of the falx that is isointense to gray matter on both T1 and T2. This is most suggestive of a falcine meningioma. A smaller 10 mm similar mass is present along the posterior aspect of the cribriform plate is most compatible with olfactory groove meningioma.There is minimal ethmoidal mucosal thickening. The orbits are unremarkable accounting for bilateral eye lens replacement.A 1.5 cm focal expansion of the right frontal bone that is bright on both T1 and T2 with tiny foci of T1/T2 hypointensity is compatible with a hemangioma. Deeply T1/T2 hypointense foci in the scalp near the vertex may represent small calcifications.

Output: 1.Global brain volume loss without specific lobar involvement, age-appropriate.2.Relatively mild white matter involvement by chronic microvascular ischemia.3.Left cerebellar nonenhancing lesion may represent a tiny nonacute focal infarct. 4.Incidental small parafalcine and olfactory groove presumed meningiomas, within limitations of this noncontrast exam.


Instruction: Generate impression based on findings.

Input: 23-year-old male presents with seizures and bilateral interictal discharges, evaluate for underlying structural abnormality. History of alcoholism. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mildly prominent perivascular spaces in the anterior left temporal lobe. The brain parenchyma otherwise appears unremarkable. In particular, the hippocampi are intact and there is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. However, there appears to be mild diffuse cerebellar volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right anterior ethmoid sinus retention cyst.

Output: 1. No evidence of potential seizure foci.2. Diffuse cerebellar volume loss, which may be related to antiepileptic medication and/or alcohol.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:1/5/1960)Reason: MS, eval for progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 hyperintense lesion present within the left middle cerebellar peduncle There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to the previous examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are patchy T2 hyperintense lesions present throughout the cervical spinal cord which were also present on the prior exam it did not appear to have changed substantially. These are located at the C1, C2, C3 and C4 levels along the posterior aspect of the spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based central disc protrusion present at this level which effaces spinal fluid ventral and posterior the spinal cord creating mild spinal stenosis.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions in the brain and cervical spinal cord which are compatible with demyelinating disorder. These are stable compared to the previous exam from April2.There are some degenerative changes present in the cervical spine which are worse at C4-5 where there is a mild degree of spinal stenosis. This is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 42-year-old female with left cervical radiculopathy and EMG changes. Evaluate for disc herniation or abnormality. The cervical vertebral bodies are appropriate in height. Alignment is maintained. No fractures are identified in the cervical spine. Bone marrow signal intensity is within normal limits.Individual levels as below:C2-3: Mild facet arthropathy on the left. No significant compromise to the spinal canal or neural foramina.C3-4: Mild bilateral facet arthropathy. No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc osteophyte complex with no significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc osteophyte complex with no significant compromise to the spinal canal or neural foramina.C6-7: Central disc protrusion approaches but does not significantly impinge on the spinal cord. There is no significant spinal canal or neural foramina narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The paraspinous soft tissues are unremarkable.

Output: Mild degenerative disc disease is most notable at C6-7. However, there is no significant spinal canal stenosis, foraminal narrowing or nerve root impingement.


Instruction: Generate impression based on findings.

Input: History of endoscopic third ventriculostomy in 12/2013 for aqueductal stenosis. Please do flow study. There is interval resolution of the previously seen extra-axial collection along the right anterolateral frontal lobe. There is linear T2/FLAIR hyperintensity coursing through the right frontal lobe towards the ventricular margin relating to the previous surgical tract and likely representing to gliosis. A punctate focus of susceptibility is present along the right ventricular margin.In the area of known parenchymal hemorrhage in the right basal ganglia and thalamus, there is susceptibility artifact and a T2 hypointense hemosiderin ring. This has decreased in size, now measuring 10 x 9 mm, previously 16 x 15 mm. The lateral and third ventricular size is overall minimally decreased.CSF flow evaluation demonstrates some CSF flow along the floor of the third ventricle at the site of the third ventriculostomy extending into the posterior suprasellar cistern. CSF flow is not identified through the cerebral aqueduct where focal stenosis is identified on FIESTA images.There is no diffusion abnormality to suggest recent ischemia. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is new mild to moderate mucosal thickening of the bilateral maxillary, ethmoid and left frontal sinuses.

Output: 1. Compared to 1/3/2014, slight interval decrease in size of the lateral and third ventricles with cerebral aqueduct stenosis again seen. Postoperative changes relating to third ventriculostomy with presence of CSF flow through the surgical defect.2. Interval decrease in size of right basal ganglia/thalamic encephalomalacic cavity. 3. New moderate paranasal sinus disease.


Instruction: Generate impression based on findings.

Input: There are 5 lumbar vertebral bodies. Marrow signal is normal. No vertebral bodies collapse. The conus medullaris ends at the level of T12-L1. Schmorl's nodes are seen at the inferior endplates of L4 and L5. T12-L1: No spinal or neural foraminal compromise.L1-L2: No spinal or neural foraminal compromise.L2-L3: No spinal or neural foraminal compromise.L3-L4: There is disc desiccation. There is mild to moderate disc bulge with no significant spinal stenosis. There is minimal narrowing of the neural foramina on the left. The right neural foramina is normal.L4-L5: There is desiccation of the disc with no disc bulge and no spinal stenosis. There is minimal narrowing of the right neural foramina. The left neural foreman is normal. There is a minimal right facet hypertrophy.L5-S1: There is desiccation of the disc with minimal disc bulge and normal bilateral neural foramina

Output: Mild degenerative changes of the lumbar spine with no significant spinal stenosis.


Instruction: Generate impression based on findings.

Input: Radiating left side pain. Evaluate for foraminal stenosis. The vertebral column alignment is within normal limits. There is exaggerated lordosis with minimal grade 1 anterolisthesis of L4 on L5. The vertebral body and disc space heights are preserved. There is disc desiccation at the L3-4 and L4-5 levels. Heterogeneous bone marrow signal is visualized which is nonspecific. The spinal cord displays normal signal and morphology and terminates at the L1-L2 level. The paravertebral soft tissues are unremarkable. T11-12: As seen on sagittal view there is a trace disc bulge but no neural foraminal or central canal stenosis.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is a trace disc bulge without neuroforaminal or central canal stenosis.L3-L4: There is a trace disc bulge with mild-to-moderate facet hypertrophy and ligamentum flavum thickening. No neuroforaminal or central canal stenosis.L4-5: There is a mild disc bulge. Facet and ligamentum flavum hypertrophy is seen which along with prominent dorsal epidural fat causes mild to moderate central canal stenosis. There is also bilateral mild neural foraminal stenosis.L5-S1: There is a small disc bulge with mild facet and ligamentum flavum hypertrophy but there is no neural foraminal or central canal stenosis.Bilateral adrenal nodules are identified with thickening of the adrenal gland limbs bilaterally. The right adrenal nodule measures 1.1 x 2.0 cm and the left adrenal nodule measures 1.3 x 1.6 cm.

Output: 1.Degenerative changes mostly involving the lower lumbar spine, most prominent at the L4-5 level, where there is mild bilateral neural foraminal and mild-to-moderate central canal stenosis.2.Minimal degenerative grade 1 anterolisthesis of L4 on L5.3.Bilateral adrenal nodules which are nonspecific. If further evaluation is indicated, dedicated CT or MRI imaging may be obtained of the abdomen.


Instruction: Generate impression based on findings.

Input: 41 year old woman with history of Hodgkin's lymphoma, s/p chemo-radiation therapy, with recent dyspnea with exertion and chest pain, referred for stress MRI for further evaluation. MEDICATIONS: albuterol, famciclovir, synthroid First Pass PerfusionDuring hyperemia, no perfusion defects were present. 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 low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 156 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 73 ml (normal range 31+/-10), the LV mass index is 30 g/m2, and the LV mass is 61 g. There are no regional wall motion abnormalities present. No intracardiac thrombus is present. 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 57%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 52 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trace pericardial effusion.Extracardiac FindingsThere is a 5.4cm x 5.2cm circular lesion in the mid body of the spleen. It is primarily iso-intense with surrounding tissue, with some small areas of T2 hyperintensity. It appears to be a soft tissue lesion, rather than a splenic cyst. Dedicated abdominal MRI imaging is recommended for further evaluation . There is high signal in the bilateral superior paramediastinum suggestive of radiation fibrosis with traction bronchiectasis. T

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and low normal systolic function (LVEF 53%).4. Normal RV size and systolic function (RVEF 57%).5. Further evaluation with a splenic lesion with dedicated abdominal MRI recommended.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69-year-old man with history of metastatic thyroid cancer. ABDOMEN:LIVER, BILIARY TRACT: In the hepatic dome (10/11) there is a 17 x 11 mm lesion which is mildly T2 hyperintense with mild peripheral enhancement. This lesion was seen on the prior examination measured 22 x 16 mm. In segment 4 of the liver (10/25) there is an 11 x 11 mm lesion which is also mildly T2 hyperintense with mild peripheral enhancement, previously 16 x 17 mm. Subcentimeter lesion in segment 6 appears stable and is likely a cyst. No new hepatic lesions identified.The gallbladder appears normal and there is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: 14 mm T2 hyperintense lesion in the body of the pancreas (10/30) is stable from prior exams and there is no clear communication with the pancreatic duct. The pancreatic duct is nondilated.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: L1 vertebral body (10/34) T2 hyperintense, enhancing lesion extending into the right pedicle is stable in size measuring 27 x 37 mm, previously 28 x 37 mm.OTHER: No significant abnormality noted.

Output: 1.Continued decrease in size of two metastatic hepatic lesions.2.Stable size of L1 osseous metastasis.3.Stable cystic lesion in the pancreatic tail, likely a side branch IPMN.


Instruction: Generate impression based on findings.

Input: 57-year-old male complaining of lower extremity pain, numbness. Please evaluate for abnormality, pars fracture, sagittal balance. Spine survey:Slight hyperlordosis of the thoracic spine measuring 70 degrees from the superior endplate of T3 to the inferior endplate of T12. Mild anterior wedging of a few mid thoracic vertebra. Mild degenerative disc disease at C3-C4 and C4-C5 as well as the upper thoracic spine.Lumbar spine:Mild degenerative disc disease affects L5-S1. Minimal (1 to 2 mm) anterolisthesis of L5, stable between flexion and extension views. There is a bilateral spondylolysis of L5, better visualized on outside MRI study from June, 2015. Facet joint osteoarthritis affects the lower lumbar spine.

Output: Mild degenerative disc disease of the cervical, thoracic, and lumbar spine with L5 spondylolysis better seen on prior MRI. Other findings as above.


Instruction: Generate impression based on findings.

Input: 68-year-old male with history of metastatic thyroid cancer suspicious liver lesion seen on PET examination. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: Segment 8 and 4b T2 hyperintense, T1 isointense, diffusion restriction, enhancing lesions with surrounding hyperemia with the segment 8 lesion measuring approximately 2.3 x 2.2 cm (series 4, image 13) most consistent with metastatic lesion. Subcentimeter segment 6 T2 hyperintense, T1 hypointense, nonenhancing lesion consistent with a cyst.SPLEEN: No significant abnormality noted.PANCREAS: There is a cystic lesion within the body of the pancreas without evidence of contrast enhancement measuring 1.3 x 0.9 cm (series 7, image 27) compatible with sidebranch IPMN. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cyst.RETROPERITONEUM, LYMPH NODES: Again noted is T1 hypointense, T2 hyperintense, enhancing lesion in L1 vertebral body extending into the right pedicle compatible with a metastatic lesion as was also seen on 3/29/2016 MRI lumbar spine; evidence of mild to moderate central spinal canal stenosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: pulmonary metastatic left base nodule.

Output: 1.Segment 8 and 4B hepatic enhancing lesions consistent with hepatic metastases.2.L1 metastatic lesion.3.Partially visualized pulmonary metastatic left base nodule.4.Pancreatic body cystic lesion most likely a side branch IPMN.


Instruction: Generate impression based on findings.

Input: 76-year-old female with history of breast cancer and pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The region of the pancreatic body/tail, there is a large well-circumscribed, multiloculated cystic lesion in a honeycomb pattern with enhancing internal septations. The contours are lobular with small foci of peripheral increased T1 signal abnormality measuring up to 11.4 x 9.0 cm in maximal axial dimensions. There is associated mass effect on the stomach anteriorly and the kidney posteriorly. The splenic vein is markedly narrowed, but patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a minimally complex left upper pole cystic lesion with enhancing septations. Large left upper pole simple cyst. Other subcentimeter cysts are seen bilaterally.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.PELVIS:UTERUS, ADNEXA: Enlarged leiomyomatous uterus. Dilated and heterogeneous endometrial cavity measuring up to 20 mm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Large cystic lesion located in the pancreatic body most compatible with serous cystadenoma. There is adjacent mass effect on the stomach, kidney, and splenic vein.2. Enlarged fibroid uterus with dilated endometrial canal concerning for endometrial carcinoma. Tissue sampling is recommended for further evaluation.3. Minimally complex left upper pole renal cyst.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, history of lung cancer with brain metastases. Since the prior examination, patchy ependymal enhancement has developed along the bodies of the lateral ventricles. Minimal ependymal enhancement at the frontal horns is relatively unchanged. No definite intraparenchymal enhancing lesions are seen. No enhancement of the cranial nerves is detected.Extensive confluent white matter T2 hyperintensity is unchanged. No evidence of generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricular size and morphology are unchanged.

Output: Interval development of ependymal enhancement along the bodies of the lateral ventricles raises concern for progressive intracranial metastatic disease. Treatment related changes do not typically present in this way and are therefore considered less likely. However, an inflammatory or infectious process is not entirely excluded.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness and numbness. Assess for worsening stenosis. Cervical spine: There is reversal of the usual cervical lordosis. The vertebral bodies are preserved in height. There is mild disc height loss at C3-C4 through C6-C7 with loss of T2 signal. There is mild degenerative marrow endplate signal alteration at C6-C7. Otherwise, there is no significant vertebral bone marrow abnormality. There is no abnormal spinal cord signal. The imaged portions of the brainstem and upper thoracic spinal cord are unremarkable.C2-C3: There is mild right neural foraminal stenosis by facet arthropathy. There is no spinal canal or left neural foraminal stenosis.C3-C4: There is a disc-osteophyte complex that results in moderate spinal canal stenosis, indenting the ventral aspect of the spinal cord. In addition, uncovertebral arthropathy causes severe foraminal stenoses bilaterally.C4-C5: There is a disc-osteophyte complex that causes mild spinal canal stenosis. In addition, uncovertebral and facet arthropathy result in severe foraminal stenoses bilaterally.C5-C6: There is a disc-osteophyte complex that results in moderate-to-severe spinal canal stenosis. In addition, right greater than left uncovertebral and facet arthropathy results in severe foraminal stenoses.C6-C7: There is a disc-osteophyte complex and ligamenta flava thickening result in mild spinal canal stenosis. Left more than right uncovertebral and facet arthropathy result in severe left and moderate right foraminal stenoses bilaterally.Lumbar spine: The lumbar spine alignment is anatomic. The vertebral bodies are preserved in height. There is mild loss of disc height and T2 signal at L2-L3 through L5-S1. There is an inferior L4 endplate Schmorl node. There is abnormal contrast enhancement involving the L3-L4 facets, worse on the right, also degenerative in nature. The conus medullaris has its tip at the upper L2 level. The conus medullaris and included caudal part of the spinal cord display normal signal and morphology. There are degenerative changes involving the sacroiliac joints, as manifested by bridging osteophytes. There are multiple bilateral renal cysts.T12-L1: There is no significant disc herniation, spinal canal stenosis or foraminal stenosis.L1-L2: There is no significant spinal canal or foraminal stenosis.L2-L3: There is a disc bulge, mild ligamentum flavum thickening, and facet arthropathy, without significant spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge with a small right paracentral protrusion, ligamentum flavum thickening, and facet arthropathy, which result in moderate central and right paracentral spinal canal stenosis, as well as mild bilateral neural foraminal stenoses.L4-L5: There is a disc bulge that is eccentric to the left, which along with ligamentum flavum thickening and facet arthropathy results in mild bilateral neural foraminal stenoses, but no significant spinal canal stenosis. There is a small posterior left facet joint synovial cyst.L5-S1: There is road-based central disc bulge and bilateral facet arthropathy associated with mild foraminal stenoses bilaterally, but no significant spinal canal stenosis.

Output: 1. Degenerative cervical spondylosis at C3-4 through C5-6 with associated mild indentation of the spinal cord and extensive bilateral neural foraminal stenoses. 2. Multilevel degenerative lumbar spondylosis consists of moderate spinal canal stenosis at L3-4, as well as mild bilateral neural foraminal stenoses at L3-4 though L5-S1. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis and renal angiomyolipomas ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Slight interval increase in size of bilateral fat containing renal lesions. The largest lesion in the left mid pole measures up to 4.5 cm in diameter (series 5, image 34), previously 3.6 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Slight interval increase in size of bilateral renal angiomyolipomas measuring up to 4.5 cm in the left midpole.


Instruction: Generate impression based on findings.

Input: Reason: Concern for mini polymyoclonus; r/o compression History: Right lower extremity tremor The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is straightening of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina or neural foramina. There are uncovertebral osteophytes present at this level associated with mild narrowing of the right neural foramen.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There some mild opacification of the visualized portions of the right mastoid air cells

Output: 1.No spinal cord mass or demyelinating lesion is appreciated2.There are minor degenerative changes present in the cervical spine


Instruction: Generate impression based on findings.

Input: 59 year old with personal history of left mastectomy for DCIS in 2006. Family history of breast cancer in maternal sister. There is heterogeneous amount of fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast. The patient is status post left mastectomy with no suspicious enhancement in the reconstruction. Intact subpectoral left silicone implant. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 59-year-old with history of right mastectomy for ILC in 2009 followed by radiation delayed reconstruction. Status post right mastectomy with reconstruction.There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or in the right reconstructed breast. No abnormal lymph nodes are identified in either axillary region.T2 hyperintense lesions in the liver are unchanged.

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


Instruction: Generate impression based on findings.

Input: Pituitary adenoma status post TSH in 11/2013: surveillance. There has been interval evolution of postoperative findings related to transphenoidal surgery. There is a hypoenhancing lobulated structure in the sella that measures up to 15 mm in width. The infundibulum remains deviated slightly to the left. The optic apparatus is intact. There is an unchanged probable Thornwaldt cyst in the nasopharynx. There is a subcentimeter left maxillary sinus retention cyst.

Output: Interval evolution of postoperative findings related to transphenoidal surgery with a hypoenhancing lobulated structure in the sella that measures up to 15 mm in width, which may represent recurrent tumor.


Instruction: Generate impression based on findings.

Input: Assess disc space in setting of acute lower back pain. There is moderate facet joint osteoarthritis of the lower lumbar spine and grade 1 anterolisthesis of L5, appearing similar to the prior study. The vertebral body heights and intervertebral disc spaces are maintained. An aortobifemoral bypass graft is present, and excreted contrast is noted within the bladder.

Output: Facet joint osteoarthrosis in the lower lumbar spine and mild anterolisthesis of L5.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [780.4] / Coronary atherosclerosis of native coronary artery [414.01] / Occlusion and stenosis of carotid artery without mention of cerebral infarction [433.10], Reason for Study: ^Reason: evaluate for cva History: dizziness when Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.There are multiple round susceptibility lesions without associated surrounding edema on bilateral frontal and parietal lobes right thalamus as well as left middle cerebellar peduncle indicating amyloid angiopathy, minute chronic hemorrhagic lesions including cavernous malformations or calcifications. 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. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal susceptibility lesions on bilateral hemispheres and cerebellum.3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Memory loss concerns. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered cerebral and pontine white matter T2 hyperintensities. The ventricles and sulci are diffusely prominent due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are scattered paranasal mucosal thickening. The skull and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Scattered white matter signal abnormality is nonspecific, but likely related to chronic small vessel ischemic disease.3. Diffuse cerebral volume loss.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified site of unspecified female breast [C50.919], Reason for Study: ^Reason: evaluating for cord compression and vertebral fracture. Patient with metastatic breast cancer and worsening back pain History: back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is about 50% height loss of L4 vertebral body with replacement of normal bone defect appropriate with T1 low signal intensity lesions indicating pathologic fracture.There are multifocal bone marrow replacing lesion which show Gad enhancement involving T12, L1, L2, L3, L5, S1, coccyx and bilateral ilium indicating metastatic lesions.There is normal lumbar lordosis. The spine alignment is anatomic. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation. There is focal bulging of disc central to right which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: Diffuse bulging of disc, mild to return protrusion of fracture fragment of L4 vertebral body associated with bilateral ligamentum flavum thickening causing severe spinal canal stenosis. L4-L5: Disc desiccation, diffuse bulging of disc associated with bilateral ligamentum flavum thickening indicate mild to moderate spinal canal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Compression fracture, 50%, L4 with minimal retropulsion of fracture fragment result severe spinal canal stenosis at the level of L3-4.2. Multifocal various extent metastatic lesions involving L spine, sacrum, coccyx and bilateral ilium as described above.


Instruction: Generate impression based on findings.

Input: 66 year old woman with history of LV dysfunction and eosinophilia, with previous cardiac biopsy suggestive of eosinophilic myocarditis. She was referred for cardiac MRI to evaluate for scar and active inflammation. Left VentricleThe left ventricle is mild to moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 52 ml/m2 (normal range 18+/-5), the LVESV is 89 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 68 g (normal range 114+/-24). There is global hypokinesis. The native T1 myocardial relaxation time is borderline elevated (between 1040-1080ms). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No LV thrombus. 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 50%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 131 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 66 ml (normal range 35+/-13). No RV thrombus. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta measures 40mm (mildly dilated). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild to moderately dilated left ventricle with mildly reduced systolic function (LV EF 46%).2. No late gadolinium enhancement to suggest an infiltrative, inflammatory or fibrotic process. Native myocardial T1 relaxation times are at the upper limits of normal. 3. Normal size right ventricle with normal systolic function (EF 50%).4. Mild aortic regurgitation. 5. Mild tricuspid regurgitation. 6. There is a small pericardial effusion. 7. Mild aortic root dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache(784.0) [784.0], Reason for Study: ^Reason: severe headache History: SMALL VESSEL ASCVD COLON ca 2006 No evidence of acute ischemic or hemorrhagic lesion.There are patchy multifocal high signal intensity lesions on FLAIR images on periventricular white matter indicating nonspecific small vessel ischemic diseaseThe ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific small vessel ischemic disease. No change since prior scan.


Instruction: Generate impression based on findings.

Input: Dysarthria and vomiting. Evaluate for posterior circulation stroke. Brain MRI: There is an area of diffusion restriction and increased T2 signal in the right cerebellar hemisphere that measures up to 16 mm. There is also a punctate focus of diffusion restriction in the superior right postcentral gyrus. There are a few tiny scattered T2 hyperintense foci in the cerebral white matter that most probably reflect mild chronic microvascular ischemia. There is no evidence of intracranial mass lesions or hemorrhage. There is no midline shift or ventricular dilatation. The orbits and paranasal sinuses are unremarkable. The skull and scalp soft tissues are also grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions. The right internal carotid artery has a retropharyngeal course.

Output: 1. Foci of diffusion restriction in the right cerebellar hemisphere and right postcentral gyrus are compatible with acute infarcts. 2. No evidence of significant steno-occlusive lesions in the head and neck arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Recurrent epistaxis, etiology presumed to be from right polypoid nasal mass. There is packing material in the right nasal cavity with low T2 and intermediate T1 signal suggestive of imbibed blood products from epistaxis. There is markedly swollen mucosa within the right maxillary sinus that communicates with a polypoid lesion within the posterior right nasal cavity and nasopharynx via an accessory ostium. The airway is otherwise intubated. There is diffuse mucosal thickening within the bilateral and sphenoid sinuses, right more than left. The orbits and imaged intracranial structures are unremarkable.

Output: Right antrochoanal polyp in the setting of diffuse sinonasal inflammatory mucosal disease and right nasal packing.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: assess for stroke and/or optic nerve lesion History: visual field defect and left sided weakness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Mucosal thickenings on bilateral ethmoid sinuses and a retention cyst on the right maxillary sinus.Pineal gland calcifications are seen.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Orbit MRIMotion artifact degraded exam quality. The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA, normal neck MRA.3. Unremarkable orbit MRI.


Instruction: Generate impression based on findings.

Input: Recurrent anaplastic oligodendroglioma, MRI needed for treatment planning and protocol. There are postoperative findings related to left temporoparietal craniotomy. There has been interval increase in size of multiple heterogeneous areas of nodular enhancement along the margins of the surgical cavity, the largest of which measures up to approximately 55 mm along the posteromedial margin of the resection cavity, previously up to 45 mm. There is associated confluent T2 hyperintensity in the surrounding brain parenchyma. There is also nonspecific mild scattered regional sulcal enhancement. There is no evidence of acute infarct. There is partial effacement of the left lateral ventricle trigone and mild dilatation of the left temporal horn. However, there is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval increase in size of the extensive foci of tumor recurrence along the margins of the surgical cavity with suggestion of left temporal horn entrapment.


Instruction: Generate impression based on findings.

Input: Cirrhosis. Hepatocellular carcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Nodular contour of the liver and fibrotic changes, compatible with cirrhosis. No enhancing lesion is identified. Status post cholecystectomy. Trace perihepatic ascites, similar to prior.SPLEEN: Splenomegaly measuring 15.7 cm in the coronal plane, increased from prior.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense renal lesions, probable cysts, too small to characterize. No hydronephrosis.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: Cirrhotic morphology of the liver, with no suspicious hepatic lesion identified.


Instruction: Generate impression based on findings.

Input: 47 year old man with history of chest pain and non-sustained ventricular tachycardia in March 2016, diagnosed with myocarditis by cardiac MRI, returns for repeat MRI to evaluate scar burden and ventricular function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 137 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 58 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 106 g (normal range 164+/-36). There are no regional wall motion abnormalities present. On T2 STIR imaging, there is no focal increase in uptake to suggest myocardial edema, and the previously seen hyperintense signal in the inferolateral and lateral walls has resolved. There is persistent late gadolinium enhancement in the basal inferior and inferolateral walls, and the mid inferolateral and anterolateral walls. There is subendocardial and epicardial involvement in this distribution, with preserved wall thickness and wall motion. While this is atypical for myocardial infarction, cannot rule out a previous circumflex embolic event. Overall there is lower intensity signal of late gadolinium enhancement when compared to the previous study, which suggests mild interval improvement of underlying fibrosing, infiltrative, or inflammatory process. Native T1 myocardial relaxation time is within normal limits (<1050ms).Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 148 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 72 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 bovine 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 upper normal (29mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (EF 58%). 2. There is persistent late gadolinium enhancement in the basal inferior and inferolateral walls, and the mid inferolateral and anterolateral walls. There is subendocardial and epicardial involvement in this distribution, with preserved wall thickness and wall motion. While this is atypical for myocardial infarction, cannot rule out a previous circumflex embolic event. Overall there is lower intensity signal of late gadolinium enhancement when compared to the previous study, which suggests mild interval improvement of underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with normal systolic function (EF 52%).When compared to the previous study of March 8, 2016, the biventricular function is unchanged. There is no longer evidence of acute myocardial edema on T2 STIR imaging. Late gadolinium enhancement persists in the basal to mid inferolateral/anterolateral wall distribution but is of lower intensity signal. There is no evidence of pericardial inflammation.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 malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: Pre-OP stealth MRI; please page neurosurgery resident on-call to place fiducials History: Cavernous malformation, this is a PRE-op MRI for stealth Multiple fiducial markers are attached on scalp for stealth localization.The left posterior temporal-occipital lobe cavernous malformation is again seen with evidence of subacute hemorrhage within the lesion. The size and MR characteristics do not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable.

Output: Post contrast enhanced limited MR scan with stealth protocol. No change of left posterior temporal-occipital lobe cavernous malformation in terms of size and MR signal characteristics since prior scan.


Instruction: Generate impression based on findings.

Input: 69-year-old female status post burn to the left index finger, please evaluate for osteomyelitis. There is acroosteolysis of the distal phalanx of the index finger of the left hand. There is diffusely abnormal marrow signal within the distal phalanx with abnormal contrast enhancement of the bone marrow. Further, there is a soft tissue defect at the tip of the index finger with a T2 hyperintense sinus tract that appears to communicate between the cutaneous surface and the underlying distal phalanx.The middle phalanx demonstrates mild edema, likely representing reactive osteitis without evidence of osteomyelitis. There is no significant joint effusion. Otherwise, the extensor and flexor tendon complexes of the index finger appear intact. Findings compatible rheumatoid arthritis about the carpus in multiple MCPs with superimposed osteoarthritis.

Output: Soft tissue swelling and osteolysis indicative of osteomyelitis secondary to history of burn injury of the distal phalanx of the index finger. Further, a sinus tract extends from the cutaneous surface to the underlying bone. Reactive osteitis is visualized within the middle phalanx, without definite findings of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Patient with metastatic small cell lung cancer status post whole brain radiation therapy. There is marked interval regression of the previously seen multiple intra-axial and extra-axial lesions. There is interval resolution of the right frontal dural metastasis with interval decrease in size of the adjacent T2 hyperintense lesion, measuring 11 x 19 mm (AP x TR), previously 36 x 16 mm. There is interval increase in the T2/FLAIR signal at the right frontal horn periventricular white matter, which approaches and is adjacent to the T2 hyperintense lesion medially. There are multiple T1- and T2/FLAIR hyperintensities corresponding to the previously seen supra- and infratentorial lesions with associated susceptibility artifact. There may be minimal, if any, residual enhancement associated with the previously seen lesions. The previously seen right dural thickening and enhancement has resolved. There is interval increase in size of the ventricles, which may be on the basis of ex vacuo dilatation and decreased mass effect from previously seen lesions, as the sulci are also more prominent. There is also increased periventricular FLAIR hyperintensity. There is no midline shift or herniation. There previously seen partially imaged mass at the right C2 level has regressed.

Output: 1. Marked interval regression of multiple supratentorial and infratentorial intracranial metastases. No new enhancing lesion. Interval resolution of right dural thickening and enhancement.2. Slight interval increase in size of the ventricles, which may be on the basis of ex vacuo dilatation, as the sulci are also more prominent. There is also interval increase in periventricular FLAIR hyperintensity which may be related to treatment change, however, given the slight increase in caliber the ventricular system, component of transependymal CSF flow cannot entirely be excluded. Suggest close follow up to exclude the possibility of developing communicating hydrocephalus.


Instruction: Generate impression based on findings.

Input: Female, 80 years old, with history of meningioma status post radiotherapy, surveillance imaging. Redemonstrated is a tumor centered on the left sphenoid wing with both intraosseous and extraosseous components. As before, the tumor encroaches upon the orbital apex, the pterygopalatine fossa and foramen rotundum, the middle cranial fossa, a small portion of the cavernous sinus, and likely the infratemporal fossa. Since the prior examination, there has been no significant interval change in size or morphology of this lesion. T2 hyperintensity and encephalomalacia of the adjacent left anterior temporal lobe have not significantly changed. Redemonstrated is evidence of prior left pterional craniotomy.No new intracranial lesions are identified. Scattered foci of FLAIR hyperintensity in the cerebral hemispheres are nonspecific and unchanged. No evidence of new parenchymal edema or mass effect is observed. The ventricles are stable and normal in size.

Output: Stable tumor centered on the left greater sphenoid wing with no evidence of any new intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with history of strep pneumonia sepsis and meningitis with right temporal soft tissue swelling and dural defect. Evaluate for abscess, infection. Findings are demonstrated compatible with bilateral temporal region synangiosis.The previously demonstrated extracranial fluid collection along the right temporal scalp has resolved. No residual fluid or edema is seen. Dense enhancement within the subcutaneous tissues is compatible with scarring and/or granulation tissue. A small amount of right temporal parenchyma continues to herniate through the calvarial defect with minimal signal abnormality suggesting gliosis.Scattered areas of sulcal and intraventricular diffusion restricting infectious material, as well as areas of leptomeningeal enhancement, have resolved. A small area of somewhat prominent enhancement along the right anterior clinoid process (see image 45 series 1601) is favored to represent an aggregation of vascular structures or perhaps some granulation tissue. No associated parenchymal edema is seen. Elsewhere, no pathologic intracranial enhancement is suspected.Chronic strokes are redemonstrated in the left perirolandic area and in the basal ganglia, similar to prior. No acute ischemia is seen. No significant generalized mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. Chronic hemosiderin staining in the basal ganglia, left more than right, is unchanged. The ventricles remain slightly prominent but similar to prior.Dedicated imaging of the IACs shows normal fluid signal characteristics of the inner ear structures. The IACs are patent and free of mass lesions. The visualized cranial nerves are unremarkable and show no evidence of pathologic enhancement. Since the prior examination, opacification of the right mastoid air cells has nearly completely resolved.

Output: 1.Interval resolution of findings related to infection and abscess formation along the right temporal scalp. Residual enhancing subcutaneous tissue likely represents scarring.2.Interval resolution of findings related to intracranial infection/meningitis. No significant sequelae or resulting brain lesions are seen. Mildly prominent enhancement along the right anterior clinoid process is favored to represent an aggregate of vascular structures or perhaps some granulation tissue.3.Unremarkable evaluation of the IACs.4.Redemonstration of findings related to moyamoya disease including prior cortical and basal ganglia strokes.