Instruction: Generate impression based on findings.

Input: 49-year-old female with spontaneous hemorrhage of the thenar muscles. Evaluate for intramuscular hemangioma. Best seen on the T2-weighted images, is mild increased signal intensity, suggesting mild edema within the thenar musculature, suggesting a strain injury. There is also minimal enhancement along the deep fibers of the thenar musculature, but we see no hematoma or mass to suggest an underlying vascular malformation. There is also enhancement along the volar aspect of the first metacarpal phalangeal joint, which may reflect a capsular sprain, but we see no discrete ligamentous tear or fracture. There is also a small amount of fluid and enhancement within the first metacarpophalangeal joint which may reflect a mild synovitis. The flexor pollicis longus tendon appears intact. The remaining of the visualized bones and soft tissues are normal.

Output: Mild edema and enhancement along the thenar musculature and volar aspect of the first metacarpal phalangeal joint may reflect a mild muscle strain and capsular sprain, respectively. We see no hematoma or underlying mass, such as a vascular malformation.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: There is horizontal linear signal across the lateral meniscus involving the posterior horn and body (sagittal series 7 image 23/28) which extends to the superior articular surface. There is globular signal within the posterior horn of the medial meniscus without extension to the articular surface however there is truncation of the body and anterior horn of the medial meniscus suspicious for tearing.ARTICULAR CARTILAGE AND BONE: There is heterogeneous signal intensity of the articular cartilage of the lateral compartment of both the tibial plateau and femoral condyle. There is no full-thickness cartilage defect however. Similar moderate articular cartilage thinning is noted in the medial compartment particularly of the femoral condyle with near full-thickness loss anteriorly. There is marked articular cartilage loss of the patellar facet, lateral greater than medial. Heterogeneous signal of the femoral trochlea is also noted. Degenerative cystic changes noted in the lateral tibial plateau.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Horizontal tearing of the lateral meniscus with findings suspicious for radial tear of the body and anterior horn of the medial meniscus.2. Severe patellofemoral articular cartilage loss with more moderate changes noted in the medial and lateral compartments.3. Moderate suprapatellar effusion.


Instruction: Generate impression based on findings.

Input: Dizziness, tinnitus, and left hearing loss. Audiogram revealed moderate rising to mild sensorineural hearing loss at 250-1500Hz, rising to normal limits 2-8kHz. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. However, there is apparent paucity of bone overlying the left superior semicircular canal. The right-sided inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells also appear unremarkable. 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 normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Possible left superior semicircular canal dehiscence. Further evaluation via a temporal bone CT may be useful.


Instruction: Generate impression based on findings.

Input: 66-year-old male with very painful medial sided knee pain with any range of motion or provocative testing. Evaluate for medial meniscus bucket-handle tear. MENISCI: Best seen on sagittal image 7 of series 401 and coronal image 23 of series 801 is a defect within the peripheral undersurface fibers of the medial meniscus at the junction of the body and the posterior horn that measures approximately 6 mm in AP dimension. Despite the presence of this defect, we do not see a displaced flap fragment on this study. There is, however, additional obliquely-oriented vertical signal abnormality more centrally within the posterior horn of the medial meniscus, best seen on sagittal image 10 of series 401 and coronal image 22 of series 801, that appears to extend to both the femoral and tibial articular surfaces and is associated with a slight step-off of the meniscal contour. We suspect that this constellation of findings represents 2 separate tears of the medial meniscus, although it is conceivable that this could represent a single complex tear with meniscal fragments currently situated in a relatively normal position. There is perhaps minimal medial extrusion of the body of the medial meniscus, but the root of the medial meniscus appears intact. The anterior horn of the medial meniscus appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is perhaps minimal superficial degeneration of the articular cartilage of the medial femoral condyle just above the aforementioned suspected meniscal tear, but we see no discrete fluid-filled defect. The articular cartilage of the lateral compartment appears normal. There is focal blistering of the articular cartilage of the medial facet of the patella indicating degeneration. There is also a near-full-thickness cleft of the articular cartilage of the medial facet of the femoral trochlea with adjacent articular cartilage degeneration. The bone marrow signal intensity is within normal limits.LIGAMENTS: The ACL and PCL are within normal limits. There is mild inflammation along the superficial fibers of the medial collateral ligament, which is nonspecific, but the ligament itself appears intact. The lateral collateral ligament structures are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Medial meniscus tear(s) as described above, likely with a displaced/displaceable flap, although the flap itself is not visualized on this study.2. Focal articular cartilage abnormalities and other findings as described above.


Instruction: Generate impression based on findings.

Input: 73 year old female. Left shoulder pain/weakness. Evaluate for rotator cuff pathology. Evaluation of multiple sequences is limited by patient motion artifact.ROTATOR CUFF: Supraspinatus: Complete tear of the supraspinatus tendon from its insertion on the greater tuberosity with retraction of the tendon to the top of the humeral head. There is thickening of the retracted tendon, likely representing tendinosis. Moderate fatty atrophy of supraspinatus muscle is noted. Infraspinatus: Near complete tear to complete tear of the infraspinatus muscle with similar retraction and mild to moderate atrophy of the muscle.Teres minor: The tendon and muscle are intact.Subscapularis: Thickening of the subscapularis tendon likely represents tendinosis but we see no fluid-filled tear. The subscapularis muscle is intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. A small amount of fluid is seen in the subacromial/subdeltoid bursa. The humeral head is high riding with narrowing of the acromiohumeral interval to 3 mm.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild-moderate osteoarthritis of the glenohumeral joint with areas of near full-thickness cartilage degeneration. Portions of the labrum are attenuated likely reflecting degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps is not distinctly visualized in the rotator interval, and a tear cannot be excluded.ADDITIONAL

Output: Massive rotator cuff tear and other findings, as described above.


Instruction: Generate impression based on findings.

Input: Left calf pain Note that the examination is limited by susceptibility artifact from the patient's knee arthroplasty. The examination is also markedly limited by motion artifact.There is diffuse subcutaneous edema of the lower extremity which is most prominent along the medial aspect inferiorly. There is also diffuse T2 signal hyperintensity of the calf musculature particularly of the medial head of the gastrocnemius reflecting nonspecific edema. There is mild fatty atrophy of the lower extremity musculature as well. A focus of scarring is identified medially just below the level of the tibial plateau. There is no evidence of a focal fluid collection.The marrow signal of the proximal tibia and fibula is normal aside from areas of poor fat saturation. There is an irregular focus of low T1/high T2 signal intensity within the distal tibia which appears to enhance. This was not evident on a radiograph dated 1/18/2016. There is no evidence of osteomyelitis.

Output: 1. Limited exam secondary to motion artifact and the patient's knee arthroplasty.2. Diffuse subcutaneous and muscular edema of the lower extremity predominantly involving the medial soft tissues and head of the gastrocnemius.3. Focus of signal abnormality in the distal tibia may reflect a small bone infarction.


Instruction: Generate impression based on findings.

Input: Female 62 years old Reason: Knee pain evaluate for meniscal tear History: same MENISCI: There is degenerative tearing of the lateral meniscus near its posterior horn root junction. There is mild meniscal extrusion.Some intrasubstance changes in the posterior horn of medial meniscus without a discrete tear.ARTICULAR CARTILAGE AND BONE: There is diffuse cartilage thinning involving the medial and lateral compartments with foci of cartilage fissuring involving the lateral tibial plateau.In the extensor compartment, there is full-thickness cartilage loss involving the median ridge the patella extending into the medial facet. There are subchondral cystic changes.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Findings suspicious for a tear at the posterior horn root junction and of lateral meniscus with mild meniscal extrusion.2.Chondromalacia patella.


Instruction: Generate impression based on findings.

Input: There has been slight interval decrease in the size of the enhancing pineal mass, currently measuring 12 x 12 x 10 mm in the AP, transverse, and craniocaudal dimensions, previously 13 x 14 x 12 mm. The nonenhancing, cystic thalamic components are minimally smaller when compared to the prior study, especially on the right. The endoscopic third ventriculostomy catheter appears patent. The right transverse frontal Ommaya catheter terminates in the region of the right foramen of Monro. The ventricles and sulci are within unchanged in size. There is no midline shift or mass effect. There is no evidence of acute infarction. The skull and extracranial structures are unchanged.

Output: Minimal interval decrease in size of the enhancing pineal mass, with persistent associated peritumoral cystic components within the bilateral thalami.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with history of pancreatic cancer and back pain. Thoracic:Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No pathologic marrow enhancement is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic parenchymal or leptomeningeal enhancement is seen. No epidural abnormalities are present.The intervertebral disc spaces are preserved with no significant disc bulging or disc herniations. No significant narrowing of the spinal canal or neural foramina is seen.Incidental note is made of a right thyroid nodule measuring up to 29 mm in size.Lumbar:A 16 x 12 mm area of marrow replacement within the sacrum, spanning S2 and S3, and a 27 x 23 mm area of marrow replacement in the left posterior iliac bone are new from the prior examination. Both of these lesions enhance avidly.Elsewhere, no pathologic marrow replacement or enhancement is seen. Vertebral body morphology is otherwise unremarkable. Spinal alignment is anatomic.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic parenchymal or leptomeningeal enhancement is seen. No epidural abnormalities are evident.Axial images are degraded by motion artifact, but within this limitation, very mild disc bulging is seen at most lumbar levels with progressive facet arthropathy at lower lumbar levels. At no point is there any large disc bulge or disc herniation. The spinal canal and neural foramina are not significantly compromised.A lobular T2 hyperintense lesion is evident within the posterior liver.

Output: 1.New metastatic lesions are evident within the sacrum and left iliac bone.2.No additional concerning lesions are seen in the lumbar or thoracic spine.3.No significant spinal canal or neuroforaminal stenosis is noted.


Instruction: Generate impression based on findings.

Input: 44-year-old male presents with headaches for approximately 2 weeks. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical white matter, which are nonspecific. Chronic lacunar infarct in the left anterior basal ganglia and corona radiata with associated susceptibility suggestive of prior hemorrhage. There is a partially empty sella.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Incidental note is made of a right parietal developmental venous anomaly.The orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. No pathologic intracranial enhancement. 2. Chronic lacunar infarct in the left anterior basal ganglia and corona radiata with associated susceptibility suggestive of prior hemorrhage. 3. Partially empty sella which may be a normal variant, however, may reflect idiopathic intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is focus of encephalomalacia and volume loss within the medial left occipital lobe. There are scattered punctate foci of T2 hyperintensity throughout the supratentorial white matter most compatible with chronic small vessel ischemic disease. There is a punctate focus of susceptibility effect within the deep right parietal white matter compatible with chronic micro hemorrhage. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.Interval development of a PCA distribution chronic-appearing infarct within the left occipital lobe.2.Mild chronic small vessel ischemic disease and a single punctate chronic micro hemorrhage.


Instruction: Generate impression based on findings.

Input: History of brain metastasis. Status post craniotomy. Examination demonstrates postoperative change of the left parietal craniotomy, including blood products at the surgical site of the left posterior parietal lobe and left frontal pneumocephalus. Surrounding the surgical site, there is diffuse edema. There is a redemonstration periventricular small vessel ischemic disease. No other hemorrhage, midline shift or abnormal extra-axial fluid collection is identified. The ventricles and sulci appear prominent but symmetric. There is effacement of the left occipital horn.The previously MRI identified masses are not visualized on the present non-infused exam.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Expected postoperative changes of the left parietal craniotomy including blood products at the surgical site and pneumocephalus. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 28 year-old female with headache and syncope. Please evaluate for bleed/mass. Family history of aneurysms. There is no evidence of intracranial hemorrhage, parenchymal, intra-axial mass or edema. Adjacent to the left parietal lobe, there is a small extra axial broad based soft tissue density mass with punctate areas of calcification which has associated hyperostosis of the adjacent skull and measures 8 x 15 mm, (coronal series 80232, image 40). This most likely represents a meningioma. Further evaluation with MRI is recommended as clinically indicated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormalities, specifically no bleed.2. Small left parietal region extra-axial mass with adjacent associated hyperostosis most likely representing a meningioma. Further evaluation with MRI is recommended as clinically indicated.


Instruction: Generate impression based on findings.

Input: 41 year old with no past medical history presenting after witnessed cardiac arrest during running event. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 160 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 116 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a small epicardial region of late gadolinium enhancement involving the basal inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. This pattern of LGE/ fibrosis is non-specific and has even been described in frequent marathon runners.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 51 ml (normal range 54+/-17). There is no focal RV wall motion abnormality or aneurysm. No evidence of RV fat infiltration or late gadolinium enhancement.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.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.Coronary Arteries. Normal origin of the coronary arteries.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 64%) with evidence of mild atypical late gadolinium enhancement of the basal inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. This pattern of LGE/ fibrosis is non-specific and has even been described in frequent marathon runners.2. Normal RV size and systolic function (RVEF 66%). No cardiac MRI of arrhythmogenic right ventricular dysplasia.3. Normal coronary artery origins. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: eval for upper extremity injury; midhumerus stress fracture History: mid humerus pain with throwing LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is cortical thickening at the mid humerus with no evidence of periosteal reaction. Minimal marrow edema noted at the greater tuberosity of the humerus.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Nonspecific cortical thickening of the humerus without periosteal reaction may represent a stress reaction.


Instruction: Generate impression based on findings.

Input: Leg pain and numbness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: There is disc desiccation with a disc bulge which is slightly eccentric to the right. There is also a small central disc protrusion. There is mild narrowing of the right neural foramen and minimal contact of the left S1 nerve root in the lateral recess. There is otherwise no significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Minimal degenerative changes in the lumbar spine without high-grade spinal canal or high-grade neural foraminal stenosis at any level. 2. At the L5-S1 level is a mild disc bulge with a small central protrusion which is associated with very mild contact of the right L5 nerve root in the right neural foramen as well as the left S1 nerve root in the left lateral recess, but without clear evidence of impingement.


Instruction: Generate impression based on findings.

Input: Reason: medial knee pain History: pain MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: The medial and lateral tibiofemoral articular cartilage appears intact. The patellofemoral articular cartilage appears intact. No full-thickness or near full-thickness articular cartilage defects are seen. Mild heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Normal-appearing right knee without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for CVA. Signs and symptoms: Left-sided weakness, slurred speech. Non-infused head CT: Examination demonstrate multiple foci of low-attenuation in the periventricular white matter of bilateral cerebral hemispheres. These are highly suspected for areas of encephalomalacia and likely result of small vessel ischemic stroke of indeterminate age. They produce no mass effect and they are not associated with any hemorrhage. There is no detectable acute cortical stroke on this exam. There is no evidence of hemorrhage, midline shift or hydrocephalus. Please correlate with history and if clinically desired an MRI examination is recommended.

Output: Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Hepatic mass and history of lung cancer. LUNG BASES: Small left pleural effusion with left lower lobe consolidation/atelectasis.ABDOMEN:LIVER, BILIARY TRACT: Segment 5/8 4.2 x 3.5 cm mildly T2 weighted hyperintense mass abutting the right portal vein. The lesion is hypointense relative to the liver parenchyma on T1-weighted imaging. It demonstrates peripheral thick rim of enhancement. There is distal perfusion anomaly in the liver. There is associated right greater than left biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.4.2 cm segment 5/8 mass suspicious for metastatic disease resulting in downstream right greater than left biliary ductal dilatation.2.No additional suspected sites of disease.


Instruction: Generate impression based on findings.

Input: Reason: eval for stenosis History: leg pain Minimal retrolisthesis of L2 on L3, L4 on L5 and L5 and S1. Mild superior endplate depressions at T12 and L1. Severe multilevel disc desiccation and disc space loss with near-complete loss of disc height at L2-L3 and moderate disc space loss at L4-L5 and L5-S1. No abnormal signal within the distal cord or conus which ends L3. Benign marrow signal. Schmorl's nodes along the superior aspect of T12, L1 and L2 and inferior aspect of L1. Postsurgical changes with removal of the L2 and L3 spinous processes.Left diffuse disc bulge at T10-T11 seen only on the lateral view with mild effacement of the ventral thecal sac.T12-L2: Diffuse disc bulge. No spinal canal or neural foraminal stenosis.L1-L2: Diffuse disc bulge. Mild facet arthropathy and ligamentum flavum thickening No spinal canal or neural foraminal stenosis.L2-L3: Mild posterior disc osteophyte complex. Moderate facet arthropathy. Minimal spinal canal narrowing. Mild bilateral neural foraminal stenosis.L3-L4: Diffuse disc bulge. Mild facet arthropathy and ligamentum flavum thickening. Mild spinal canal stenosis. Mild left neural foraminal stenosis. No right neural foraminal stenosisL4-L5: Severe disc space loss and diffuse disc bulge. Moderate facet arthropathy and ligamentum flavum thickening. Moderate spinal canal stenosis. Moderate left and severe right neuroforaminal stenosis.L5-S1: Moderate disc space loss. Mild facet arthropathy. Mild central canal stenosis, right greater than left. Moderate to severe bilateral neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: Multilevel spondylosis, most severe at L4-L5 where there is moderate central canal stenosis, moderate left and severe right neural foraminal stenosis. Additional areas of spinal canal and neural foraminal stenosis as above.


Instruction: Generate impression based on findings.

Input: A 54 year old female with recently diagnosed non-ischemic cardiomyopathy, severe left ventricular dysfunction and significant mitral regurgitation. Now the patient is hospitalized because of acute decompensated heart failure and referred to cardiac MRI to further evaluate the etiology and severity of the cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 129 ml/m2 (normal range: 65+/-11), the LVEDV is 261 ml (normal range 109+/-23), the LV end systolic volume index is 104 ml/m2 (normal range 18+/-5), the LVESV is 210 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 130 g (normal range 114+/-24). There is global hypokinesis with regional dyskinesis. No iron overload was noted. Native myocardial T1 is mildly increased, most pronounced in the interventricular septum, which suggests that there might be underlying midwall myocardial fibrosis present.Left AtriumThe left atrium is mildly dilated dilated. The LA volume is 102 ml.Right VentricleThe right ventricle is normal in size with moderate systolic function. The overall RV ejection fraction is 35%, the RV end diastolic volume index is 52 ml/m2 (normal range 69+/-14), the RVEDV is 105 ml (normal range 110+/-24), the RV end systolic volume index is 80 ml/m2 (normal range 22+/-8), and the RVESV is 162 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 with limited images.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation with limited images.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary 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 FindingsMild left pleural effusion was noted. Small mediastinal lymph nodes are noted.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 dilated with severe systolic dysfunction, LVEF is 20%. There is global hypokinesis with regional dyskinesis. No evidence of myocardial iron overload. Native myocardial T1 is mildly increased, most pronounced in the interventricular septum, which suggests that there might be underlying midwall myocardial fibrosis present. No late gadolinium enhancement imaging was performed due to patient inability to complete exam. As a consequence, the presence of other infiltrative cardiomyopathies or other specific etiologies can not be determined.2. The right ventricle is normal in size with moderate systolic function, RVEF is 35%. 3. The left atrium is mildly dilated dilated. 4. The mitral valve opens widely and there is at least moderate mitral regurgitation.5. Small pericardial effusion is noted.6. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: The craniocervical junction is within normal limits and there is no evidence of cerebellar ectopia. There is biphasic CSF flow through the foramen magnum both anterior and posterior to the cervical cord. Additionally, there is biphasic flow through the fourth ventricle and aqueduct of Sylvius. The ventricles and sulci are within normal limits. There is no diffusion abnormality to suspect acute stroke. No extra-axial fluid collection is identified.A small focus of susceptibility weighted artifact in the falx is noted and likely represents dural mineralization. Normal flow-voids are demonstrated in the major intracranial vascular structures. Scattered mucosal retention cysts and mild thickening are noted in the paranasal sinuses bilaterally. There is normal signal in the mastoid air cells.

Output: 1.No evidence of structural abnormality or abnormality of CSF flow. Specifically, no evidence of Chiari malformation.2.Mild mucosal thickening and retention cysts in all of the paranasal sinuses, please correlate with clinical exam for findings of sinusitis.


Instruction: Generate impression based on findings.

Input: Any evidence of paraspinal plexiform neurofibromas? NF1 and severe back pain, more between the shoulder blades. The paravertebral soft tissues are unremarkable. There is no evidence of spinal or paraspinal masses. 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 in the thoracic or lumbar spine. However, there is prominent epidural lipomatosis in the sacrum. The spinal cord displays normal signal and morphology.

Output: No evidence of paraspinal plexiform neurofibromas.


Instruction: Generate impression based on findings.

Input: Neurosarcoidosis with intermittent right arm and leg numbness. There are postoperative findings related to right frontal craniotomy. There is unchanged encephalomalacia and distortion of the right inferior temporal lobe. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are postoperative findings related to endoscopic sinus surgery and persistent bilateral maxillary sinus retention cysts.

Output: 1. Unchanged postoperative findings with encephalomalacia in the right temporal lobe, but no evidence of recurrent neurosarcoidosis.2. Postoperative findings related to endoscopic sinus surgery and persistent bilateral maxillary sinus retention cysts.


Instruction: Generate impression based on findings.

Input: Reason: 61 M with metastatic pancreatic neuroendocrine tumor, please eval for interval change from prior MRI. History: none. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Numerous arterially enhancing hepatic metastases are overall not significantly changed. A right segment 5 lesion measures 2.2 x 1.9 cm (series 10/50), unchanged. A right segment 5/6 reference lesion measures 2.1 x 2.0 cm (series 10/65).Mild intrahepatic biliary ductal dilatation is unchanged. Gallbladder sludge.SPLEEN: No significant abnormality noted.PANCREAS: Ill-defined lesion in the pancreatic head measures 2.2 x 1.7 cm (series 10/72), unchanged. No pancreatic ductal dilatation.ADRENAL GLANDS: Mild nonspecific thickening of the left adrenal gland, similar to prior exam..KIDNEYS, URETERS: Left renal cysts and left renal atrophy are unchanged.RETROPERITONEUM, LYMPH NODES: Mildly enlarged peripancreatic node (series 10/62), not significantly changed.BOWEL, MESENTERY: Stable descending duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in pancreatic head mass and numerous hepatic metastases.


Instruction: Generate impression based on findings.

Input: Lumbar epidural phlegmon/abscess. To evaluate for other foci of infection. Cervical Spine: The vertebral alignment is straightened in the sagittal plane. The vertebral body heights are preserved. There are multilevel disc-osteophyte complexes and ossification of the posterior longitudinal ligament, which result in narrowing of the spinal canal and indentation of the spinal cord, particularly at C4-5 and C5-6. The spinal cord signal is otherwise normal. The vertebral bone marrow signal is unremarkable. There is no abnormal intraspinal contrast enhancement. There is no abnormal diffusion restriction. There is a right posterior neck subcutaneous lipoma that measures 12 mm in thickness.Thoracic Spine: The vertebral alignment is anatomic. The vertebral body and disc heights are preserved. There are mild multilevel anterior osteophytes, but the spinal canal and neural foramina are patent. The spinal cord signal is normal. The vertebral bone marrow signal is unremarkable. There is no abnormal epidural contrast enhancement. There is no abnormal diffusion restriction. The paravertebral soft tissues are unremarkable.

Output: 1. No cervical or thoracic osteomyelitis, discitis, or epidural abscess.2. Multilevel degenerative cervical spondylosis and ossification of the posterior longitudinal ligament that result in spinal cord indentation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pancreatic tail lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No focal suspicious liver lesions. No intra or extrahepatic biliary ductal dilatation. The common bile duct is normal in caliber. Normally distended gallbladder without gallstones.SPLEEN: Punctate mildly hyperintense probable cysts.PANCREAS: 6 x 6 mm cystic lesion in the pancreatic tail communicating with a normal caliber main pancreatic duct without suspicious postcontrast imaging features (series 6/17).The pancreas parenchyma is otherwise normal in intrinsic signal intensity and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 6 mm cystic lesion in the pancreatic tail communicating with a normal caliber main pancreatic duct without suspicious postcontrast enhancement compatible with a side branch IPMN.


Instruction: Generate impression based on findings.

Input: 48-year-old male patient with shoulder pain consistent with rotator cuff injury. Evaluate for tear. ROTATOR CUFF: There is partial thickness articular surface tearing of the supraspinatus tendon. There is increased signal within the subscapularis tendon and infraspinatus tendon compatible with tendinopathy though no full thickness tear. The teres minor tendon is intact. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid articular cartilage appears intact. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Partial thickness articular surface tearing of the supraspinatus tendon.2. Tendinopathy of the infraspinatus and subscapularis tendons.3. Small amount of fluid in the subdeltoid bursa.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. There is fenestration of the M1 segment of the left middle cerebral artery. The right middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is an extracranial origin of the right PICA. There is no evidence of flow-limiting stenosis or aneurysm.

Output: Fenestration of the left M1 segment without flow limiting stenosis or aneurysm.


Instruction: Generate impression based on findings.

Input: 69 year old with history of right lumpectomy in 2006 followed by radiation therapy, and right mastectomy in 2014 for IDC with DCIS. Status post right mastectomyThere is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.Stable intramammary lymph node in the lower outer left breast.No abnormal enhancement is seen in left breast or right mastectomy bed. 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: Clinical question: Evaluate exam after 8 weeks of systemic therapy. Compared to prior baseline exam from 3 -- 17 -- 15. Signs and symptoms: Patient with history of glioblastoma multiform. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination redemonstrates a very large irregular, enhancing and centrally necrotic tumor in the left temporal lobe with interval increased size since prior study. A very irregular shape of tumor makes precise measurements difficult however within this limitation are measurements in variation of undulation stem mostly increased size of tumor. Similar to prior study the posterior medial aspect of tumor is inseparable from the trigone and the occipital horn of left lateral ventricle which is involved with the tumor and demonstrate enhancement along the ependymal lining of the ventricle. Extensive surrounding vasogenic edema involving the entire left temporal lobe and extending into the left occipital and left basal ganglia demonstrate no convincing evidence of change. The overall mass effect of this tumor results in deviation of midline to the right of approximate the 6-mm at the level of third ventricle which has a slightly progressed since prior exam. Mild prominence of the right lateral ventricle demonstrates subtle interval progression as well. The basal cistern remains patent.There is no remote new foci of flair hyperintensity or enhancement since prior exam.

Output: 1.Interval increased size and extent of left temporal lobe glioblastoma as detailed.2.Slight interval increased mass effect and resultant 6-mm rightward midline shift at the level of third ventricle.3.Slight interval increased size of right lateral ventricle since prior exam without evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: Reason: eval scapholunate ligaments - arthrogram History: wrist pain LIGAMENTS: Intra-articular gadolinium traverses the lunotriquetral ligament indicating tear. Intra-articular gadolinium also traverses the scapholunate ligament indicating disruption. Intra-articular gadolinium is identified within the mid carpal joint.TRIANGULAR FIBROCARTILAGE COMPLEX: Intra-articular gadolinium traverses the articular disc of the triangular fibrocartilage complex, particularly involving the ulnar styloid attachment indicating a partial-thickness tear.TENDONS: The flexor and extensor tendons appear intact.BONES: There are foci of increased signal abnormality within the lunate, capitate, and hamate which may reflect degenerative changes. ADDITIONAL

Output: 1. Findings indicating disruption of the lunotriquetral and scapholunate ligaments.2. At least partial-thickness tearing of the triangular fibrocartilage complex, particularly involving its ulnar styloid attachment.


Instruction: Generate impression based on findings.

Input: Obstructive jaundice, evaluate bile duct obstruction ABDOMEN: LIVER, BILIARY TRACT: T2 hyperintense hepatic lesions consistent with metastases increasing in size and number. Dominant hilar mass measures 5.6 x 3.2 cm (series 701, image 21), previously 4.2 x 3.5 cm. Increasing and now severe bilobar intrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Dominant obstructive hilar mass with increasing and now severe bilobar intrahepatic biliary ductal dilation.2.Hepatic metastases increasing in size and number.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 35 seconds

Output: Successful fluoroscopic injection of dilute gadolinium into the right hip for subsequent MRI arthrogram.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic disease? Signs and symptoms: History of cancer, neck pain on the left. Pre and post enhanced cervical MRI:There is normal anatomical alignment of vertebral column and stable since prior exam.There is a short segmental focus of T2/T2 STIR hyperintensity within the cervical cord at C3 level with decreased cord caliber and without abnormal enhancement representing a focus of nonspecific myelomalacia. This finding demonstrate no interval change since prior exam from 2012. The signal intensity of the cord is otherwise within normal limits and without abnormal enhancement.The signal intensity of vertebral column is unremarkable and without abnormal enhancement to suggest metastatic disease.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild left neural foraminal compromise secondary to degenerative disease and unremarkable otherwise.C4-C5 is unremarkable.C5-C6 demonstrate a right ventral small disc-osteophyte complex with resultant partial effacement of subarachnoid space without central spinal stenosis or neural foraminal compromise. There is no significant change of this finding since prior exam from 2012.History 6/C7 is unremarkable.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord is unremarkable.

Output: 1.Pre- and post enhanced cervical MRI demonstrate no evidence of metastatic disease.2.Small focus of myelomalacia of cord at C3 without change since prior exam from 2012.3.Normal signal intensity of the cord otherwise and without abnormal enhancement.4.Stable small disc-osteophyte complex on the left at C5-C6 since 2012.5.No central spinal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: Assess for stroke History: L face/arm/leg weakness, gaze deviation to L There is a focal restricted diffusion at mid Pons especially on the right side without evidence of hemorrhagic transformation indicating mid basilar pleural prior type of ischemic infarct.Underlying brain shows scattered minimal FLAIR/T2 high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease.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. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There is a small retention cyst in the right side sphenoid sinus.There is about 14.8 mm x 16.3 mm sized Thornwaldt cyst.

Output: 1. Acute ischemic infarct at mid Pons especially on the right side from the midline likely represent basilar artery perforator territory. No hemorrhagic transformation.2. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: eval for rtc tear History: after lifting heavy object, pain to shoulder since Dec, 2015. 4/5 strength for abd and er. Several sequences are limited by patient motion artifact.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus at its insertion involving the majority of the tendon, perhaps with a few intact anterior fibers. The tear extends posteriorly to involve the majority of the infraspinatus tendon, perhaps with a few intact posterior fibers. There is approximately 5 mm of retraction of the supraspinatus fibers and approximately 1 cm of retraction of the infraspinatus fibers. There is mild atrophy of the supraspinatus and infraspinatus muscles. There is increased signal intensity within the subscapularis tendon indicating moderate tendinosis and likely fraying of the undersurface fibers. There is mild atrophy of the subscapularis muscle. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a trace amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. There is minimal posterior translation of the humeral head relative to the center of the glenoid with what we suspect is a vacuum phenomenon within the anterior aspect of the joint. There is a small amount of fluid within the joint without evidence of a large effusion. Given the limitations of a non arthrogram study, the glenoid labrum appears normal for age.BICEPS TENDON: Given the limitations of a non arthrogram study, the tendon of the long head of the biceps appears normal for age.

Output: Slightly limited study due to patient motion artifact showing near complete and slightly retracted tears of the supraspinatus and infraspinatus tendons, with other findings as described above.


Instruction: Generate impression based on findings.

Input: 35-year-old female with left foot wound, evaluate for osteomyelitis A fiducial marker was placed along the plantar surface of the second and third toe. Mild increased T2 signal with accompanying slight decreased T1 hypointensity within the mid and distal aspect of the first metatarsal may represent marrow edema. A small amount of fluid surrounds the head of the first metatarsal. Mild soft tissue ulceration along the ball of the foot. There is significant soft tissue edema surrounding present.

Output: Marrow signal abnormality in the first metatarsal may represent marrow edema without convincing evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 49 year-old female with history of right breast low-grade DCIS status post lumpectomy at an outside hospital. Recent MRI demonstrated an area of non mass enhancement in the right retroareolar region for which biopsy was recommended.. On subtraction images, the area of focal non mass enhancement in the right breast retroareolar region previously described on prior MRI is not as conspicuous. Using landmarks from the breast tissue, this area was chosen as the target. PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 8 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC rod shaped clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a right unilateral mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed at 11 o'clock position with no evidence of any complications due to the procedure. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Udoji under direct supervision of Dr. Abe who was present throughout the procedure.

Output: Successful MR guided core needle biopsy of the right breast upper outer quadrant near the 11 o'clock position non mass enhancement. Successful rod shaped clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Dementia, rapidly progressive. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. The hippocampi appear to be intact. 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, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: Minimal nonspecific cerebral white matter T2 hyperintensity, but no evidence of acute intracranial hemorrhage, mass, or territorial infarct.


Instruction: Generate impression based on findings.

Input: A 60 year old female with syncope and abnormal electrocardiogram (giant negative T-wave) and suspected apical hypertrophy by echocardiogram. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with systolic hyperdynamic performance. Mild apical cavity obliteration was noted. The overall LV ejection fraction is 75%, the LV end diastolic volume index is 52 ml/m2 (normal range: 65+/-11), the LVEDV is 83 ml (normal range 109+/-23), the LV end systolic volume index is 13 ml/m2 (normal range 18+/-5), the LVESV is 20 ml (normal range 31+/-10), the LV mass index is 67 g/m2 (normal range 67+/-11), and the LV mass is 107 g (normal range 114+/-24). There are no regional wall motion abnormalities present. The basal septum is thickened at 15mm at end diastole. The apical anterior wall is 12mm. No late gadolinium enhancement. While this is not typical case of hypertrophic cardiomyopathy, some cases may not demonstrate late gadolinium enhancement.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 54 ml/m2 (normal range 69+/-14), the RVEDV is 86 ml (normal range 110+/-24), the RV end systolic volume index is 18 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). The RV free wall has normal thickness.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. Systolic anterior movement (SAM) of the mitral valve causes accelerated flow forward in the subvalvular outflow tract. 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 branching pattern. The aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a right lateral thoracic meningocele.

Output: 1. The left ventricle is normal in size with systolic hyperdynamic performance, the LVEF is 75%. LV mass is normal. Mild apical cavity obliteration with basal septal hypertrophy causing SAM. No enhancement. While this is not a typical case of hypertrophic cardiomyopathy, the constellation of findings do raise the question of LV HCM. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 66%. The RV free wall demonstrates normal thickness.4. The aortic valve opens widely and there is no significant aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 65 year old male with presumed ischemic cardiomyopathy, hypertension, hyperlipidemia admitted for acute decompensated heart failure. MEDICATIONS: Outpatient medications: Aspirin, Atorvastatin, Carvediolol, Furosemide, and Lisinopril. First Pass PerfusionDuring hyperemia, there is a subtle perfusion defect of the mid lateral wall noted. There is dark rim artifact also noted. Viability/ Myocardial ScarThere is subendocardial late gadolinium enhancement noted of the apical to mid anterior and inferior walls suggesting prior myocardial infarction. This territory has intermediate probability of viability. There is near full-thickness (>75%) to full-thickness late gadolinium enhancement of the anterolateral and inferolateral walls (apex to basal) and basal anterior wall. This territory is unlikely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 144 ml/m2 (normal range: 74+/-15), the LVEDV is 279 ml (normal range 142+/-34), the LV end systolic volume index is 110 ml/m2 (normal range 25+/-9), the LVESV is 212 ml (normal range 47+/-19), the LV mass index is 66 g/m2, and the LV mass is 128 g. There are several wall motion abnormalities present. The apical to mid anterior, anterolateral, and lateral walls are hypokinetic/akinetic. The inferolateral and inferior walls are also akinetic. Additionally there is hypokinesis of the mid anteroseptum. Pre-contrast, native myocardial T1 relaxation time is normal (1010 ms) at the level of the septum. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly-moderately reduced systolic function. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 118 ml/m2 (normal range 82+/-16), the RVEDV is 228 ml (normal range 142+/-31), the RV end systolic volume index is 74 ml/m2 (normal range 31+/-9), and the RVESV is 142 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Incompletely assessed mild focal thickening may relate to leaflet calcification.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 at least mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, there is a subtle perfusion defect of the mid lateral wall noted. There is dark rim artifact also noted. 2. There is subendocardial late gadolinium enhancement noted of the apical to mid anterior and inferior walls suggesting prior myocardial infarction. This territory has intermediate probability of viability. There is near full-thickness (>75%) to full-thickness late gadolinium enhancement of the anterolateral and inferolateral walls (apex to basal) and basal anterior wall. This territory is unlikely to be viable. 3. The left ventricle is severely dilated with severely reduced systolic function (LVEF 24%). 4. There are several wall motion abnormalities present. The apical to mid anterior, anterolateral, and lateral walls are hypokinetic/akinetic. The inferolateral and inferior walls are also akinetic. Additionally there is hypokinesis of the mid anteroseptum. 5. The right ventricle is mildly dilated with mildly-moderately reduced systolic function (RVEF 38%).6. Mild mitral/tricuspid regurgitation.7. Moderate biatrial enlargement.


Instruction: Generate impression based on findings.

Input: Causes of dysautonomia: syncope, weakness, and gastroparesis. Many of the images are degraded by patient motion. 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.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct, although the exam is partly limited by patient motion.


Instruction: Generate impression based on findings.

Input: Reason: h/o L first metatarsal fracture, concern for osteomyelitis History: pain, swelling, purulent drainage There is nonenhancing fluid signal intensity which extends from the tip of the great toe to the tuft of the distal phalanx likely representing ulceration or sinus tract formation. The distal phalanx is replaced with abnormal signal intensity and enhancement likely due to both osteomyelitis and edema from the pathologic fracture as seen on recent radiographs. The fracture itself is better seen on prior radiographs. There is edema and enhancement of the surrounding soft tissues of the first toe indicating inflammation. We see no evidence of osteomyelitis of the proximal phalanx of the great toe or of the first metatarsal. We see no first metatarsal fracture. Mild osteoarthritis affects the midfoot. There is fatty atrophy of the musculature of the foot. There is a small amount of fluid within the flexor hallucis longus tendon sheath, proximal to the sesamoids, which may represent a mild tenosynovitis but this is of questionable current clinical significance.

Output: Osteomyelitis of the distal phalanx of the great toe and pathologic fracture. These findings were relayed to Dr. Demagio via phone at 11:38 AM on 12/11/2015.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma. Please evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with caudate lobe hypertrophy and prominent fissures.The segment 4 ablation cavity measures 3.0 x 3.5 cm and is predominantly T2 weighted hypointense with T1 weighted hyperintense proteinaceous/blood product.Evaluation for hepatocellular carcinoma is significantly limited by the absence of intravenous contrast, however there are no new T2-weighted hyperintense or restricting focal lesions.Cholelithiasis and cholecystostomy tube.SPLEEN: Splenomegaly, measuring 15 cm in craniocaudal dimension, unchanged. Splenic varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 weighted hyperintense foci compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild portal hypertensive colopathy. Trace right paracolic gutter fluid.BONES, SOFT TISSUES: Multiple well-defined T2 hyperintense osseous foci compatible with hemangiomas, unchanged.OTHER: No significant abnormality noted.

Output: Limited study due to lack of intravenous contrast without significant change in treated hepatic lesion and no new lesion evident.


Instruction: Generate impression based on findings.

Input: 35-year-old female with a left ovarian endometrioma. Follow-up size and characterization. PELVIS:UTERUS, ADNEXA: Anteverted retroflexed uterus. Endometrium is normal in thickness.The inner myometrium/junctional zone is thickened with an ill-defined inner/outer myometrial junction compatible with diffuse adenomyosis.There is a left adnexal mass measuring 7.8 x 6.4 cm (series 501, image 35), previously measuring 7.8 x 6.8 cm and extending into the rectouterine pouch displacing the uterus anteriorly. This lesion demonstrates hyperintensity on T1-weighted imaging with T2 hypointensity. Numerous cervical nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free pelvic fluid, most likely physiologic in etiology.BONES, SOFT TISSUES: Degenerative disc disease at L5/S1.OTHER: No significant abnormality noted.

Output: 1.7.8 cm left adnexal mass in the rectouterine pouch likely represents an endometrioma. However, neoplasm cannot be entirely excluded.2.Diffuse adenomyosis.


Instruction: Generate impression based on findings.

Input: Daily headaches. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. There is mild parenchymal volume loss commensurate with age. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild paranasal sinus disease with mild mucosal thickening involving the left maxillary sinus and partial opacification of the bilateral anterior ethmoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. MRI of the brain is essentially unremarkable for age. No intracranial mass or mass effect. 2. Mild chronic small vessel ischemic changes. 3. Mild paranasal sinus mucosal thickening.


Instruction: Generate impression based on findings.

Input: 35-year-old male with subcutaneous masses in the left forearm and history of NF1. Evaluate for subcutaneous NF involvement with ulnar nerve. Note is made of a 2.1 x 1.2 x 2.0 cm mass within the subcutaneous tissues along the anterior aspect of the left forearm at the level of the distal ulnar diaphysis. There is associated increased signal abnormality on fluid sensitive sequences and slight enhancement following contrast administration. There are some foci of decreased signal abnormality on T2-weighted images centrally. This finding likely represents a neurofibroma. There is no extension to involve the underlying musculature. There is an additional mass within the subcutaneous tissue along the medial aspect of the left forearm at the level of the proximal diaphysis of the ulna which abuts the fascia along the flexor musculature and measures 2.7 x 0.8 cm and also demonstrates increased signal abnormality on fluid sensitive sequences and minimal enhancement following contrast administration. There is an associated internal septation and foci of decreased signal abnormality on T2-weighted images internally.

Output: Multiple subcutaneous masses along the anterior and medial aspect of the left forearm as described above which likely represent neurofibromas.


Instruction: Generate impression based on findings.

Input: 8-year-old female with medulloblastoma resection and treatment, 3 months off therapy. Brain:Redemonstrated are postoperative findings related to suboccipital craniotomy for resection of a cerebellar medulloblastoma. There is unchanged mild confluent T2 hyperintensity in the medial cerebellar hemispheres along the margins of the resection site. Also redemonstrated is an unchanged the punctate focus of enhancement at the inferior aspect of the fourth ventricle which may be vascular related. There are no new abnormal enhancing foci.There is no evidence of acute intracranial hemorrhage, or infarct. The ventricles and basal cisterns are stable in size and configuration. Redemonstrated is susceptibility along a previous left parietal region ventriculostomy tract. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged. Expected vascular flow voids are demonstrated. The visualized paranasal sinuses and mastoid air cells are clear.Spine: The spinal cord and cauda equina nerve roots display normal signal characteristics. There is no evidence of abnormal enhancement within the spinal canal. The vertebral bone marrow displays diffuse T1 and T2 hyperintensity, most compatible with radiation effects, unchanged in appearance. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The paraspinal soft tissues are unremarkable.

Output: 1. No convincing evidence of tumor recurrence in the posterior fossa. 2. No evidence of drop metastases in the spinal canal.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation [782.0], Reason for Study: ^Reason: stroke? History: hx TIA, weakness No evidence of acute ischemic or hemorrhagic lesion.Several scattered high signal intensity lesions on bilateral hemispheric white matter on FLAIR imaging are nonspecific.No change of previously demonstrated right cerebellar hemispheric linear tissue defect since prior scan.Opacification of paranasal sinus appear to be improved since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral PCAs are fetal origin. There is no intracranial aneurysm. No significant luminal stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Right cerebellar hemispheric encephalomalacia and few non specific high signal foci on FLAIR images, no change since prior scan.3. Normal brain MR angiogram and neck MR angiogram.


Instruction: Generate impression based on findings.

Input: Breast cancer screening, IRB 13073B, strong family history of breast cancer and BRCA2 mutation. History of breast cancer in mother diagnosed at the age of 44 and maternal grandmother diagnosed at the age of 63. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Waldenstrom macroglobulinemia [C88.0], Reason for Study: ^Reason: 35M with Waldenstrom's macroglobulinemia presents with vertigo, imbalance and blurred vision, eval for intracranial lesion History: 35M with Waldenstrom's macroglobulinemia No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement.A couple of FLAIR/T2 tiny high signal intensity lesions are seen on bilateral frontal lobes which are non specific.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cysts on the left maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: 42 yo with mild biliary stricture on previous MRI please evaluate History: none. History of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis. Geographic T2 hyperintensity and progressive enhancement is likely due to fibrosis, similar in distribution to the prior exam.Minimal narrowing of the proximal common bile duct appears similar to the prior exam.SPLEEN: Small splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal narrowing of the proximal common bile duct is unchanged. No new areas of narrowing.


Instruction: Generate impression based on findings.

Input: Ms. Nori is a 61 year old female with a strong family history of breast cancer, including two sisters. Personal history of benign left breast biopsy in 2000 for fibrous tissue and benign right cyst aspiration in 2004. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen in both breasts, all of which are stable in size and appearance when compared to multiple prior examinations. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: 65 years Female (DOB:7/29/1951)Reason: evaluate for cervical myelopathy History: gait imbalance, hand tinglingPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.Exam is mildly degraded due to patient motion.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are minor degenerative changes present in the cervical spine.2.No abnormal lesions are appreciated in this cervical spinal cord. Please note the exam is mildly degraded patient motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Neck pain, arm pain, history of C4-C7 with instrumentation. Mid back pain and numbness. CERVICAL: There are postsurgical changes of anterior cervical discectomy and fusion from C4 through C7. Interbody grafts, anterior plate, and screws can be better assessed with radiographs or CT, but demonstrate no gross evidence of displacement compared to radiograph from 2/25/2014.Spinal canal caliber is significantly improved from the C4 to C7 levels without residual spinal canal stenosis at these levels. There is a disc bulge at the C3-C4 level which contributes to mild spinal canal stenosis and appears slightly worse since prior MRI. No cord signal abnormality. Additional details described level by level as below:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild disc bulge and uncovertebral hypertrophy. There is mild spinal canal stenosis. There is mild right and moderate to severe left neural foraminal stenosis.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal. There is mild right and no significant left neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or right neural foramen. There is mild to moderate left neural foraminal narrowing related to facet arthropathy and uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal. Mild to moderate left neural foraminal stenosis related to facet arthropathy. Right neural foramen is patent.THORACIC: Vertebral body heights in the thoracic spine are normal. There is a small Schmorl's node involving the inferior endplate of T8. There is mild levocurvature of the upper thoracic spine and dextrocurvature of the mid to lower thoracic spine.There are mild to moderate degenerative changes. At T2-T3 and T3-T4, there are right paracentral disc protrusions which contact the right ventral cord. At T6-T7, a left paracentral disc protrusion contacts the left ventral aspect of the cord. Small disc bulge at T7-T8 without stenosis. Small central protrusion at T8-T9 without stenosis. Scattered mild multilevel ligamentum flavum thickening and facet arthropathy also noted. There is no high-grade spinal canal stenosis at any level in the thoracic spine. No cord signal abnormality. There is also multilevel mild to moderate neural foraminal narrowing in the upper thoracic spine which is suboptimally evaluated due to motion degradation.

Output: 1. Postsurgical changes of anterior cervical fusion from C4 through C7. Previously seen spinal canal stenosis from C4-C5 to C6-C7 has resolved. There is mild spinal canal stenosis at the C3-C4 level related to disc bulge. No cord signal abnormality. Multilevel neural foraminal stenosis, particularly on the left, as detailed above.2. Mild to moderate degenerative changes in the thoracic spine without high-grade spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Assess for possible retrocochlear pathology: asymmetric high frequency sensorineural hearing loss and right sided tinnitus. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. The left Meckel cave is asymmetrically prominent and there is slight protrusion of cerebrospinal fluid through the left foramen ovale. There is a partially-empty sella. There is mucosal thickening and secretory disease in the left maxillary sinus.

Output: 1. No evidence of retrocochlear or inner ear lesions, although the assessment is limited without intravenous contrast.2. The left Meckel cave is asymmetrically prominent and there is slight protrusion of cerebrospinal fluid through the left foramen ovale, which may represent a small meningocele. In addition, there is a partially-empty sella. The constellation of findings may indicate pseudotumor cerebri.3. Findings suggestive of acute left maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: History of neuroendocrine tumor in head of pancreas. ABDOMEN:LIVER, BILIARY TRACT: A simple cyst in segment 6/7 measures up to 3 cm. Additional scattered subcentimeter cysts are also present. The previously described tiny focus of arterial enhancement in the inferior right hepatic lobe is not well seen on this examination. No suspicious hepatic lesions are identified. The common bile duct measures up to 9 mm and tapers smoothly distally without obstructing stone or lesion identified. The hepatic vasculature appears patent.SPLEEN: There is a lesion within the spleen (series 14, image 31) measuring 2.3 x 2.8 cm which demonstrates isointense T1 and T2 signal as well as heterogeneous early enhancement with filling in on delayed imaging. The lesion appears grossly similar to the outside 12/19/2013 examination allowing for differences in technique.PANCREAS: There is significant pancreatic ductal dilation measuring up to 7 mm which abruptly tapers at the level of the pancreatic neck, and is again mildly prominent near the ampulla. At the level of the narrowing, there is a tiny hyperenhancing intraductal lesion (series 13, image 48) measuring up to 5 mm. There is moderate-severe atrophy of the pancreatic body and tail appearing similar to prior with sparing of the pancreatic head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A small duodenal diverticulum is present in the third portion of duodenum.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted.

Output: 1.5 mm hyperenhancing intraductal lesion at the pancreatic head/neck with resultant ductal dilation compatible with patient's known history of intraductal neuroendocrine tumor, not significantly changed. 2.A 2.8 cm enhancing splenic lesion which is nonspecific but similar to 2013 exam and thus most likely benign.


Instruction: Generate impression based on findings.

Input: 35-year-old female with a history of sickle cell disease with venoocclusive crisis. Points to the left groin area with severe pain. Unable to bear weight. Severely limited examination secondary to patient motion artifact. There is nonspecific edema within the anterior thigh musculature extending from the level of the femoral neck to the mid femoral diaphysis, extending off of the field of view of this study. There is also edema surrounding the proximal femoral diaphysis as well as increased signal intensity within the medullary space of the proximal femoral diaphysis. These findings could represent bone infarction and sequela of vaso-occlusive crisis. We cannot entirely exclude the possibility of osteomyelitis on this very limited study. Given the aforementioned limitations, we see no findings to suggest avascular necrosis of the femoral head. There is a small amount of fluid within both hip joints, which is within normal limits.

Output: Extremely limited study as described above showing edema within the proximal femoral diaphysis and the surrounding soft tissues, particularly within the anterior compartment musculature of the thigh. These findings likely represent bone infarction / vaso-occlusive crisis with soft tissue edema. Please note that we cannot entirely exclude osteomyelitis in the basis of this study.


Instruction: Generate impression based on findings.

Input: Reason: Dedicated liver MRI to rule out mass, evaluate peri-splenic fluid collection, and for signs of pancreatitis History: acute onset abdominal pain, elevated Lipase, questionable liver mass and perisplenic fluid collection on abdominal ultrasound. Mildly elevated lipase of 66. ABDOMEN:LIVER, BILIARY TRACT: The liver is upper normal in size with an otherwise normal morphology. Out of phase images demonstrate diffusely decreased signal intensity with several areas of geographic sparing compatible with hepatic steatosis with areas of sparing. No focal hepatic lesions are identified.The hepatic vasculature appears patent.The gallbladder appears within normal limits without evidence of cholelithiasis or gallbladder wall thickening. There is no biliary ductal dilatation.SPLEEN: No significant abnormality noted. The splenic vasculature appears patent.PANCREAS: The pancreas demonstrates normal parenchymal T1 signal intensity and enhancement without evidence of necrosis. The pancreatic tail is enlarged with associated peripancreatic fat stranding primarily within the left upper quadrant compatible with acute pancreatitis. There is a small perisplenic fluid collection subjacent to the left abdominal wall measuring up to 7 mm in thickness. There is a small area of focally increased T2 signal within the pancreatic tail with reference measurements as below.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/16/2016 21:21:32)PANCREATIC TAIL CYSTIC LESION: 1.0 x 0.9 cm (Image 33, Series 301).

Output: 1.Focal enlargement of the pancreatic tail and surrounding peripancreatic fat stranding compatible with acute pancreatitis.2.Small cystic lesion within the pancreatic tail which is nonspecific but could represent a small pseudocyst, a sidebranch IPMN, among other etiologies.3.Short-term follow-up MRCP is recommended following resolution of acute symptoms to exclude underlying pancreatic neoplasm.4.Hepatic steatosis with geographic areas of sparing without suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with right-sided back pain radiating down leg, positive straight leg test, history of herniated disc status post discectomy now with recurring pain on the right side. Innumerable foci of marrow replacement are identified involving every level of the spine as well as the visualized sacrum and iliac bones. At several levels, significant tumor extension is seen into the epidural and/or extraosseous spaces with details as follows:At T2, extraosseous or epidural tumor extension causes effacement of the left aspect of the spinal canal, completely excluding CSF, deforming and displacing the cord to the right. Tumor extends into the left T1-2 and T2-3 neural foramina.At T5, extraosseous or epidural tumor extension is seen on the left causing effacement of the left spinal canal, with deformity and rightward displacement of the spinal cord. The left C5-6 neural foramen is invaded.At T6, ventral epidural tumor extension is seen bilaterally with narrowing of the spinal canal and bilateral deformity of the spinal cord. The left T6-7 neural foramen is invaded as well.At L3, tumor within the right lateral and posterior epidural space causes significant effacement of the spinal canal, exclusion of CSF, deformity and displacement of the cauda equina towards the left. A smaller quantity of epidural tumor is also seen on the right at L1 and L2. The right L1-2, L2-3 and L3-4 neural foramina are all invaded by tumor.Numerous additional areas of epidural invasion are seen throughout the spine, though with less severe compromise of the spinal canal and neural foramina. At no point is there any definite evidence of spinal cord edema. No pathologic spinal cord or leptomeningeal enhancement is identified.Spinal alignment is grossly anatomic. Vertebral body heights are preserved. In the cervical spine, disc osteophyte formation is seen from C4-5 through C7-T1 but without significant spinal canal compromise. The neural foramina at these levels are mildly to moderately narrowed. In the lumbar spine, disc bulging and osteophytic ridging is seen at L4-5 and L5-S1, again without significant spinal canal compromise. Moderate bilateral foraminal narrowing seen at L5-S1.

Output: Diffuse osseous metastatic disease is seen involving every level of the spine and the visualized sacrum and iliac bones. At multiple levels, epidural tumor extension is seen causing severe spinal canal compromise and impingement or displacement of the spinal cord or cauda equina with details as above. At no level is there any definite evidence of cord edema.After initial attempts to contact by page, these findings were communicated to Drs. Campbell and Meza by email at 8:15 PM on 11/11/16.


Instruction: Generate impression based on findings.

Input: OCD status post laser ablation. There has been interval evolution postoperative findings related to bilateral anterior internal capsule laser ablation, including residual T2 hypertensity, enhancement, and susceptibility effect in the treatment zones, but decreased swelling. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a subcentimeter left maxillary sinus retention cyst.

Output: Expected postoperative findings related to bilateral anterior internal capsule laser ablation.


Instruction: Generate impression based on findings.

Input: 59-year-old male. Stage III to IV sacral decubitus ulcer. Evaluate for osteomyelitis. Small deep sacral decubitus ulcer to the left of midline with soft tissue signal abnormality at its base (T1 hypointense and T2 hyperintense) that diffusely enhances consistent with granulation tissue and/or phlegmon. This signal abnormality extends down to the medial left gluteus maximus muscle, which shows focal very mild inflammatory edema type signal. This abnormal soft tissue also abuts a very small area of the coccyx, which demonstrates no signal abnormality to indicate osteomyelitis. No abscess is identified. Chronic deformity of the left ilium, which may be from remote trauma. Mild left SI joint and bilateral hip osteoarthritis. Right femur dynamic screw and sideplate device produces metal artifact, limiting evaluation of adjacent anatomy. Diffusely decreased T1 bone marrow intensity of the lumbar spine and heterogeneous signal intensity of the pelvis, nonspecific, may be seen with red marrow reconversion.Suprapubic catheter terminates in a diffusely thickened bladder with intraluminal air. Rectal catheter is noted. Subcutaneous edema in the left lateral upper thigh.

Output: Small deep sacral decubitus ulcer to the left of midline with soft tissue signal abnormality at the base consistent with granulation tissue and/or phlegmon. No evidence of osteomyelitis in the underlying coccyx.


Instruction: Generate impression based on findings.

Input: 30 year old female with a newly diagnosed left breast cancer (IDC grade 3) presents for breast MRI. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Multiple benign-appearing enhancing foci and small masses are present bilaterally.In the left breast at posterior 2:00 position, there is a known cancer seen as an enhancing mass, measuring 10 x 15 x 13 mm (AP x LR x CC), with a marker clip inside.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal left breast cancer2. No MRI evidence of malignancy in right breast. 3. No abnormal lymph nodes in either axillary region.Follow up MRI in 6 months is recommended for multiple benign-appearing enhancing foci and small masses in both breasts. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 75-year-old female with knee pain. MENISCI: There is linear signal abnormality within the posterior horn and body of the medial meniscus extending to the tibial articular surface compatible with a horizontal tear. This is associated with small parameniscal cysts along the posteromedial aspect of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness loss of articular cartilage along the medial facet of the patella with small underlying subchondral cyst formation. There is also diffuse thinning of the articular cartilage of the lateral facet of the patella with a focal full-thickness defect, which is associated with edema-type signal in the underlying bone. There is full-thickness cartilage loss along the medial facet of the femoral trochlea with mild degenerative signal abnormality in the underlying bone. There is focal near full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle. There is relative sparing of the articular cartilage of the lateral tibiofemoral compartment.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Medial meniscus tear.2. Cartilage degeneration as described above.3. Small joint effusion.4. Mild edema/inflammation anterior to the patellar tendon is nonspecific.


Instruction: Generate impression based on findings.

Input: Large facial hemangioma; concern for PHACES syndrome; r/o intracranial malformation. Brain MRI: There is diffuse thickening and enhancement of the skin of the right side of the face and scalp, measuring up to 2 mm in thickness, which is compatible with a hemangioma. There is a T2 hyperintense enhancing mass centered in the right lacrimal fossa that measures up to approximately 25 mm with associated proptosis and remodeling of the lateral orbital wall, which also likely represents an hemangioma. There is mild right cerebellar hemisphere with associated prominence of the lateral posterior fossa CSF spaces. There is no midline shift or herniation. The degree of myelination is within normal limits. There is no evidence of intracranial hemorrhage or mass. There is a right tympanomastoid effusion.Brain MRA: There is a diffusely and markedly hypoplastic right internal carotid artery. There is an anomalous right ophthalmic artery that arises from the left cavernous carotid artery. There is a diffusely hypoplastic right vertebral artery There is an anomalous branch that supplies the right posterior fossa derived from the right external carotid artery. There is reconstitution of the circle of Willis vessels, with intact bilateral anterior, middle, and posterior cerebral arteries. The Neck MRI: There is a T2 hyperintense and enhancing lesion in the right posterior triangle of the neck that measures up to 25 mm, which likely represents an hemangioma. There are also multiple subcentimeter T2 hyperintense and enhancing lesions in the right buccal fat pad, right cheek, right temporal fossa subcutaneous tissues, and perhaps in the right parapharyngeal space, which also likely represent hemangiomas. Otherwise, there is no significant lymphadenopathy in the neck, and the thyroid and salivary glands are unremarkable. The cervical spine appears to be intact. Neck MRA: There is an aberrant right subclavian artery. There is moderate diffuse hypoplasia of the right common carotid artery and severe diffuse hypoplasia of the right internal carotid artery. There is also diffuse hypoplasia of the right vertebral artery diffusely. The left vertebral and internal carotid arteries are intact.

Output: The findings are compatible with PHACES syndrome, including right orbital, facial, and upper neck hemangiomas, mild right cerebellar hypoplasia, and hypoplasia of the right carotid and vertebral arteries with anomalous collateral vessels supplying the right orbit and posterior fossa and reconstitution of the circle of Willis branches. Discussed with Dr. Rosenblatt at 1:30 PM on 4/23/15.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out CVA. Signs and symptoms: Slurred speech and facial tube. Nonenhanced CT of brain:Findings consistent with extensive small vessel disease of indeterminate age is noted. There is no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. No evidence of acute cortical stroke is detected. Prominence of cortical sulci and ventricular system is concerning for underlying volume loss. Follow-up with an MRI is recommended.Calvarium, visualized paranasal sinuses, mastoid air cells and middle cavities are unremarkable.

Output: 1.Small vessel disease of indeterminate age.2.No evidence of acute cortical stroke or hemorrhage.3.Calvarium, paranasal sinuses and mastoid air cells are pneumatized and unremarkable.


Instruction: Generate impression based on findings.

Input: 47 years Female (DOB:8/10/1968)Reason: lumbar radiculopathy History: lower backPROVIDER/ATTENDING NAME: TARIQ M MALIK TARIQ M MALIK 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.At L4-5 there is no significant compromise to spinal canal or neural foramina.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: No compromise to lumbar spinal canal or neural foramina.