Instruction: Generate impression based on findings.

Input: 37 year old with history of prior myocardial infarction is referred to evaluate LV function and viability. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 127 ml/m2 (normal range: 65+/-11), the LVEDV is 294 ml (normal range 109+/-23), the LV end systolic volume index is 85 ml/m2 (normal range 18+/-5), the LVESV is 197 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 147 g (normal range 114+/-24). The LV dysfunction is global with regional variation, specifically the mid to basal inferior, inferoseptum, and septal walls appear hypokinetic . There is mid-wall stripe pattern of myocardial late gadolinium enhancement in the septal wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is more typical of nonischemic cardiomyopathy such as dilated cardiomyopathy or old myocarditis rather than ischemic cardiomyopathy. Left AtriumThe left atrium is severely enlarged.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 135 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 58 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. There is a small pericardial effusion. Extracardiac FindingsThe thyroid gland is somewhat enlarged. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely enlarged with moderately reduced systolic function. The overall LV ejection fraction is 33%. There is evidence of a mid-wall stripe of septal late gadolinium enhancement. The pattern is not typical for prior myocardial infarction. It is well described to represent myocardial fibrosis in patients with dilated cardiomyopathy or old myocarditis.2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%3. Severe left atrial dilation.4. Small pericardial effusion.5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50 year old female with frequent PVCs from the RVOT, decreased EF and decreased exercise tolerance. Referred for MRI evaluation for possible infiltrative disorders/ARVC. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 41%. The LVEDV is 212 ml (normal range 109+/-23), LV end diastolic volume index is 116 ml/m2 (normal range: 65+/-11), LVESV is 125 ml (normal range 31+/-10), and LV end systolic volume index is 68 ml/m2 (normal range 18+/-5). The LV mass is 91 g (normal range 114+/-24) and the LV mass index is 50 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is late gadolinium enhancement involving the epicardial basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with normal systolic function. The overall RV ejection fraction is 58%, the RVEDV is 188 ml (normal range 110+/-24), the RV end diastolic volume index is 103 ml/m2 (normal range 69+/-14), the RVESV is 80 ml (normal range 35+/-13), and the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8). There are no focal RV aneurysms noted. Right AtriumThe right atrium is mildly dilated. There is a small patent foramen ovale with a left to right shunt.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small pericardial effusion. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 41%. There is evidence of myocardial fibrosis, inflammation, or infiltration involving the basal inferolateral wall. The pattern of involvement is atypical for prior myocardial infarction. 2.The right ventricle is moderately dilated with normal systolic function. The overall RV ejection fraction is 58%. No evidence of obvious focal right ventricular aneurysms. No major CMR criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy. 3.There is likely a small patent foramen ovale with a left to right shunt.4.Mild right atrial and moderate left atrial dilation.5.Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are post treatment findings within the right neck including T2 hyperintensity within the right neck soft tissues. In particular, there is diffuse T2 hyperintensity and loss of muscle bulk in the right trapezius muscle. There is perhaps slightly increased T2 signal diffusely along the inferior portions of the right brachial plexus, although assessment is limited by various artifacts. Otherwise, there is no evidence of right cervical or axillary mass, or significant lymphadenopathy in the neck. The osseous structures are unremarkable.

Output: Post-treatment findings within the right neck with denervation injury of the right trapezius muscle and possibly inferior right brachial neuritis, although assessment is limited by various artifacts. Otherwise, no evidence of mass lesions in the region of the right brachial plexus.


Instruction: Generate impression based on findings.

Input: 19 year-old female with shoulder pain, evaluate for labral tear ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint appears within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear signal abnormality and contrast undercutting the superior labrum seen best posteriorly but with anterior extension consistent with a SLAP tear (image 9, series 2).BICEPS TENDON: The biceps tendon is normally situated within the bicipital groove.ADDITIONAL

Output: 1. SLAP tear, as described above.2. Intact rotator cuff.


Instruction: Generate impression based on findings.

Input: 44-year-old man with history of alcoholic cirrhosis ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with decreased parenchymal signal. The gallbladder is distended without evidence of cholecystitis. There is a 11 mm cyst in segment 7 of the liver. No suspicious focal lesion is identified. There is recanalization of the umbilical vein.SPLEEN: There is splenomegaly measuring 178-mm.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a moderate amount of ascites.

Output: Cirrhotic morphology of liver with portosystemic collateralization. No suspicious focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: 73 years Female (DOB:10/10/1942)Reason: r/o stroke History: left facial tingling. Postural instability. Patient also endorses paresthesia over the dorsal aspect of the left hand, and the last two toes of the left foot, which she reports being common aurous phenomena. She denies headache, photophobia, nausea, or vomiting. Last migrainous attack was one month ago.PROVIDER/ATTENDING NAME: JAMES J WALTER JAMES J WALTER MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 7 x 5 mm axial dimension aneurysm originating from the left half of the anterior communicating artery which is directed towards the right and the posteriorly. It appears multilobulatedThere is a 9 x 4 mm axial dimension aneurysm present originating from the distal right internal carotid artery at the origin of the right posterior cerebral artery which has a fetal origin.There is a 1.5 mm aneurysm present at the distal left internal carotid artery possibly the origin of the left anterior choroidal artery.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left vertebral artery is larger than the right vertebral artery. The left posterior inferior cerebellar artery is dominantMRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no significant stenosis identified of the great vessels from the aortic arch. As a mild narrowing of the left subclavian artery at its origin and 40% stenosis of the left subclavian artery proximal to the left vertebral artery origin. There is On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. The right vertebral artery is smaller than the left vertebral artery. There is 50% stenosis at the origin of the right vertebral artery.

Output: 1.Left sided 7 mm anterior communicating artery aneurysm2.9 mm right communicating segment aneurysm.3.An alphanumeric page was sent to Andrea Loggini at the time of this dictation to discuss the above findings given the reported history of migrainous headache attacks.4.There is approximately 50% stenosis at the origin of the right vertebral artery and mild atherosclerotic narrowing along the left subclavian artery. The right vertebral artery is smaller than the left vertebral artery.


Instruction: Generate impression based on findings.

Input: disturbance of skin sensation There is 13mm x 9mm x 5mm sized lesion with ectatic venous structure indicating arteriovenous malformation on the left middle posterior temporal gyrus possibly within the left lateral occipital sulcus. There is no associated hemorrhage or surrounding edema.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate enlarged left MCA angular branch with vascular blushing on the left temporo occipital lobe area indicating AVM.Otherwise unremarkable brain MRA.

Output: Possible left temporo-occipital AVM without evidence of hemorrhage or surrounding edema supplied from the left MCA angular artery.


Instruction: Generate impression based on findings.

Input: Left hand cyst and pain. There is a 1.5 cm focus of subcutaneous swelling of the dorsal wrist without underlying osseous or soft tissue involvement. MRI or ultrasound may be considered if further evaluation is clinically warranted.Proximal juxta-articular osteoporosis cannot be excluded, which can be associated with early findings of inflammatory arthritis. There is minimal osteoarthritis at the base of the first metacarpal.

Output: Subcutaneous focal swelling of the dorsal wrist without underlying osseous or soft tissue involvement. If further evaluation is clinically warranted, consider MRI or ultrasound.


Instruction: Generate impression based on findings.

Input: Status post right mastectomy in June 20, 2013, completed chemotherapy in October 20, 2013.TCH There is scattered fibroglandular tissue in left breast. Status post right mastectomy with reconstruction.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in the left breast or right reconstructed breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of Marfan syndrome status post orthotopic heart transplant. CHEST:MRA

Output: 3.9 x 2.2 cm partially thrombosed pseudoaneurysm at the level of the aortic anastomosis. No surrounding fluid collection to suggest ongoing infection (i.e. mycotic aneurysm), especially in an asymptomatic patient.Findings were relayed to ordering service (Catherine Murks, pager 8504).


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of left shoulder pain. ROTATOR CUFF: Complete, full thickness tear of the supraspinatus tendon, with delamination of the tendon and retraction of the deep fibers to approximately the level of the glenohumeral joint. Increased signal intensity in the retracted tendon likely represents tendinosis. The tear extends posteriorly to involve the anterior half of the infraspinatus tendon. Increased signal intensity in the intact portion of the infraspinatus tendon is compatible with tendinosis. There is mild fatty atrophy of the myotendinous junction of the infraspinatus, otherwise the supraspinatus and infraspinatus muscles appear normal. The subscapularis and teres minor tendons and muscles are within normal limits.SUPRASPINATUS OUTLET: Moderate to severe osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa, as well as foci of intermediate signal intensity which likely represent synovitis and debris. There is narrowing of the acromiohumeral interval to 5 mm, consistent with a chronic rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral articular cartilage appears normal for age. A small amount of fluid undercuts the superior labrum on multiple slices, which we suspect represents a SLAP tear extending into the superior aspect of the anterior labrum, although, this could conceivably represent an unusually long sublabral recess. A small glenohumeral joint effusion is present, with a small amount of synovitis superiorly within the joint.BICEPS TENDON: The tendon of the long head of the biceps is within normal limits.

Output: Full-thickness rotator cuff tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: 20 year old female with syncope referred for further evaluation. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 118 ml/m2 (normal range: 65+/-11), the LVEDV is 208 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 98 ml (normal range 31+/-10), the LV mass index is 76 g/m2 (normal range 67+/-11), and the LV mass is 134 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The LA volume is 76 ml.Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 115 ml/m2 (normal range 69+/-14), the RVEDV is 203 ml (normal range 110+/-24), the RV end systolic volume index is 62 ml/m2 (normal range 22+/-8), and the RVESV is 110 ml (normal range 35+/-13). No focal or regional wall motion abnormalities noted. Right AtriumThe right atrium is mildly dilated (105ml). Aortic ValveThe aortic valve opens widely and is trileaflet. There is mild aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root and thoracic aorta are normal in size. No evidence of aortic coarctation. Normal origin of the right and left coronary artery arteries. Sinus of Valsalva: 34x32x31mmST Junction: 29mmAscending Aorta: 30x31mmPulmonary 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. Severe LV dilation with low normal systolic function (LVEF 53%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Moderate RV dilation with mildly reduced systolic function (RVEF 45%) without evidence of focal or regional aneurysm. 3. Normal left atrial volume.4. Mild right atrial dilation.5. Tricuspid aortic valve with mild aortic regurgitation.6. Normal thoracic aorta.7. Normal origins of the coronary arteries. 8. Small pericardial effusion.


Instruction: Generate impression based on findings.

Input: 49 year old female. Right knee pain. Evaluate right knee for loose body versus meniscus tear. MENISCI: Medial and lateral menisci are intact without evidence of a atear.ARTICULAR CARTILAGE AND BONE: Small area of near full thickness to full-thickness cartilage loss in the weight-bearing surface of the medial femoral condyle (series 4, image 18). High signal abnormality and mild fraying of the articular cartilage of the patella diffusely; no full thickness defect.Bone marrow signal intensity is within normal limits.LIGAMENTS: ACL, PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small area of near full thickness to full thickness cartilage loss in the medial femoral condyle. 2. Patellar chondromalacia with mild articular cartilage surface fraying.3. 4 mm loose body in the lateral recess of the suprapatellar pouch.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of ulcerative colitis presents with periumbilical pain. ABDOMEN:LUNG BASES: The lung bases are clear and the heart size is normal.LIVER, BILIARY TRACT: No significant abnormality noted. Multiple stable hepatic lesions have been previously evaluated and are most compatible with adenomas and segments 6 and 7. No new hepatic lesions were found.SPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There are numerous borderline enlarged mesenteric lymph nodes.BOWEL, MESENTERY: The stomach is moderately distended and the patient was unable to tolerate the full dose of oral contrast. This may be due to delayed gastric emptying. The stomach had normal appearance on the previous CT and MRI examinations.There is diffuse small bowel wall thickening. No evidence of obstruction was found. There is diffuse thickening of the colon wall involving the descending and sigmoid colon. The colon is only minimally distended, so accurate evaluation of wall thickening is difficult.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted PELVIS:UTERUS, ADNEXAE: The uterus is markedly enlarged and it contains multiple heterogeneously enhancing masses. The myomatous uterus measures approximately 7.1 x 10.2 cm at axial image 120/166.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is sigmoid and rectal diffuse wall thickening which may be due to ulcerative colitis flare.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Diffuse small bowel wall thickening and diffuse descending, sigmoid and and rectal wall thickening. Findings are compatible with inflammatory bowel disease. The bowel wall thickening is new since the recent MRI examination. Multiple additional findings, as described above.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: Rotator cuff tear after shoulder dislocation vs labral tear History: pain ROTATOR CUFF: There is a partial articular surface tear of the supraspinatus at the insertion. No full-thickness tear is identified.SUPRASPINATUS OUTLET: Osteophyte formation is noted at the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Anterior labrum is internal increased signal and is most likely torn.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Partial articular surface tear of the supraspinatus. No full-thickness tear.2.Likely torn anterior labrum. If clinically indicated, further evaluation may be obtained with MR arthrogram.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma resection yearly follow up. Pituitary: There are postoperative findings related to transsphenoidal pituitary resection and radiotherapy, including intrasellar adhesions and a defect in the clivus, but no evidence of a discrete tumor. The infundibulum is intact and remains deviated slightly to the right. There is no mass effect upon the optic chiasm or cavernous sinuses. Rather, there is ptosis of the optic chiasm.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged scattered cerebral white matter T2 hyperintensities. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged. There are bilateral lens implants. There is a persistent right maxillary sinus retention cyst.

Output: 1. Post-treatment findings in the sella without evidence of tumor progression.2. Unchanged moderate probable chronic cerebral small vessel disease.


Instruction: Generate impression based on findings.

Input: metastatic breast cancer to brain, post SRS follow up. Again there is a focal enhancing nodular lesion on the left frontal lobe middle frontal gyrus likely located on the subcortical gyrus subcortical white matter. Comparing to prior scan, the size of the enhancement appears to be slightly smaller (3.5mm to 3mm).The right pre central gyrus around the paracentral lobule lesion (about 2mm) does not show any interval change since prior exam.There is no associated perilesional edema. There is no other enhancing lesion on this scan.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. 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 change of right pre-central gyrus close to paracentral lobule lesion since prior exam.Slightly decreased in size of the left frontal middle frontal gyrus lesion since prior exam.


Instruction: Generate impression based on findings.

Input: Male 65 years old; MRI abdomen evaluated liver lesions, masses, HCC. Liver vascular patency. LIVER, BILIARY TRACT: Liver has a nodular contour and widened fissures compatible with chronic liver disease/cirrhosis. Within segment 8 of the liver there is a mildly T2 hyperintense lesion that demonstrates arterial enhancement with areas of subtle washout. The lesion measures at least 4.5 x 3.2cm. It is in continuity with the hepatic vein and hepatic venous involvement is suspected. Left and right portal veins are patent. The anterior branch of the right portal vein is involved with tumor. There is overlying capsular retraction.There are other enhancing foci in both lobes of the liver. Which does not show washout and is considered indeterminate.There is a indeterminate lesion measuring 1.5 cm x 1.2 cm in segment 3 of the liver which does not show arterial enhancement and shows questionable washout. The background liver is nodular and fibrotic.There is enlarged portacaval and peripancreatic lymphadenopathy.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: Upper abdominal peripancreatic and portacaval lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 7/26/2016 18:55:00)SEGMENT 8 LESION: 4.5 x 3.2 cm (Image 16, Series 10).SEGMENT 3 LESION: 1.5 x 1.2 cm (Image 36, Series 15).

Output: 1.Dominant segment 8 hepatic lesion (4.5cm) with suspected extension into the hepatic vein. The lesion also involves the anterior branch of the right portal vein.2.Hypoattenuating segment 2 lesion measuring 1.5 cm is considered indeterminate.3.Additional small hypervascular foci in the liver too small to characterize.


Instruction: Generate impression based on findings.

Input: Reason: questioning bilateral shoulder pain History: bilateral shoulder pain Examination is limited by patient motion artifact.ROTATOR CUFF: There is diffuse mild muscle atrophy, which may be an age-related finding. There is marked atrophy of the supraspinatus muscle, with increased signal within the supraspinatus tendon compatible with tendinopathy. No rotator cuff tear is evident.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small paralabral cyst of the mid superior labrum. No labral tear is evident.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Findings compatible with frozen shoulder.2. Diffuse mild muscle atrophy, and marked atrophy of the supraspinatus muscle, but with no discrete rotator cuff tear evident.3. Moderate osteoarthritis of the acromioclavicular and glenohumeral joints.


Instruction: Generate impression based on findings.

Input: 18-year-old male with wrist pain and clicking for 7 months. Evaluate for TFCC tear. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact within the limitations of a non arthrogram study.TRIANGULAR FIBROCARTILAGE COMPLEX: Although this is a non arthrogram study, the TFCC appears intact. There is a punctate focus of fluid signal abnormality along the undersurface of the triangular fibrocartilage complex which appears to be within the distal radioulnar joint. This finding is nonspecific and may reflect a very mild synovitis or mechanical irritation.TENDONS: The extensor flexor tendons appear intact. BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: No evidence of TFCC tear as clinically questioned.


Instruction: Generate impression based on findings.

Input: Headache, fatigue, heat intolerance. There is mild flattening of the pituitary gland, measuring up to 4 mm in craniocaudal dimension. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Mild flattening of the pituitary gland may indicate atrophy or perhaps pseudotumor cerebri in the appropriate clinical setting, for example. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: BRAIN: There are unchanged postoperative findings related to suboccipital craniotomy for resection of right cerebellar medulloblastoma. There is minimal surrounding T2 prolongation surrounding the surgical cavity without significant change. There is no suspicious intracranial enhancement. There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are mucus retention cysts in both maxillary sinuses. However, sinus opacification and mucosal thickening has overall markedly decreased from prior examination. The skull and extracranial soft tissues are unremarkable. SPINE: The vertebral body and intravertebral disk height are maintained. The marrow signal is unchanged with increased T1 and T2 signal, likely representing post treatment change. There is no acute fracture or subluxation. The conus medullaris terminates at L1-2. There is no suspicious enhancement within the spine.

Output: Stable postoperative and post treatment findings without recurrent tumor or drop metastases within the spine.


Instruction: Generate impression based on findings.

Input: There has been interval expected evolution of previously seen postoperative changes from right temporal craniotomy for partial resection of a mesial right temporal lobe mass. The resection cavity margins are now better delineated, although the cavity is now filled with diffuse homogeneous intrinsic T1 and FLAIR hyperintensity, with marginal mild T2 hypointensity and susceptibility consistent with hemosiderin deposition. The resection cavity demonstrates mild marginal enhancement as well. Medial to the resection cavity, there is again persistent focal oval T2 hyperintensity with peripheral enhancement related to residual tumor in the posterior right parahippocampal gyrus. The rind of enhancement has slightly increased since the prior exam. In addition, there has been interval increased thickness of the rind of enhancement along the anterior area of nodular enhancement extending from the medial aspect of the resection cavity. There is also now new focal nodular enhancement along the more superior medial right temporal lobe as seen on 1001/13. Overall, extent of FLAIR hyperintensity involving the right temporal lobe consistent with the extent of tumor, appears similar to the baseline exam. However, now subtle FLAIR within the splenium of the corpus callosum on the right side, as seen on 401/17, with mild expansion. Relatively mild associated localized mass effect appears similar.Trace fluid is present in the right mastoid air cells. Extracranial fluid collection along the craniotomy flap has significantly decreased in size, with minimal residual fluid along the posterior margin of the craniotomy. There remains minimal extra-axial fluid underlying the flap, measuring 3 mm in greatest thickness

Output: 1. Interval expected evolution of previously seen postsurgical changes related to subtotal resection of medial right temporal lobe mass, with interval increased thickness of rind of enhancement in areas of residual tumor as well as new nodular enhancement more superiorly in the heel right temporal lobe. Findings are most suggestive of tumor progression.2. Mild expansion with increased FLAIR signal in the splenium of the corpus callosum on the right side adjacent area of tumor, concerning for tumor progression. Overall extent of FLAIR abnormality involving the right temporal lobe otherwise appears similar to baseline, likely representing a combination of vasogenic edema and nonenhancing tumor.


Instruction: Generate impression based on findings.

Input: Male, 17 years old. Weight loss, bloody stool and abnormal UGI study with 10 cm bowel narrowing of distal loop.EXAMINATION: MR enterography without and with IV contrast 07/08/2016, 1508 ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys enhance symmetrically, without focal lesion or hydronephrosis. No obstructing urinary stone.RETROPERITONEUM, LYMPH NODES: Scattered mildly prominent right lower quadrant lymph nodes are likely reactive.BOWEL, MESENTERY:The distalmost 8-10 cm of terminal ileum show diffuse wall thickening, luminal narrowing, wall hyperenhancement, and decreased motility, compatible with active inflammatory involvement. Enhancement and proliferation of the surrounding fat. Mild hyperenhancement also involves the cecum. The bowel loops immediately proximal are not significantly dilated. The remainder of the bowel appears normal, without other areas of abnormal wall thickening or dysmotility. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: A 10 cm segment of active inflammation and luminal narrowing involves the terminal ileum, with secondary inflammatory changes in the surrounding mesenteric fat and the cecum. The remainder of the bowel appears normal.


Instruction: Generate impression based on findings.

Input: Liver transplantation patient, altered mental status. No evidence of acute ischemic or hemorrhagic lesion.There is a focal high signal intensity on the left frontal lobe superior frontal gyrus subcortical white matter on FLAIR imaging which indicate age indeterminate ischemic lesion. Another focal tissue loss on the right cerebellar hemisphere is also seen which indicates chronic infarct.Bilateral basal ganglia signal intensities are normal.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Chronic infarct with tissue loss, left frontal lobe and right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a 13 x 15 x 11 cm enhancing mass arising from the left ICA with extension to the left CPA most compatible with a vestibular schwannoma. There is no significant mass effect on the adjacent brain stem. No evidence of a high riding jugular bulb or aberrant course of the ICA. Normal sigmoid sinus.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no midline shift or herniation. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear.

Output: Left CPA mass, compatible with a vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: AMS, right sided weakness and hypertension. There is an area of high T2 signal and restricted diffusion measuring up to 20 mm in the left posterior basal ganglia and corona radiata. There appears to be mild patchy enhancement. There is no evidence of intracranial hemorrhage. There is a background of scattered areas of high T2 signal in the cerebral white matter bilaterally without restricted diffusion and a small focus of encephalomalacia in the right caudate head. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Recent infarct in the left posterior basal ganglia and corona radiata without evidence of hemorrhagic conversion superimposed on chronic small vessel white matter ischemic disease and a chronic right caudate head lacunar infarct.


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0], Reason for Study: ^Reason: Evaluate for ischemia History: LUE and facial numbness Brain MRIThere is focal restricted diffusion on the right thalamus but the lesion already shows FLAIR/T2 high signal intensity indicating possible subacute ischemic infarct. There is no evidence of hemorrhagic conversion.Subtle patchy FLAIR/T2 high signal intensities on bilateral periventricular white matter are nonspecific. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. 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.Bilateral P-comm arteries are patent. A common artery is also patent.

Output: 1. Subacute ischemic infarct without hemorrhagic transformation, right thalamus.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with recurrent lesion. Preoperative planning examination. Redemonstrated is evidence of high vertex craniotomy for prior resection of a falcine meningioma. Residual enhancing tissue most likely representing meningioma to the right of the falx has increased in size, now measuring up to 38 mm in AP dimension, previously 30 mm, and up to 14 mm in thickness, previously 12 mm. Thin enhancement along the resection margin to the left of the falx is unchanged and may represent postoperative granulation.Also redemonstrated is evidence of left frontal and left parietal craniotomy. A resection cavity in the left middle frontal gyrus is unchanged. An enhancing nodule along the left superior temporal gyrus measuring up to 8 mm in diameter is unchanged. An enhancing focus within the left squamous temporal bone is unchanged as well. No new intracranial lesions are seen. The ventricular system is stable in size and morphology.

Output: Continued interval growth of residual tumor at the high right vertex to the right of the falx.


Instruction: Generate impression based on findings.

Input: Atypical meningioma status post resection on 7/14/2015. There are postsurgical findings related to left frontal craniotomy for resection of a left frontal convexity meningioma. There is a small amount of scattered blood products and trace confluent T2 hyperintensity surrounding the resection cavity. There is mild dural thickening and enhancement overlying the resection cavity as well as a few punctate foci of enhancement along the margins of the surgical cavity. There is minimal ex vacuo dilatation of the frontal horn of the left lateral ventricle. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is unchanged mild predominantly periventricular nonspecific cerebral white matter T2 hyperintensity. There is no midline shift or mass effect. There is no evidence of acute infarction. There is scattered fluid signal in the mastoid air cells, right greater than left. There are bilateral lens implants.

Output: Postoperative findings related to gross total left frontal meningioma resection with a few nonspecific punctate foci of enhancement along the margins of the surgical cavity.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with altered mental status. Assess for new stroke. No restricted diffusion is seen. Minimal scattered small foci of periventricular T2 hyperintensity are seen. No evidence of parenchymal edema or mass effect is detected. No intracranial hemorrhage or abnormal extra axial fluid collections is evident. The ventricular system is normal in size and morphology. Marrow signal is unremarkable. Minimal ethmoid air cell mucosal thickening is seen.

Output: 1.No evidence of acute ischemia or any other acute intracranial abnormality.2.No findings are seen to account for the patient's altered mental status.


Instruction: Generate impression based on findings.

Input: 41-year-old male with known amyloidosis and bilateral labral tears, presenting with sudden onset left shoulder pain for one week and mild chronic right shoulder pain. Left shoulder:There is a small sclerotic focus in the humeral head, suggestive of a bone island. The shoulder otherwise appears normal without findings to account for patient's sudden onset pain.Right shoulder:There is a small sclerotic focus in the humeral head, suggestive of a bone island. The shoulder otherwise appears normal without findings to account for patient's pain.

Output: No specific radiographic findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: MRI brain: A right frontal approach ventricular catheter again terminates in the inferior aspect of the right lateral ventricle, near the foramen of Monro.The prior leptomeningeal enhancement involving the sulci of the left occipital and temporal lobes has improved with only trace residual enhancement seen at these locations and elsewhere. There is also interval improvement of dural thickening and enhancement along the left temporal and occipital convexities. A thin line of apparent enhancement is seen running along the posterior upper spinal cord precisely at midline. This finding was not present on prior examinations, and it is unclear if it represents a pathologic process or simply a vascular phenomenon.There has been significant interval increase in the periventricular and subcortical white matter T2 FLAIR hyperintensity, likely related to treatment effects. There is no intracranial mass effect, midline shift, or herniation. Ventricles are not significantly changed in size since prior. There is again heterogeneity of the bone marrow which is nonspecific.MRI orbits: There is increased T2/FLAIR signal and enhancement along the optic nerve sheaths, right more so than left. No abnormal enhancement is evident in the right optic nerve. The left optic nerve is normal in size and signal intensity. No discrete retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Improved leptomeningeal enhancement with mild residual abnormal enhancement in the brain.2. A thin line of apparent enhancement is evident running along the dorsal aspect of the visualized spinal cord at midline. The significance of this finding is unclear as it may reflect true pathology or simply a vascular phenomenon. Attention on subsequent exams is suggested, and dedicated spine imaging can be considered if clinically warranted.3. Progressive white matter signal abnormality, probably related to treatment changes.4. Prior enhancement of the right optic nerve has resolved. Abnormally increased T2 signal and enhancement around the optic nerve sheaths, right more so than left, has developed and could be related to disease involvement of the nerve sheaths.


Instruction: Generate impression based on findings.

Input: Right sciatica Examination is limited by motion artifact. Numbering is performed as per recent radiograph with the last rib- bearing vertebra labeled T12. L5 demonstrates a transitional morphology with advanced hypertrophic degenerative changes at the right L5 transverse process-sacral articulation.Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of of L4 on L5 and mild dextrocurvature of the lumbar spine as seen on recent radiograph. Alignment is otherwise maintained. There is T1 hypointense and T2 hyperintense lesion involving the T11 vertebral body which may represent an atypical hemangioma but is indeterminate. Bone marrow signal is otherwise benign. There is advanced facet arthropathy at the bilateral L4-5 level and right L5-S1 articulation.The conus medullaris is within normal limits terminating at the mid L2 level. There is a filum lipoma measuring up to 8 x 7 mm in the axial dimension and extends from the upper L3 to the sacrum. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is disk desiccation, disk uncovering, and mild bulge. There is moderate right neural foramina stenosis which may be impinging on the exiting right L4 nerve root. There is minimal left neural foramina narrowing. Advanced bilateral facet arthropathy and grade 1 retrolisthesis. No spinal canal stenosis.L5-S1: Transitional anatomy as above. No spinal canal stenosis or neural foramina stenosis. There is contact of the right L5 nerve root with osteophyte at the right L5-sacral articulation. Paraspinous soft tissues are within normal limits.

Output: 1. Transitional anatomy at the lumbosacral junction as detailed above. Advanced hypertrophic degenerative changes are seen at the right L5 transverse process-sacral articulation.2. Conus is at the mid L2 level which is within normal limits with this numbering scheme. There is a lipoma involving the filum terminale. Correlate with clinical findings for possibility of tethered cord. 3. Grade 1 L4-5 anterolisthesis with advanced bilateral facet arthropathy at this level. There is moderate right L4-5 neural foraminal stenosis which maybe impinging on the exiting right L4 nerve root. There is also contact of the right L5 nerve root with osteophyte at the right L5-sacral articulation. 4. Nonspecific vertebral body lesion at T11, possibly an atypical hemangioma. CT might be helpful to identify striations which can be seen with a hemangioma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Abdominal pain, right lower quadrantClinical question: r/p cauda equina/stenosisSigns and Symptoms: unable to hold urine Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy of a moderate degree at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is no compromise to lumbar spinal canal or exiting nerve roots. No abnormal mass lesions are appreciated in the lumbar spine.2.There are some degenerative changes present in the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (8/31/15), digital mammographic images (9/10/15), ultrasound images of both breasts (9/10/2015), images from ultrasound guided biopsy of right breast and right axilla with post procedural right mammographic images (9/10/2015) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images (10/1/14, 10/1/13) are available. As per outside report, the patient is BRCA2 mutation carrier, and there is a strong family history of breast cancer. BREAST MRI (8/31/15):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a slowly enhancing, oval shaped mass at the central aspect of right breast, measuring 8 x 5 x 5 mm (AP x LR x CC). An enlarged lymph node is present at low right axilla.In the left breast, there is an intramammary lymph node at posterior lower outer quadrant. No abnormal enhancement is seen in left breast.DIGITAL MAMMOGRAPHIC IMAGES (9/10/15):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Mildly enlarged lymph node is seen in the right low axilla.ULTRASOUND IMAGES OF BOTH BREASTS (9/10/2015):An oval hypoechoic mass with partially indistinct margins is detected at 10:00 position, 5 cm from nipple, in the right breast, likely corresponding to the mass seen on MRI.In the right lower axilla, there is a circumscribed oval mass with marked vascularity, likely an enlarged lymph node with effaced hilum.There is a possible normal intramammary lymph node at 3:00 position, 7 cm from nipple in the left breast.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND RIGHT AXILLA WITH POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (9/10/2015):Ultrasound guided biopsy of the mass in the right breast at 10:00 position, and the mass in the right axilla was performed with appropriate needle placement.Postprocedural mammograms demonstrates a coil clip at upper outer quadrant, and a wing clip in the left axillary mass.The pathology results are not available.

Output: 1. Status post ultrasound guided biopsy of the right breast mass and right axillary mass, both of which are initially detected on MRI. Pathology results are not available. Management should be determined based on the pathology results.2. No MRI or mammographic evidence for malignancy in left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male 62 years old with right-sided weakness and dysarthria, evaluate for acute stroke. There is a focus of of diffusion restriction within the periventricular white matter involving the corona radiata and posterior aspect of the caudate nucleus. No other foci of restricted diffusion. There are multiple foci of susceptibility within the pons and additional ones in the cerebellum and left temporal lobe. There is no evidence of intracranial mass. There is moderate subcortical and periventricular T2/FLAIR hyperintensity suggestive of chronic small vessel ischemic disease. There are chronic lacunar infarcts in the left thalmus and right dorsal pons. There is parenchymal volume loss which is slightly prominent for patient's age. There is no midline shift or herniation. No hydrocephalus. The major cerebral flow voids are intact aside from diminutive flow-related signal involving the right vertebral artery.Minimal paranasal sinus mucosal thickening and bilateral mastoid air cell opacification is noted. Left lens implant is in place.

Output: 1. Acute infarct involving the right corona radiata and posterior aspect of the caudate nucleus.2. Moderate chronic small vessel ischemic disease. Chronic left thalamic and right dorsal pontine lacunar infarcts.3. Multiple chronic microhemorrhages with a distribution predominantly suggesting a chronic hypertensive etiology.


Instruction: Generate impression based on findings.

Input: NF type 1, failed vision testing, headaches. Orbits: The optic nerve are not enlarged and display normal signal characteristics. The bilateral optic nerve discs appear to be slightly prominent and there may be mild staphylomatous deformity of the globes. The extraocular muscles, lacrimal glands, and orbital fat otherwise appear to be intact bilaterally. There is no evidence of abnormal intraorbital enhancement or tumors. Brain: There appears to be a punctate focus of high T2 signal in the left posterior thalamus. The brain parenchyma otherwise appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The lateral ventricles are asymmetric, in which the right is slightly smaller than the left. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The bilateral optic nerve discs appear to be slightly prominent, but there is no evidence of optic nerve gliomas otherwise.2. An apparent punctate focus of high T2 signal in the left posterior thalamus may represent a stigmata of neurofibromatosis type 1.


Instruction: Generate impression based on findings.

Input: Male 76 years old Reason: eval thyroid nodules seen on CT History: above RIGHT LOBE MEASUREMENTS: 4.8 x 2.2 x 2.5 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.5 x 2.4 cmISTHMUS MEASUREMENTS: 3-mmRIGHT LOBE: Multiple nodules in the right lobe of the thyroid. Largest nodule is predominately complex and cystic measuring 2.1 x 1.3 cm. the smaller nodule is solid and measures 1.6 x 0.4 cm adjacent to this complex cystic nodule.LEFT LOBE: A small solid appearing nodule in the inferior aspect of the left lobe of the thyroid measuring 1.1-cm in diameter.ISTHMUS: There is a 1.6 by 1.6-cm solid appearing nodule with cystic components on the right side of the isthmusPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiterMultiple bilateral solid and cystic nodules in the thyroid.


Instruction: Generate impression based on findings.

Input: As suspected on recent prior CT, there are at least 15 parenchymal enhancing lesions ranging from punctate to 10-mm in size seen in both cerebral hemispheres. There is mild edema associate with larger lesions, but no gross mass effect. One or two of the larger lesions are associated with punctate susceptibility artifact, which may be microhemorrhage, but there is no significant intracranial hemorrhage. The ventricles and sulci are normal in size without evidence of hydrocephalus. There is no evidence diffusion-weighted abnormality. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. The orbits, paranasal sinuses, and mastoid air cells are unremarkable. No osseous lesion is identified.

Output: At least 15 intraparenchymal enhancing lesions compatible with metastases ranging from punctate to 10-mm in size seen in both cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: Evaluate for demyelinating lesions: paresthesias. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: No evidence of acute intracranial or cervical spine demyelinating lesions.


Instruction: Generate impression based on findings.

Input: History of neurofibromatosis type I with plexiform neurofibromas at L2-L3, evaluate thoracic spine. There is a small (approximately 1 cm) T2 hyperintense enhancing nodule between the anterior and middle scalene muscles at C7-T1 likely arising from a component of the brachial plexus and compatible with a neurofibroma. There is questionable thickening of the bilateral foraminal nerve roots at C7-T1 and T1-T2 which could represent additional neurofibromas or simply prominent vascularity. Additional small scattered nodules in the lower neck could represent lymph nodes or small neurofibromas.The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: 1.Findings compatible with a small neurofibroma in the right cervical paraspinal musculature. 2.Additional possible small neurofibromas versus lymph nodes in the low neck.3.Questionable neurofibromas arising from the foraminal nerve roots at C7-T1 and T1-T2.4.No other obvious abnormalities.


Instruction: Generate impression based on findings.

Input: Pain after injury MENISCI: There is vertically oriented tearing through the posterior horn of the lateral meniscus near its interface with the ligament of Wrisberg. The popliteomeniscal fascicles are indistinct and likely torn. The body and anterior horn of the lateral meniscus are intact.There is complex, predominantly longitudinal tearing involving the peripheral third of the posterior horn and body of the medial meniscus which is seen on multiple sequential images. The anterior horn is intact.ARTICULAR CARTILAGE AND BONE: There is slight depression of the articular surface of the lateral femoral condyle just above the anterior horn of the lateral meniscus indicating an impaction fracture with associated marrow edema. Marrow edema is also evident in the lateral tibial plateau posteriorly indicating a bone contusion with small contrecoup contusions present in the medial femoral condyle and medial tibial plateau. There is a small partial-thickness articular cartilage defect of the medial femoral condyle just above the head of the posterior horn of the medial meniscus.LIGAMENTS: There is full-thickness rupture of the ACL. The PCL is intact. There is mild edema along the superior band of the MCL which may represent a sprain, but the ligament itself otherwise appears normal. The distal fibers of the anterolateral ligament are intact although more proximally they are indistinct which may represent tearing. The lateral collateral ligament complex otherwise appears intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. ACL rupture with associated bone contusions.2. Medial and lateral meniscal tears as detailed above.3. Additional findings described above.


Instruction: Generate impression based on findings.

Input: Known brain lesion and history of neurofibromatosis type 1. There is an infiltrative T2 hyperintense, non-enhancing, mildly expansile lesion centered within the pons with extension into the medial left cerebellum and medulla. There is diffuse leptomeningeal enhancement within the posterior fossa, particularly within along the brainstem. There is also a non-enhancing, rounded, subcentimeter, T2 hyperintense, subcortical lesion in the lateral left occipital lobe. There are also punctate non-enhancing T2 hyperintense foci in the white matter of the bilateral parietal lobes. There is coaptation of the right lateral ventricle frontal horn. Otherwise, the lateral and third ventricles are borderline prominent. There is no evidence of acute infarction or hemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are several punctate enhancing nodules in the scalp.

Output: 1. An infiltrative lesion within the pons with extension into the medial left cerebellum and medulla and regional leptomeningeal enhancement may represent a neoplasm, such as a low-grade glioma in the setting of neurofibromatosis versus less likely an infectious or inflammatory process. 2. A subcentimeter subcortical lesion in the lateral left occipital lobe and small white matter lesions in the bilateral parietal lobes may also represent manifestations of neurofibromatosis.3. Several punctate enhancing nodules in the scalp may represent neurofibromas. Discussed with Dr. Awad at 9:30 AM on 1/20/16.


Instruction: Generate impression based on findings.

Input: Reason: eval for spondylolysis History: lbp with hockey for months with significant LLD--left sided pain; right leg long Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. The conus medullaris is normal in position. Bone marrow signal is benign. There appear to be bilateral L5 pars defects with mild fluid along the defect and mild adjacent edema. There is also mild fluid in the L4-L5 and L5-S1 facet joints, left relatively greater than right. Paraspinous soft tissues are otherwise unremarkable.There are minimal disc bulges in the lumbar spine at L4-L5 and L5-S1 with minimal narrowing of the neural foramina. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: Likely bilateral L5 spondylolysis without spondylolisthesis. CT can be considered for optimal visualization of the pars defects. There is small amount of fluid at the site of the pars defects with mild surrounding edema and mild fluid extending into the L4-L5 and L5-S1 facet joints, left relatively greater than right.


Instruction: Generate impression based on findings.

Input: Left visual loss related to a large pituitary adenoma status post debulking on 6/23/15: surveillance imaging. There are postoperative findings related to transsphenoidal surgery for debulking of a pituitary macroadenoma. There is a residual enhancing mass that measures up to approximately 25 mm centered in the left sella with extension into the left cavernous sinus with partial encasement of the left internal carotid artery, which is not significantly changed, accounting for differences in technique. There also appears to be invasion of the left clivus. There is high T2 signal and perhaps mild volume loss of the optic chiasm. However, there is no discernible mass effect upon the optic apparatus by the pituitary mass. There are persistent secretions and mucosal thickening within the sphenoid sinuses.

Output: Postoperative findings related to transsphenoidal surgery for debulking of a pituitary macroadenoma with residual tumor into the left cavernous sinus with partial encasement of the left internal carotid artery. While there is apparent encephalomalacia in the optic chiasm, there is no evidence of mass effect upon the optic apparatus.


Instruction: Generate impression based on findings.

Input: 69 year old female with a personal history of left breast lumpectomy in June 1999 for DCIS and right breast lumpectomy in January 2013 for triple negative IDC. She was treated with chemotherapy, radiation and tamoxifen therapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Expected post-operative changes in each breast are present. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. The vertebral body heights are preserved. There is normal T2 signal in the intravertebral disks with preserved disk heights. The osseous marrow signal is benign. The conus terminates at L1-2 and is normal in caliber and signal. There is no fatty filum or lipoma. There are scattered tiny facet joint dorsal synovial cysts, predominantly on the right side which are external to the spinal canal.T11-12: No disk herniation or spinal stenosis.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis.L3-4: Minimal disk bulge with no spinal stenosis.L4-5: Minimal disk bulge with no spinal stenosis.L5-S1: Mild disk bulge with no spinal stenosis.

Output: Essentially unremarkable exam.


Instruction: Generate impression based on findings.

Input: Altered mental status. Assess for acute stroke. The study is limited by patient motion, most pronounced for the susceptibility-weighted sequences which are nondiagnostic.There is no acute infarct. Nonspecific T2 FLAIR hyperintense signal in the frontoparietal periventricular white-matter likely reflects chronic microvascular ischemia. Focal T2 FLAIR hyperintensity with increased diffusion is present in the left hemipons, probably represents chronic sequela of prior ischemia. There is mild ex vacuo dilatation of the lateral ventricles and other CSF-containing spaces reflecting underlying parenchymal volume loss. There is no mass-effect, midline shift or brain herniation. Orbits are notable for findings of bilateral lens replacement.

Output: 1.Examination is significantly limited by motion especially for susceptibility-weighted imaging.2.No acute infarct. No mass-effect, midline shift or herniation.3.Moderate white-matter abnormality is nonspecific but likely reflect chronic microvascular ischemia. Similarly, focal pontine lesion with increased diffusion probably reflect chronic ischemia.


Instruction: Generate impression based on findings.

Input: Please evaluate for any signs of progressive disease since last MRI scan: Congenital microcephaly, severe intellectual disability, loss of some acquired language since about age 5, altered responsiveness after a fall 4 weeks ago. There is redemonstration microcephaly and marled bilateral colpocephaly with thinning of the brain parenchyma in the posterior cerebral hemispheres and a relatively simplified gyral pattern. The posterior portions of the corpus callosum appear to be deficient or markedly thinned as well. The brainstem and vermis of the cerebellum are mildly hypoplastic. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is diffuse paranasal sinus mucosal thickening and secretions. There is a right frontal scalp contusion.

Output: 1. Redemonstration microcephaly and marled bilateral colpocephaly with thinning of the brain parenchyma in the posterior cerebral hemispheres and a relatively simplified gyral pattern, as well as mild hypoplasia of the vermis and brainstem. 2. Right frontal scalp contusion, but no evidence of acute intracranial hemorrhage.3. Findings suggestive of pansinusitis.


Instruction: Generate impression based on findings.

Input: 57 year old female patient with left weakness and left temporoparietal lesion. Follow up examination status post craniotomy. Interval post-surgical changes of a temporoparietal craniotomy for resection of a mass in the right temporoparietal lobe with swelling and edema of the overlying scalp tissues. There is a small amount of fluid underlying the craniotomy flap measuring up to 4 mm in thickness. The resection cavity within the right temporoparietal region measures approximately 2.3 x 0.8 cm and contains fluid. There is a thin, discontinuous peripheral rim of intrinsic T1 hyperintensity compatible with blood products. There is perhaps a minimal amount of enhancement along the superior aspect of the resection cavity which could represent minimal residual tumor.There is marked surrounding vasogenic edema within the right cerebral hemisphere posteriorly with a similar degree of effacement of the right lateral and third ventricles with 8 mm of leftward midline shift, previously 9 mm. The temporal horn of the right lateral ventricle remains mildly dilated. There is fluid within the right mastoid air cells.

Output: 1. Expected post-surgical changes of craniotomy with near total resection of a previously seen temporoparietal mass with perhaps minimal residual enhancement along superior aspect of the resection cavity which could represent minimal residual tumor.2. Similar degree of extensive right cerebral vasogenic edema and leftward midline shift.


Instruction: Generate impression based on findings.

Input: 67 years Male (DOB:7/8/1949)Reason: evaluate for cause of movement disorders and dementia History: shuffling walk, slurred speech, limited EOMPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI There is a mild degree of generalized brain atrophy present with atrophy of the hippocampi. There are subdural effusions present in the posterior fossa. This is probably related to atrophy.There is a mild (5-10) degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Findings suggest cerebral atrophy.3.There is no evidence for intracranial mass lesion4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: s/p TACE/RFA, HCC surveillance History: HCV cirrhosis, HCC ABDOMEN:LIVER, BILIARY TRACT: Stable segment 5 ablation cavity without evidence of recurrence. There are scattered foci of arterial enhancement which do not persist or washout on delayed phases. No new suspicious hepatic lesions.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: Bilateral breast prostheses.OTHER: No significant abnormality noted.

Output: Status post ablation without evidence of recurrence or new disease.


Instruction: Generate impression based on findings.

Input: Female, 6 months old, with complex febrile seizure. Parenchymal morphology is within normal limits. The pattern of gyral development is normal. No migrational anomalies are suspected. No restricted diffusion or other areas of focal parenchymal signal abnormality are seen.The pattern of white matter myelination would suggest an age of more than 3 months but less than 6 months, based on standard references. The pituitary region is unremarkable. The corpus callosum is fully formed and normal. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable.Dedicated views of the mesial temporal structures show no discrete abnormalities. No pathologic parenchymal or extra-axial enhancement is detected.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is normal in size and morphology.

Output: 1. No specific findings are seen to account for the patient's seizures.2. Mild discrepancy between the degree of white matter myelination observed and that expected for the reported age of 6 months. This could reflect normal individual variation. Correlation with corrected gestational age, taking into account any prematurity, may also account for this observation.


Instruction: Generate impression based on findings.

Input: 55-year-old male with pain, evaluate for rotator cuff tear ROTATOR CUFF: Interval surgical repair of supraspinatus and subscapularis tear. Susceptibility artifact from fixation screws within the humeral head. Increased signal along the insertion of the supraspinatus tendon and thickening of the supraspinatous tendon extending posteriorly towards infraspinous tendon insertion with surrounding fluid signal compatible with partial-thickness tear without retraction. Some fibers can be seen inserting at the greater tuberosity. Small amount of reactive subchondral edema at the greater tuberosity.Mild fatty atrophy of the superior fibers of the infraspinatus and subscapularis. There are cysts in the underlying lesser tuberosity.SUPRASPINATUS OUTLET: Status post acromioclavicular resection.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild arthritis of the glenohumeral joint. Mild intermediate intrinsic signal and blunting of the superior labrum. Increased degenerative tearing of the anterior and inferior labrum.BICEPS TENDON: Status post biceps tenodesis. ADDITIONAL

Output: 1.Thickening of and increased signal within the supraspinatous tendon compatible with a partial thickness tear without evidence of retraction.2.Similar appearing fatty atrophy of the infraspinatus and subscapularis. 3.Progressive degenerative tearing of the labrum as described above.4.Post surgical changes as described above.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild scattered fluid opacification of left greater than right mastoid air cells. Focal plaque like probable dural mineralization is present along the posterior falx. There is a left-sided concha bullosa.CERVICAL SPINE

Output: 1.Unremarkable contrast enhanced MRI of the brain, without evidence of demyelinating disease or other acute intracranial process.2.No definite cord abnormality to suggest demyelinating disease.3.Developmental narrowing of the cervical spinal canal with superimposed lower moderate spondylotic changes, most conspicuous at C6-C7 where there are prominent bilateral paracentral disc protrusions resulting in moderate-severe central spinal canal stenosis and severe deformity of the cord. There is also moderate-severe left foraminal narrowing at this level.4.Incompletely visualized thyroid gland, although visualized portion appears enlarged without focal lesion identified. Please correlate with thyroid function tests and thyroid ultrasound may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: eval for nerve impingementSigns and Symptoms: pain in L groin radiates to back, positive contralateral leg raise test Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level as well as some mild disc desiccation. There is mild bilateral facet hypertrophy at this level. There is mild narrowing of the neural foramina present at this level however the exiting nerve roots within the neural foramina are surrounded by fatAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is fluid within the facet joints at this level and facet hypertrophy. There is a left-sided cyst present which is adjacent to the left ligamentum flavum and left facet joint which mildly distorts ligamentum flavum and abuts the nerve root at the left lateral recess. This cystic lesion measures approximately 5 mmAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a synovial cyst or ligamentum flavum cyst which projects towards the left lateral recess of L4-5 very minimally affecting the nerve root at the left lateral recess at this level. Please correlate with the patient's clinical symptoms.2.Degenerative changes of a mild degree are present in the lower lumbar spine


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of pain. There is moderate soft tissue swelling and ulceration particularly along the medial aspect of the great toe. There is mild irregularity along the medial aspect of the base of the distal phalanx which may represent acute osteomyelitis, but given the findings on the prior MRI from 3/2015, this may represent sequela of chronic osteomyelitis instead. We see no frank bone destruction to confirm acute osteomyelitis. Mild osteoarthritis affects the interphalangeal and first MTP joints.

Output: Mild irregularity along the medial aspect of the base of the distal phalanx may represent acute osteomyelitis, but given the findings from the MRI from 3/2015, this may represent sequela of chronic osteomyelitis. If there is strong clinical concern for acute osteomyelitis, MRI may be obtained.


Instruction: Generate impression based on findings.

Input: Gbm (glioblastoma multiforme62 years Female (DOB:10/30/1953)Reason: preop planning for crani History: none- preopPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI The patient status post left occipital craniotomy. There is redemonstration of a 23 by 35mm axial dimension irregularly-shaped ring-enhancing lesion associated with surrounding T2 signal hyperintensity within pattern of vasogenic edema. There is also subependymal enhancement in the adjacent occipital horn of the left lateral ventricle.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.Left occipital lobe mass associated with the vasogenic edema suspicious for an aggressive neoplasm versus radiation necrosis. This mass abuts the occipital horn of the left lateral ventricle and is associated with some subependymal involvement raising the question of possible CSF spread. This has not changed substantially since 9/28/2016. Please refer to the recent MRI exam for further comment.2.Please note that this examination performed for the purpose of stereotactic guidance during surgery. It is limited in its diagnostic ability.


Instruction: Generate impression based on findings.

Input: 55 year old with left breast pain and strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No new or suspicious enhancement is seen in either breast. A few scattered enhancing foci are stable, including a few foci at the level of the left nipple. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: pre-surgical planning. Assess extent of ischial osteomyelitis History: ischial osteomyelitis Again seen is a soft tissue defect extending from the perineal region/upper left thigh to the left ischium. As seen on the recent CT scan, there is destruction of the ischial tuberosity indicating osteomyelitis. There is abnormal signal intensity and enhancement which extends proximally throughout the ischium into the acetabular dome posteriorly. There are nonenhancing foci within the acetabulum which may reflect bone necrosis. Edema is also seen extending anteriorly from the ischium into the inferior pubic ramus on the fat-suppressed T2-weighted images which may reflect extension of osteomyelitis. There is a branching rim-enhancing collection of fluid noted within the obturator internus muscle on the left with a tract extending from this collection along the gluteal musculature posteriorly along the hip joint. There is inflammation of the adjacent soft tissues extending into the adductor musculature of the hip. There is a small left hip joint effusion with synovial enhancement indicating synovitis. We cannot exclude the possibility of a septic arthritis, but we see no edema within the femoral head at this time. There also appears to be a small sinus tract extending from the right ischial tuberosity through the posterior subcutaneous fat to the skin surface, but we see no abnormal signal intensity within the ischium to indicate osteomyelitis on the right. There is an additional sinus tract extending to the right greater trochanter without evidence of osteomyelitis. There is also edema-type signal without enhancement within the musculature of the right hip which may be due to generalized atrophy of the musculature.

Output: 1. Multiple decubitus ulcerations as described above with osteomyelitis of the left ischium extending into the acetabular dome posteriorly, and likely into the inferior pubic ramus as well.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 29 years old, with history of epilepsy status post laser ablation. Surveillance imaging of the ablation focus. Sequelae of left occipital approach laser fiber placement are seen. Mild tissue distortion and signal abnormal are seen within the mesial left temporal lobe compatible with ablation. Two foci of enhancement at this site are present and appear smaller than the enhancing regions noted on the intraprocedural examination.The remainder of the brain is free of pathologic signal alteration or enhancement. No abnormal extra-axial fluid collections are detected. No significant edema or mass effect is seen. The ventricles are normal in size and morphology. Left frontal and left temporal burr hole defects are seen.

Output: Expected findings status post left mesial temporal ablation.


Instruction: Generate impression based on findings.

Input: Pilar cyst near cranial suture just left of midline. Does cyst communicate through suture? Brain or eye involvement? Subjective complaints of "my eyes hurt". Brain: There is a well-defined, partially enhancing, low T1 and T2 signal mass in the left apical scalp that measures 20 mm. There are multiple other punctate low signal foci within the scalp diffusely. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. A left apical scalp mass, as well as multiple other punctate low signal foci within the scalp diffusely, may represent pilomatrixomas or related skin adnexal lesions, without evidence of skull erosion or intracranial extension.2. The orbits are unremarkable.


Instruction: Generate impression based on findings.

Input: 78 year old male with a history of coronary artery disease, pulmonary embolism, with recent ventricular fibrillation arrest (Torsades de Pointes). He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is moderately dilated with moderately reduced ejection fraction. The overall LV ejection fraction is 32%, the LV end diastolic volume index is 132 ml/m2 (normal range: 74+/-15), the LVEDV is 301 ml (normal range 142+/-34), the LV end systolic volume index is 90 ml/m2 (normal range 25+/-9), the LVESV is 205 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 105 g (normal range 164+/-36). There is hypokinesis of most of the inferior wall and the basal inferoseptum. There is late gadolinium enhancement of the basal inferoseptum and basal to mid inferior wall, consistent with prior myocardial infarction. This territory is not likely to be viable. The remainder of the myocardium is free of late gadolinium enhancement and is viable. The global pre-contrast myocardial T1 relaxation times is normal (1042 ms). Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 196 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 77 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral lower lung infiltrates vs atelectasis vs infarct. Small left pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with moderately reduced systolic function (LVEF 32%).2. The right ventricle is normal in size and systolic function (RVEF 61%).3. There is an old, transmural myocardial infarction involving the basal inferoseptum and the basal to mid inferior wall. This territory is not likely to be viable. 4. Main pulmonary artery is moderately dilated.5. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Epistaxis. MRI: There is evidence of blood products in the right nasal cavity and nasopharynx as well as right nasal packing material, but no discernible evidence of a tumor. There is mild diffuse mucosal thickening of the pneumatized paranasal sinuses. There is diffuse prominence of the adenoids, which is an expected findings in infants. The salivary glands are unremarkable. There is non-specific high T2 signal within the mastoid air cells bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is mild prominence of the anterior cerebral convexity extra-axial cerebrospinal fluid spaces, which can be encountered in infants. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions or anomalous arteries in the sinonasal region.

Output: Stigmata of right nasal cavity epistaxis with packing material and hemorrhage, but no discernible sinonasal tumor and no evidence of maxillofacial vascular malformations within the limits of detection made possible by the modality.


Instruction: Generate impression based on findings.

Input: Left arm weakness. Brain: There are punctate foci of restricted diffusion with corresponding high T2 signal at the grey-white matter interfaces of the right precentral and postcentral gyri, as well as the left inferior parietal lobule. There is a background of mild bilateral cerebral and pontine white matter T2 hyperintensity without corresponding restricted diffusion. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered mild paranasal sinus mucosal thickening.Cervical Spine: There is a diffusely congenitally narrow spinal canal. At C2-3, there is bilateral uncovertebral hypertrophy with mild bilateral neural foraminal narrowing, but no spinal cord compression. At C3-C4, the vertebral bodies are fused, but there is no spinal cord compression or significant neural foraminal stenosis. At C4-5, there is bilateral uncovertebral and facet joint hypertrophy with moderate bilateral neural foraminal narrowing, but no spinal cord compression. At C5-6, there is a posterior disc-osteophyte eccentric to the right, which indents the spinal cord and bilateral uncovertebral hypertrophy, which narrows the bilateral neural foramina. At C6-7, there is an eccentric left posterior disc-osteophyte complex that abuts the left aspect of the spinal cord and markedly narrows the left neural foramen, while uncovertebral hypertrophy mildly narrows the right neural foramen. At C7-T1, there is no significant spinal canal or neural foraminal stenosis. Aside from endplate degenerative signal alterations at multiple levels, the vertebral bone marrow signal is unremarkable. There is no spondylolisthesis. The vertebral body heights are preserved. There is no abnormal spinal cord signal. The paravertebral soft tissues are unremarkable.

Output: 1. A few punctate recent infarcts in the bilateral cerebral hemisphere are likely embolic in nature and superimposed a background of what likely represent mild chronic small vessel ischemic white matter disease. Head and neck vascular imaging may be useful for further evaluation.2. A congenitally narrow spinal canal with superimposed degenerative spondylosis results in multilevel spinal canal and neural foramina stenosis, particularly at C4 though C7.Discussed with Dr. Solivan at 3:15 PM on 4/11/16.


Instruction: Generate impression based on findings.

Input: Pancreatic tail mass ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver cysts. No suspicious hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: 1.1 x 1.1 cm round circumscribed T1 hypointense, T2 hyperintense, enhancing soft tissue mass in the distalmost tail of the pancreas. The signal characteristics and enhancement pattern follows that of the spleen on all sequences. Otherwise normal pancreatic parenchymal signal and enhancement. Normal pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.1 cm lesion in the pancreatic tail, compatible with an intrapancreatic splenule.


Instruction: Generate impression based on findings.

Input: 40 year-old male status post fall. Experiencing left-sided numbness/tingling. Evaluate for ICH/C-spine fracture There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Mucosal thickening in the ethmoid sinuses representing mild sinus disease. Mastoid air cells are normally pneumatized.Cervical spine demonstrates normal alignment and no fracture. Neuroforamina are patent. No prevertebral soft tissue swelling. Questionable disc protrusion at the C5/C6 level to the left of midline. An MRI would be warranted if clinically indicated.

Output: 1. No evidence of intracranial process or cervical spine fracture.2. Questionable protruding disc to the left of midline at the level of C5/C6. MRI would provide more detail if clinically warranted.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning Stealth MRI. Craniotomy for cavernous malformation resection. Signs and symptoms: Preoperative Stealth brain MRI. Pre and post stealth brain MRI:Examination is performed utilizing a Stealth protocol for surgical planning and is not a true diagnostic exam.Examination demonstrates a previously known cavernoma in the posterior left median midbrain. The lesion measures approximately 11.5 x 15 mm in transaxial dimensions. Finding is not associated with any detectable surrounding edema and supplies subtle mass effect on the quadrigeminal plate cistern and mildly bulges into the superior aspect of the fourth ventricle.Compared to prior exam there is no appreciable interval change.There is a tiny left frontal developmental venous anomaly present.There is no additional detectable foci of abnormal parenchymal or leptomeningeal enhancement. Ventricular system remains within normal size and without deviation of midline.

Output: Cavernoma measuring approximately at 11.5 x 15 mm in the left paramedian posterior midbrain without surrounding edema and with subtle mass effect as detailed.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with GBM, currently off all therapy, status post surgery, RT/TMZ. Findings are redemonstrated compatible with prior left frontal craniotomy and left frontal lobe tumor resection. The mildly hemosiderin stained resection bed has not significantly changed in size or morphology. On postcontrast images, no pathologic enhancement is seen within the operative region. In addition, a small focus of enhancement within the right superior frontal gyrus, seen on prior examinations, is no longer visualized.Ill-defined white matter T2 hyperintensity within the frontal lobes, left side more than right, has progressed from prior examinations. However, there are no areas of masslike signal abnormality, and no mass effect is detected.A few scattered foci of white matter T2 hyperintensity elsewhere in the cerebral hemispheres are nonspecific and unchanged. No pathologic intracranial enhancement is seen. No abnormal extra-axial fluid collections are detected. The ventricular system is stable in size and morphology. A left maxillary mucus retention cyst is unchanged.

Output: 1.Stable appearing left frontal lobe surgical bed with no evidence of suspicious enhancement or mass effect.2.Progressive ill-defined frontal lobe white matter signal abnormality which likely represents a treatment related effect.3.The previously noted focus of enhancement in the right superior frontal gyrus is no longer visualized.


Instruction: Generate impression based on findings.

Input: Myeloma and back pain. RIGHT HIP: Serpiginous low T1 and high T2/STIR signal in the subchondral femoral head is compatible with avascular necrosis. No femoral head contour irregularity or collapse is present. No fracture or malalignment is present. The labrum is unremarkable. No hip joint effusion is noted. LEFT HIP: Evaluation is limited by artifact from an intramedullary rod and screw device affixing the femur. Serpiginous low T1 and high T2/STIR signal in the subchondral femoral head is compatible with avascular necrosis. No femoral head contour irregularity or collapse is present. No fracture or malalignment is present. The labrum is unremarkable. No hip joint effusion is noted. OTHER: Low T1 signal throughout the visualized bones is compatible with reconverted red marrow. No enhancing osseous lesions are seen to suggest myeloma. The soft tissues and intra-abdominal contents are otherwise unremarkable. Please see the separate complete spine MRI report for evaluation of the spine.

Output: 1. Bilateral early avascular necrosis of the femoral heads. 2. No enhancing osseous lesions to suggest myelomatous deposits.