Instruction: Generate impression based on findings.

Input: History of hypertrophic pituitary, hydrocephalus, slit vent syndrome: yearly follow up. Brain: There is a right transoccipital ventricular catheter with unchanged mild T2 hyperintensity surrounding the catheter, which may represent gliosis and/or encephalomalacia. The ventricles are unchanged in size and configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is a subcentimeter right maxillary sinus retention cyst.Pituitary: There are postoperative findings related to transsphenoidal surgery. There is an unchanged punctate area of T2 hyperintensity along the left lobe of the pituitary gland. The pituitary stalk is intact. There is no mass effect upon the optic apparatus or cavernous sinuses.

Output: 1. Unchanged appearance of the shunted ventricular system.2. Unchanged appearance of the pituitary gland without evidence of recurrent hypertrophy.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: 10 year old male with h/o seizures, partial epilepsy, very active interictal spikes on left temporal area. to evaluate for any structural abnormality History: seizures, well controlled No evidence of acute ischemic or hemorrhagic lesion on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on bilateral ethmoid sinuses, bilateral maxillary and sphenoid sinuses.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Clinical question: R/O cord compression. Signs and symptoms. Signs and symptoms: Quadriplegia, worsening with new bladder deficits. Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol and without the dictated axial images of the spine.Examination demonstrate normal signal intensity and caliber of cervical and thoracic cord as well as the cauda equina without detectable mass effect.There is normal signal intensity and alignment of the entire spine without evidence of a spinal canal compromise or stenosis. There is also no significant degenerative disease or neural foraminal compromise at any level.The perispinal soft tissues are unremarkable.

Output: Negative nonenhanced total spine MRI for cord compression.


Instruction: Generate impression based on findings.

Input: 18-year-old female presents with chronic left hip pain, evaluate for labral tear. ACETABULAR LABRUM: There is curvilinear intermediate signal intensity within the anterior superior labrum that may represent surgical suture material, however, there is no gadolinium-filled defect to suggest a labral tear. Small foci of signal void in the anterior portion of the joint are favored to represent air bubbles.ARTICULAR CARTILAGE AND BONE: No gadolinium-filled articular cartilage defects are identified. Bone marrow signal intensity is normal. Scalloping of the femoral head/neck junction suggesting prior osteoplasty.SOFT TISSUES: Defect in the anterior capsule reflects prior surgery. The ischiofemoral space measures approximately 8 mm, which is narrowed. There is perhaps minimal edema in the quadratus femoris muscle. These findings suggest the possibility of iliofemoral impingement, although the clinical significance of this is uncertain. The ischiofemoral space on the left also appears narrowed. Otherwise, the musculature of the hip appears normal.ADDITIONAL

Output: 1. Surgical changes of a prior hip arthroscopy/surgery as described above. No labral tear is identified.2. Narrowing of the ischiofemoral space with minimal edema and the quadratus femoris may reflect ischiofemoral impingement, although the clinical significance of this is uncertain.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke, inflammation. Signs and symptoms: Right periorbital pain. Pre and post enhanced brain MRI:Negative diffusion weighted series/.Examination demonstrates extensive confluent FLAIR hyperintensity of the periventricular white matter of bilateral cerebral hemispheres and to a lesser degree of the subcortical white matter. Similar signal changes are also present in bilateral basal ganglia and mild to moderate in the pons. Findings demonstrate no susceptibility associated signal changes or abnormal enhancement. Considering patient's stated age of 89 above findings are highly suggestive of advanced chronic nonhemorrhagic small vessel ischemic strokes.There is mild ex vacuo dilatation of lateral ventricles. Caval septum pellucidum anteriorly which is an anatomical variation is noted.The signal intensity of the cerebral cortex remains within normal. Post enhanced images demonstrate no abnormal parenchymal or leptomeningeal enhancement.The signal voids of major intracranial arterial branches are identified and without detectable abnormality. Images through the orbits and including axial fat sat post enhanced series are unremarkable. There is no detectable preseptal periorbital soft tissue abnormality or enhancement. Bilateral cavernous sinuses demonstrate normal pattern of enhancement and unremarkable. Paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized.

Output: 1.Negative diffusion weighted series.2.Findings highly suggestive of moderate to advanced chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.No detectable abnormal enhancement.4.Unremarkable images through the orbits and without finding to explain patient's presenting clinical symptoms.5.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Pituitary tumor: yearly surveillance. There are postoperative findings related to transsphenoidal pituitary surgery. The previously demonstrated tiny lesion within the right pituitary gland is no longer perceptible. There is unchanged inferior angulation and deformity of the left aspect of the optic chiasm, which may be due to ptosis or adhesions. Otherwise, there is no mass effect upon the optic apparatus, which displays normal signal characteristics. The infundibulum is intact and remains deviated slightly to the left. The skull and scalp soft tissues are unremarkable.

Output: Postoperative findings related to transsphenoidal pituitary surgery. The previously demonstrated tiny lesion within the right pituitary gland is no longer perceptible.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with history of prior oral surgery for recurrent tongue cancer status post neck dissection, with tongue soreness. Evaluate for tumor and neck adenopathy. Evidence of right hemiglossectomy and flap reconstruction is again seen. T2 hyperintense signal seen within the operative bed on the prior MRI has resolved, and the overall appearance of the tongue and postoperative changes is similar to that seen on more recent CT exams. No masslike lesion or definite pathologic enhancement is seen.Evidence of bilateral neck dissection is noted. No pathologic adenopathy is identified. Supraglottic mucosal edema is unchanged. Small nodules in the parotid glands are less conspicuous than on the prior MRI. The remaining salivary glands and thyroid are unremarkable. Bone marrow signal of the upper cervical spine reflects prior radiotherapy. Otherwise, marrow signal is within normal limits.

Output: 1.Findings are redemonstrated compatible with right hemiglossectomy and flap reconstruction with bilateral neck dissection.2.No definite evidence of any recurrent primary tumor or pathologic adenopathy is seen.


Instruction: Generate impression based on findings.

Input: Possible right parotid mass. Per epic: right cheek swelling. This began 1-1/2 years ago. She has episodes that come and go that are associated with pressure and a subsequent salivary 'gush." There is focal dilatation of the right parotid duct overlying the masseter muscle, measuring up to 4 mm in diameter. There is diffuse enhancement of the parotid duct walls, but no associated discrete mass lesions. The right parotid gland is atrophic and does not display ductal dilatation. The left parotid gland and bilateral submandibular glands are unremarkable. There is an enhancing 4 mm diameter nodular lesion in the right buccal space inferior to the level of the parotid duct. There is otherwise no significant lymphadenopathy in the imaged portions of the neck. The osseous structures, paranasal sinuses, orbits, and imaged intracranial structures are unremarkable.

Output: 1. Focal dilatation of the right parotid duct overlying the masseter muscle, measuring up to 4 mm in diameter, along with diffuse enhancement of the parotid duct walls, but no associated discrete mass lesions. These findings may represent chronic ductal inflammation, perhaps secondary to a partially obstructive stricture, with resultant right parotid gland atrophy.2. A 4 mm diameter nodular lesion in the right buccal space inferior to the level of the parotid duct may represent a mildly reactive lymph node or perhaps a neoplasm.


Instruction: Generate impression based on findings.

Input: Clinical question: 45 year-old with metastatic lung cancer. Assess for acuity of compression fracture of L2. Has prior L4 vertebroplasty. Signs and symptoms: Low back pain. Pre and post enhanced Thoracic MRI:Examination demonstrates a fairly extensive osseous metastatic lesions involving vertebral bodies and the posterior elements of the thoracic spine. There is no evidence of fracture or malalignment. There is however progression of disease since prior MRI study from January of 2015. There is mild expansion of tumor into the ventral epidural space at T11 and T12 levels with resultant mild central spinal stenosis. Epidural spread of tumor at T12 also extends laterally to the left and partially into the left T11 -- T12 neural foramina. There is also mild epidural spread of tumor at T6, T7 and T9 levels and posteriorly at T3 level. There is however no appreciable compromise of the spinal canal secondary to this finding.The signal intensity and caliber of thoracic cord remains within normal without detectable abnormal in enhancement.Pre-and post enhanced lumbar MRI:Examination demonstrates very extensive marrow signal changes of the tubercle consistent with diffuse osseous metastatic lesions. There is no evidence of malalignment. There is compression deformity of the superior and inferior endplates of L2 vertebrae however without evidence of marrow space edema to suggest an acute compression. The height of L2 vertebrae at their maximum level of compression measures 14.6-mm and it 27.6-mm height along the dorsal aspect of L2 vertebrae.There is ventral epidural spread of tumor from this tube into the spinal canal and resultant spinal stenosis. No evidence of spinal stenosis at any other level.No detectable signal abnormality or abnormal enhancement of the cauda equina.

Output: 1.Pre-and post enhanced MRI of thoracic spine demonstrate extensive osseous metastatic lesions involving the vertebral bodies / posterior elements and with evidence of interval progression since prior exam 1-12-14. No fracture or malalignment. There are multiple foci of epidural spread of tumor noticeably at T11 and T12 with resultant mild central spinal stenosis as detailed above.2.Pre-and post enhanced MRI of the lumbar spine demonstrate extensive osseous metastatic lesions from patient's known lung cancer. There is mild less than 50% compression fracture of the superior and inferior endplates of L2 without detectable marrow space hyperintense signal to suggest edema and likely representing a chronic change. Epidural spread of tumor at the S2 results in central spinal stenosis.


Instruction: Generate impression based on findings.

Input: There is bilateral cystic encephalomalacia, white matter loss, gliosis, and ex vacuo dilatation of the left lateral ventricle atrium and occipital horn. Bilaterally this involves frontal, parietal, and occipital lobes, with the left hemisphere more predominantly affected. There is also associated thinning of the body and splenium of the corpus callosum.There are no findings of hydrocephalus. The more normal-appearing white matter anteriorly appears to have an appropriate myelination pattern. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear.

Output: Bilateral periventricular leukomalacia, left greater than right, with associated thinning of the corpus callosum.


Instruction: Generate impression based on findings.

Input: 10-month-old female status post tumor biopsy. Evaluate for hemorrhage. Status post right frontotemporal craniotomy with expected postoperative pneumocephalus and subcutaneous gas. Small amount of extra-axial fluid is seen in the operative field. No evidence of intra-or parenchymal or subarachnoid hemorrhage. The mixed cystic and solid attenuation suprasellar mass, which extends superiorly to the level of the foramen of Monro and posteriorly to the interpeduncular fossa, appears not significantly changed from recent MRI. There is mild compression of the anterior aspect of third ventricle, unchanged. The lateral and fourth ventricles appear unchanged from prior exam. No significant midline shift or evidence of herniation. The visualized paranasal sinuses and mastoid air cells are normal for age.

Output: 1.Expected postoperative pneumocephalus, subcutaneous gas, and small amount of extra-axial blood in surgical field. No evidence of intraparenchymal or subarachnoid hemorrhage.2.Known suprasellar mass appears not significantly changed.


Instruction: Generate impression based on findings.

Input: 4/23/2015 twisted knee and felt pop. MENISCI: Comminuted tear of the posterior horn of the medial meniscus with a large radial component with lateral and anterior displacement of the tear fragment. The remainder of the medial meniscus and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: Fissuring of the medial facet of the patellar cartilage with delamination, measuring 2 x 4 mm (transverse by CC). The remainder of the cartilage is intact with no focal partial or full thickness defects.No acute fracture or malalignment.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Disruption of the posterior horn of the medial meniscus due to comminuted tear with a large radial component with slight lateral and anterior displacement of the tear fragment.2.Fissuring and delamination of the articular cartilage of the medial facet of the patella.3.Small joint effusion.4.No acute fracture.


Instruction: Generate impression based on findings.

Input: 72 year old with severe tricuspid regurgitation presenting for evaluation of right heart enlargement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 57 ml/m2 (normal range: 65+/-11), the LVEDV is 97 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 36 ml (normal range 31+/-10), the LV mass index is 20 g/m2 (normal range 67+/-11), and the LV mass is 33 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). Right AtriumThe right atrium is at least moderately dilated. Aortic ValveThe aortic valve is trileaflet and opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%3. There is significant tricuspid regurgitation4. The right atrium is at least moderately dilated5. Significant artifact limited study interpretation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.________________________________________________________________________


Instruction: Generate impression based on findings.

Input: Male, 5 years old, with sickle cell disease, history of subperiosteal humeral abscess, presenting with back pain, fever, and increasing ESR/CRP. Assess for osteomyelitis. There is a normal complement of vertebral bodies which are in anatomic alignment. Some of the vertebral bodies show early morphologic changes including a slight posterior wedging which likely reflect the underlying sickle cell disease.Marrow signal is diffusely low on T1 weighted images indicating anemia-related marrow reactivity. Superimposed on this is scattered patchy marrow T2 hyperintensity and enhancement, most notably in the T7 and L4 vertebral bodies, and in the T5 and T6 spinous processes. Other levels are affected to a lesser degree. There is no associated osseous destruction, and no paraspinal or epidural fluid collections.The spinal cord and cauda equina demonstrate normal signal and morphology. No pathologic cord or leptomeningeal enhancement is seen. The conus tip terminates at the L1 level which is normal. No spinal canal or neuroforaminal narrowing is seen.Right lower lobe opacification and a right pleural effusion are seen. The urinary bladder is distended.

Output: 1.Patchy scattered areas of marrow edema and enhancement are seen, favored to represent osteitis or marrow ischemia. There is no osseous destruction or adjacent fluid collections to suggest infection at this time.2.Additional changes related to sickle cell disease are seen including diffuse marrow reactivity and early vertebral body morphologic abnormalities.3. Right lower lobe opacification and pleural effusion may reflect acute chest syndrome or pneumonia.


Instruction: Generate impression based on findings.

Input: 71-year-old male with intracranial mass, evaluate tumor for surgery in the morning, left leg weakness. Redemonstrated is a large irregularly-shaped peripherally enhancing mass located in the right frontal lobe and measuring. There is associated mass effect with midline shift, stable in appearance. There is a moderate degree of vasogenic type edema associated with this. The septum pellucidum is shifted approximately 9 mm to the left of midline, unchanged. As before, the uncus is shifted medially. Expected vascular flow voids are demonstrated. Fiducials are in place. The visualized portions of the paranasal sinuses and the mastoid air cells are clear.

Output: Redemonstrated is a large mass centered in the right frontal lobe with associated mass effect, midline shift, and subfalcine herniation, stable in appearance.


Instruction: Generate impression based on findings.

Input: 19 year-old male status post left S1 tumor resection. Osteoblastoma. Lumbar spine:Since the previous examination there are new postoperative changes including bilateral pedicular fusion of the L5 vertebrae and trans-sacral alar fusion at the S1 level. There is no evidence of hardware complication including loosening or fracture of the osseous structures or hardware components. There is 1-2 mm of extracortical extension of the screw tip of the left S1 hardware component.Alignment of the lumbar spine is within normal limits. Attenuation and morphology of the vertebral bodies and intervertebral disk spaces is within normal limits. The pre-and paravertebral soft tissues are within normal limits. Limited intra-abdominal imaging is within normal limits.L1-2: within normal limits without central or neuroforaminal narrowing.L2-3: within normal limits without central or neuroforaminal narrowing.L3-4: within normal limits without central or neuroforaminal narrowing.L4-5: within normal limits without central or neuroforaminal narrowing. Left-sided L5 and S1 laminectomies. L5-S1: within normal limits without central or neuroforaminal narrowing. Mottled and expansile appearance of the left S1 facet with left-sided neuroforaminal narrowing from bony encroachment. Expansile and lytic/sclerotic appearance of the left S1 facet extends to the dorsal aspect of the body of S1 and minimally into the left transverse process, most likely representing postsurgical change. Soft tissues within the surgical site and within the intracanalicular space cannot be evaluated on this examination secondary to lack of contrast. If there is further need for soft tissue evaluation an MRI with contrast may be considered.

Output: 1. Postoperative changes including bilateral pedicular fusion at L5-S1 without gross hardware complication.2. Postoperative change including left-sided L5 and S1 laminectomies with mottled and expansile appearance of the left S1 facet joint, body of S1 and left transverse process as described above.


Instruction: Generate impression based on findings.

Input: Female 16 years old Reason: right knee pain now with swelling and pain. Mild effusion. Pain with full extension MENISCI: Medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: T2 hyperintense bone contusion in the inferior aspect of the patella, with focal thinning of the patellar articular cartilage.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Parameniscal cysts anterior to the lateral meniscus. Even though no discrete tear is evident, meniscal tear is the most likely etiology of parameniscal cyst.2.Patellar contusion suggesting transient dislocation of the patella.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Status post fall from 3 stories with low GCS upon arrival. Now with posturing. Examination redemonstrates extensive previously noted post traumatic findings of the skull fracture, small left frontal subdural and pneumocephalus. There is no evidence of parenchymal hemorrhage or definitive edema on the current exam. The ventricular size and basal cisterns remain similar and within normal limits to prior study and with no evidence of any compromise. No evidence of midline shift or hydrocephalus. No evidence of transtentorial herniation.Extensive scalp hematoma on the left is again identified. New since prior examination this placement of a intracranial pressure monitor with minimal adjacent pneumocephalus.Further evaluation for the extent of brain parenchymal injury with an MRI is again recommended.

Output: 1.No evidence of new hemorrhage or edema. Stable ventricular system and basal cisterns.2.Right frontal ICP monitor.


Instruction: Generate impression based on findings.

Input: History of left choroid plexus papilloma status post full resection, yearly follow up Please note that thin section post contrast images were inadvertently not obtained. Extensive susceptibility artifact along the right temporoparietal region limits evaluation of surrounding structures.There is a stable right parietal approach ventriculostomy catheter, with tip terminating in the left frontal horn. There is redemonstration of encephalomalacia of the left temporoparietal lobe with associated ex vacuo dilatation of the adjacent portions of the left lateral ventricle, unchanged. Ventricular sizes and leftward deviation of the septum pellucidum are also stable. There is no abnormal enhancement to suggest recurrent or residual disease. Foci of susceptibility along the resection cavity are unchanged.Expected vascular flow voids are demonstrated. Persistent enlargement of the palatine tonsils is stable.

Output: 1.No evidence of recurrent or residual tumor.2.Stable ventricular size and ventriculostomy catheter.


Instruction: Generate impression based on findings.

Input: Note that the examination is limited due to patient movement and the lack of intravenous contrast due to poor renal function.There is a mass involving the left posterior cingulate gyrus and corpus callosum measuring 2.2 x 2.2 cm with susceptibility effect compatible with hemorrhagic component and extensive vasogenic edema. Vasogenic edema extends into the left posterior frontal and temporal lobes. There is significant effacement of the left lateral ventricle and up to 6 mm of rightward midline shift. No uncal herniation. No hydrocephalus. There is also a lesion in the right superior frontal gyrus that measures 7 x 8 mm also with extensive surrounding vasogenic edema. There are additional smaller lesions with mild vasogenic edema in the anteroinferior left temporal lobe and right temporal lobe.Atrophy is again noted in the right cerebellum. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1.Limited examination due to patient motion and absence of intravenous contrast. There are at least four lesions which are seen with extensive surrounding vasogenic edema, the largest of which is in the left posterior cingulate gyrus. These lesions are suspected to represent metastatic disease and biopsy can be considered as clinically warranted.2.Mass effect with up to 6 mm of rightward midline shift. No uncal herniation. No hydrocephalus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Syrinx, 6 month follow-up status post Chiari decompression. Cervical: Again seen are postsurgical changes of Chiari 1 decompression including suboccipital craniectomy and C1 laminectomy without significant change since 7/10/2014. There is good CSF space ventrally and dorsally at the C1 level which is improved compared to preoperative MRI. There is mildly diminished CSF space and biphasic flow ventral to the medulla and diminished to a relatively greater degree dorsal to the cerebellum, similar to 7/10/2014. Mild retroflexion of the dens is again seen which contributes to the effacement of the premedullary cistern.There is no cervical cord signal abnormality including no residual syrinx in the cervical cord. Minimal degenerative changes are seen including mild disc bulges at the C4-C5, C5-C6, and C6-C7 levels without significant spinal canal or neural foraminal stenosis at any level in the cervical spine. Vertebral body heights and alignment are maintained. Bone marrow signal is benign.Thoracic: At the mid T3 level there is a tiny residual syrinx which measures 1 to 2 mm and extends to the T7 level similar to prior MRI from 12/18/2014, but markedly improved from prior study from 2/3/2014.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 or neural foraminal stenosis. The paravertebral soft tissues are unremarkable. Again partially visualized is a T2 hyperintense lesion in the posterior right hepatic lobe which is not well evaluated and can be assessed with ultrasound as clinically warranted.

Output: Postoperative changes of Chiari decompression again seen. No residual cervical syrinx. Minimal residual thoracic syrinx measuring 1 to 2 mm is not significantly changed since 12/18/2014 but markedly improved since study from 2/3/2014.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with metastatic breast cancer and dural based metastasis, status post radiation treatment. The previously seen dural based plaque-like enhancing lesion along the clivus is redemonstrated. Since the prior examination, the lesion has decreased in size now measuring up to 15 mm in the craniocaudal dimension (previously 19 mm) and up to 6 mm in thickness (previously 9 mm).No additional new dural enhancing lesions are seen and no pathologic parenchymal enhancement is detected. Scattered foci of white matter T2 hyperintensity are unchanged and nonspecific. No evidence of any abnormal extra-axial fluid collection or acute intracranial hemorrhage is observed. The ventricular system is stable and normal in size.Numerous foci of marrow replacement are redemonstrated involving the entire visualized calvarium and upper upper cervical spine. As before, some of the calvarial lesions violate the cortex. No significant interval change from the prior examination is suspected.

Output: 1.Decrease in size of a plaque-like dural based tumor along the clivus likely representing response to treatment.2.Redemonstrated is extensive osseous metastatic disease without significant interval change.3.No evidence of parenchymal metastatic disease.


Instruction: Generate impression based on findings.

Input: Ms. Hampton is a 45 year old female with a strong family history of breast cancer in two maternal aunts and ovarian cancer in maternal aunt. Patient recently complains of 2 weeks of right breast pain. Recent mammogram performed in April 2016 was normal. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Specifically, no abnormal enhancement is seen in the right breast to address the right breast pain.No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: Evaluation/staging of Crohn's disease, known colonic Crohn's disease and eval small bowel History: abdominal pain, diarrhea ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild apparent hyperenhancement of the ileocecal valve only seen on one sequence and likely due to decompression. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bowel wall thickening and hyperenhancement involving a long segment of the sigmoid colon compatible with active inflammatory bowel disease. Mild upstream constipation may be related to mechanical obstruction.


Instruction: Generate impression based on findings.

Input: Pain Mild osteoarthritic changes of the shoulder without evidence of malalignment or additional significant interval change. Changes are similar to the MR given differences in technique.Incomplete visualization of multiple calcified AP window lymph nodes suggesting old granulomatous disease exposure

Output: Mild to moderate osteoarthritis


Instruction: Generate impression based on findings.

Input: 40 year-old female with a history of fistula. Presents with perirectal pain. PELVIS:UTERUS, ADNEXA: Incidental note is made of a arcuate uterus. Again seen are nabothian cysts. Again seen are left adnexal cystic lesions, appearing decreased in size compare to the prior study, likely representing physiologic ovarian follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a curvilinear focus of increased signal abnormality extending from the 12 o'clock position of the anus to the skin surface along the right medial gluteal crease consistent with the known history of trans-sphincteric perianal formation. There is also extension to the level of the posterior wall of the vagina raising the question of an entero-vaginal fistula. The previously described fluid collection/abscess is no longer visualized. A seton is in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval resolution of the previously described perianal abscess. Persistent perianal transsphincteric fistula formation extending posteriorly to the skin surface of the right gluteal crease as well as anteriorly to the level of the posterior wall of the vagina, which also appears less prominent when compared to the prior study.


Instruction: Generate impression based on findings.

Input: 40 year-old female. Kidney vasculitis history. Antopol-Goldman lesion. Hypoperfusion in the right kidney. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter scattered T2 hyperintense foci in the liver without appreciable enhancement, most likely cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. Normal enhancement and symmetric size of the kidneys. No renal mass. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of renal infarct. Normal size, enhancement, and morphology of both kidneys.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with bilateral upper extremity weakness and dysphagia. Diffuse central T2 hyperintensity is seen within the visualized cervical spinal cord beginning at the C2 level. As noted on prior examinations, the posterior fossa is crowded with a tapered appearance of the cerebellar tonsils which appear to herniate below the foramen magnum.Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. The spinal canal is congenitally slender. Only minimal disc degeneration is seen which causes no significant spinal canal or foraminal stenosis.

Output: Diffuse abnormal signal affects the central portion of the spinal cord beginning at C2 and continuing throughout the remainder of the visualized spinal cord. In the absence of other specific findings, the differential diagnosis is broad and would include infectious, postinfectious or autoimmune phenomena, as well as ischemia. This abnormality could also potentially be related to altered CSF dynamics in the context of Chiari I malformation. A malignant process is felt to be unlikely though definitive evaluation would require postcontrast imaging.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with MRSA endocarditis and continued positive blood cultures despite appropriate therapy. Evaluate for epidural abscess. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement, edema or pathologic enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology. No epidural abnormalities are suspected. The intervertebral discs are preserved with no significant spinal canal or foraminal stenosis seen.Thoracic:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Degenerative fatty endplate signal change is seen anteriorly from the T8 level to the T12 level. At T11, there is also small focus of enhancement at the anterior superior endplate but no osseous destruction and no involvement of the intervertebral disc. A clustering of mildly prominent retrocrural lymph nodes is seen adjacent to T11. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are seen. Intervertebral discs are preserved with no spinal canal or foraminal stenosis. Small bilateral pleural effusions and scattered airspace opacities are noted in the lungs.Lumbar:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Fatty endplate signal change is seen along the inferior endplate of L1 and minimally along the superior endplate of L3. No pathologic marrow enhancement is observed. The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected. The intervertebral discs are preserved with no evidence of spinal canal or foraminal stenosis.

Output: 1.No evidence of an epidural abscess is seen.2.No definite findings of discitis osteomyelitis are noted.3.Fatty endplate signal alteration is demonstrated at multiple levels in the lower thoracic and upper lumbar spine. Such findings are likely chronic and degenerative in nature.4.Only one small focus of abnormal marrow enhancement is seen along the anterior superior endplate of T11. In the context of chronic endplate degenerative signal at multiple additional levels, this finding is favored to represent a more inflammatory phase of the degeneration. Adjacent slightly prominent lymph nodes are, however, seen. If clinical concern for spine infection persists, a follow-up examination can be considered in one to two weeks.


Instruction: Generate impression based on findings.

Input: 69-year-old male with right knee pain MENISCI: There is moderate extrusion of the body of the medial meniscus. Complex tear of the posterior horn of the medial meniscus extending into the body with a fragment flipped into the intercondylar notch posteriorly. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Abnormal bone marrow signal is present in the medial femoral condyle and medial tibial plateau indicating a contusion injury. There is a small, nondisplaced subchondral fracture at the posterior medial tibial plateau.Moderate osteoarthritis affects the knee with subchondral cysts and joint space narrowing. There is greater than 50% thinning of the articular cartilage of the medial facet of the patella with underlying subchondral reactive bone marrow edema. There is greater than 50% thinning of the articular cartilage of the anterior medial femoral condyle. There is about 50% loss of articular cartilage of the lateral femoral condyle and lateral tibial plateau.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Nondisplaced small subchondral fracture of the posterior medial tibial plateau with bone marrow edema of the medial femoral condyle and medial tibial plateau indicating contusion injury.2.Complex tear of the posterior horn of the medial meniscus as described above.3.Degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with genetic susceptibility to tumors (p53 mutation). Evaluate for CNS tumors. No restricted diffusion is seen. No evidence of focal or generalized parenchymal edema or significant mass effect is seen. A few scattered punctate foci of FLAIR hyperintensity are unchanged and remain nonspecific. No pathologic parenchymal or extra-axial enhancement is detected. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: No evidence of intracranial tumor or any other significant intracranial abnormality.


Instruction: Generate impression based on findings.

Input: refractory headache. Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is no evidence venous congestive encephalopathy.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D MRV brain phase contrast technique and post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate hypoplastic left distal transverse and sigmoid sinus. The right transverse and sigmoid sinus appear to be normal. Forward flow through bilateral transverse and sigmoid sinuses.There were linear low signal intensities within the dural sinuses especially bilateral transverse and sigmoid sinuses. These are most likely indicating fibrous septae, however, linear thrombus cannot be completely excluded. Normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.3. No evidence of venous congestive encephalopathy.4. Patent major dural sinuses with maintained forward flow. Left distal transverse sinus and sigmoid sinus appear to be hypoplastic as described above.


Instruction: Generate impression based on findings.

Input: Tinnitus. Right asymmetric sensorineural hearing loss. The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears appear within normal limits normal with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle cisterns bilaterally or within the internal auditory canals.Mastoid air cells are clear. There is no destructive petrous lesion. There is no brainstem abnormality. Major vascular structures appear grossly unremarkable in course and caliber.Limited assessment of the brain demonstrate no evidence of intracranial mass or mass effect. Trace maxillary mucosal thickening is present.

Output: There is no mass or abnormal enhancement involving the cerebellopontine angles, internal auditory canals, or inner ear structures.


Instruction: Generate impression based on findings.

Input: Reason: liver mass, pathology unclear as to HCC vs cholangio (mixed), old MRI poor quality from outside 4/2016 that is uploaded, evaluate for satellite lesions and portal lymphadenopathy (ie resectability) History: none ABDOMEN:LIVER, BILIARY TRACT: There is hypertrophy of the caudate and left hepatic lobe with deepening of the fissures, suggestive of chronic liver disease.There is a lesion in segment 5 which appears increased since the prior exam and measures 4.6 x 4.8 cm (801/54). This lesion is slightly hyperenhancing on arterial phase images and demonstrates washout on delayed phases, a pattern suggestive of hepatocellular carcinoma. This lesion was present on the prior MRI, however no corresponding dominant lesion is identified on the CT of 11/24/2015.A previously biopsied hypoenhancing segment 4A lesion measures 4.7 x 3.3 cm (801/73), unchanged. This lesion is hypoenhancing on all phases with increased capsular retraction.There is an additional adjacent hypoenhancing segment 4A lesion in the hepatic dome (11/16) with diffusion restriction, similar in size to the prior MRI.There are numerous additional hypoenhancing T2 hyperintense lesions throughout both hepatic lobes which are suspected to represent metastases. These lesions are slightly less apparent than the prior MRI. These lesions correspond to hypodense lesions on the CT from 11/24/2015SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral perinephric stranding is unchanged.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node measuring 3.0 x 1.6 cm (14/23).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Median sternotomy wires.

Output: 1.A biopsied segment 4A lesion is unchanged in size with capsular retraction. An additional dominant segment 5 lesion is slightly increased in size. There are findings suggesting chronic liver disease and in this setting, this lesion demonstrates enhancement on arterial phase and washout, suggestive of hepatocellular carcinoma or a hepatocellular carcinoma variant such as a cholangiohepatoma. Although there is capsular retraction of the segment 4A lesion, the enhancement pattern is not consistent with cholangiocarcinoma.2.Numerous hypoenhancing lesions in both hepatic lobes are suspected to represent metastasis. These are slightly less apparent than the prior MRI, which could be due to differences in technique. These lesions correspond to hypodensities on the CT of 11/24/2015.3.Enlarged portacaval lymph nodes.


Instruction: Generate impression based on findings.

Input: Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 111 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 53 ml (normal range 31+/-10), the LV mass index is 35 g/m2 (normal range 67+/-11), and the LV mass is 60 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. There is a secundum type atrial septal defect (24x22mm) with a Qp: Qs of 3. There is 104ml of left to right flow through the atrial septal defect. Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 184 ml/m2 (normal range 69+/-14), the RVEDV is 314 ml (normal range 110+/-24), the RV end systolic volume index is 97 ml/m2 (normal range 22+/-8), and the RVESV is 165 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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 moderately dilated in size (36 mm)Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%2. The right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%3. Large secundum type atrial septal defect with Qp/Qs 3 with left to right shunting only during resting conditions.4. Moderately dilated main pulmonary artery.When compared to the prior study, her LV function and size are unchanged. Her RV is a little larger and her left to right shunting has increased.


Instruction: Generate impression based on findings.

Input: Concern for left knee septic arthritis and osteomyelitis, knee erythema and edema and refusal to bear weight with fever MENISCI AND LIGAMENTS: The cruciate and collateral ligaments are intact. The medial and lateral menisci are normal in morphology and signal characteristics.BONE AND MARROW: Bone marrow signal characteristics are normal.SYNOVIUM: Mild enhancement of synovium, which may be reactive or infectious.MUSCULATURE: Normal muscle bulk without abnormal enhancement of the muscles. ADDITIONAL

Output: 1. Extensive anterior soft tissue swelling with cutaneous pustule with underlying fluid collection with rim enhancement.2. No evidence of osteomyelitis.3. Small joint effusion with mild enhancement of synovium, which may be reactive or infectious.


Instruction: Generate impression based on findings.

Input: Possible cerebellar infarct. There is a moderate degree of cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. Aside from a mega cisterna magna, the cerebellum appears to be unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions and mucosal thickening in the right maxillary, right frontal, and left sphenoid sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Probable chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings suggestive of sinusitis.


Instruction: Generate impression based on findings.

Input: Reason: assess if changes in the spinal cord r/o radiculopathy, DJD History: loss of sensation in lower extremity , full strength Five lumbar type vertebral bodies are presumed to be present. There is mild compression fracture involving the superior endplate of the T12 vertebral body with evidence of edema. There are also Schmorl's nodes involving the inferior L2 and superior L3 endplates with associated edema. The Schmorl's node involving the superior endplate of L3 appears to be larger than on CT from 8/22/2016. There is also a Schmorl's node involving the superior L1 endplate without edema. There is minimal retrolisthesis of L5 on S1. Alignment is otherwise maintained. No suspicious osseous lesions are definitively appreciated within the limits of noncontrast study. The conus medullaris is at the lower limits of normal at the L2-L3 level.Multilevel degenerative changes are seen, as described below:T12-L1: Disc desiccation and minimal bulge. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. There is minimal narrowing of the spinal canal. There is also mild bilateral neural foraminal stenosis.L3-L4: Disc desiccation and minimal bulge. Minimal right neural foraminal narrowing and mild lateral displacement of the extraforaminal right L3 nerve root. No spinal canal or left neural foraminal stenosis.L4-L5: Mild disc bulge, asymmetric to the right. Bilateral facet arthropathy. There is mild left and minimal right narrowing of the neural foramina.L5-S1: Severe loss of disc height with vacuum phenomena and minimal retrolisthesis. Mild disc bulge and endplate osteophyte. There is also bilateral facet arthropathy, worse on the left. No spinal canal stenosis. There is mild to moderate, left worse than right, neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Mild compression fracture involving the T12 vertebral body superior endplate with edema indicating recent loss of height. There are also Schmorl's nodes at multiple levels including ones with associated edema at the L2 and L3 levels.2. Multilevel degenerative changes, relatively worse at the L5-S1 level where there is mild to moderate bilateral, left relatively worse than right neural foraminal stenosis. There is also minimal narrowing of the spinal canal at the L2-L3 level. There is otherwise no significant spinal canal stenosis at any level. Additional levels as above.3. No evidence of metastatic disease within the limits of noncontrast study.


Instruction: Generate impression based on findings.

Input: 76 years male with tinnitus.Provider Name: RIMAS V. LUKAS BRAINBilateral subdural effusions are present related to age-related atrophy. No midline shift or herniation.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. Bilateral periventricular and subcortical white matter T2/FLAIR hyperintensity which are likely vascular related; additional areas of T2/FLAIR hyperintensity are present within the basal ganglia, thalami and brainstem also most likely vascular related.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits elongation the AP dimension of the eyes associated with scleral thickening posteriorly. The eyeball lenses are thin. IACThere is a lesion within the posterior aspect of the right internal auditory canal which demonstrates intermediate T1 and T2 signal intensity with enhancement measuring 4.4 x 3.9 mm (series 19, image 12). This is stable compared to prior exam. The left internal auditory canal is normal. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns.

Output: 1.Stable small enhancing lesion within the right internal auditory canal likely a vestibular schwannoma.2.Multiple patchy lesions in the brainstem, thalami and basal ganglia are most likely vascular related.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Small Bilateral subdural effusions are present likely related to age-related atrophy.5.Bilateral staphylomas.


Instruction: Generate impression based on findings.

Input: Moyamoya disease [I67.5] / Neurofibromatosis, unspecified [Q85.00], Reason for Study: ^Reason: is there any evidence of ischemia History: girl with NF1 and moyamoya and renal artery stenosis Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Previously recognized multifocal small, somewhat nodular and somewhat patchy high signal intensity lesions on FLAIR/T2 at bilateral internal capsules, thalami, cerebral peduncle, left inferomesial cerebellar hemisphere and right internal capsule genu appear to be stable since prior scan. There is no new abnormal signal intensity lesion seen on today's 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. Small left parietal scalp nodule, no change in size and MR characteristics since prior scan.The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.No change of right maxillary sinus retention cyst.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the distal ICA beyond the level of the right ophthalmic artery origin. The right MCA appears to be reconstituted via collateral vessels but the luminal diameter of the reconstituted right MCA is very small, unchanged since prior scan. The left ICA, MCA and bilateral ACAs appear to be normal without showing any evidence of luminal irregularity.Vertebrobasilar system shows hypoplastic left distal vertebral artery, otherwise unremarkable.There is no evidence of intracranial arterial aneurysm.Bilateral Pcom arteries and Acom artery are patent.

Output: 1. Re-demonstration of multifocal parenchymal high signal intensity lesions on FLAIR/T2 images, no change since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion. No new abnormal signal intensity.3. Complete occlusion of the distal right ICA with reconstitution of the right MCA via collateral vessels, no change since prior scan. Unremarkable left ICA, bilateral ACAs, left MCA and vertebrobasilar system.


Instruction: Generate impression based on findings.

Input: Reason: 20 yo M with staph aureus bacteremia, r/o osteomyelitis History: fever There is subtle T2/STIR hyperintensity along the lateral aspect of the first distal phalanx, compatible with bone marrow edema.There is minimal surrounding enhancement within the soft tissues immediately adjacent to the distal phalanx, without definite enhancement within the bone itself. Additionally, there is subtle cortical indistinctness and intermediate T1 signal intensity corresponding to this region in the lateral aspect of the first distal phalanx. The remainder of the imaged forefoot/midfoot is normal. There is normal signal within the bone marrow in overlying soft tissues. There is minimal soft tissue edema within the ventral soft tissues of the foot, without focal fluid collection or abscess. No acute fracture is present.

Output: Findings suggestive of early osteomyelitis along the lateral aspect of the distal first phalanx.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with lumbar radiculopathy, spondylolysis and spondylolisthesis. Grade 1 anterolisthesis of L5 relative to S1 is unchanged. Associated bilateral L5 spondylolysis is also redemonstrated.Elsewhere, spinal alignment is anatomic. Vertebral body height is preserved. Scattered areas of degenerative endplate marrow signal abnormality are seen.The visualized spinal cord, conus and cauda equina are unremarkable except as discussed below.L1-2: Mild left foraminal and far lateral disc bulging which is probably slightly progressed from prior. No significant spinal canal or neuroforaminal stenosis. L2-3: Facet hypertrophy. Progressive loss of disc height with progressive mild disc bulging. Along with prominent dorsal epidural fat, these findings contribute to a mild narrowing of the spinal canal but no evidence of nerve root impingement. Moderate right and mild left foraminal narrowing, progressed. L3-4: Facet hypertrophy. Progressive loss of disc height with slightly progressed disc bulging. Along with prominence of the dorsal epidural fat these findings contribute to a mild narrowing of the spinal canal but no evidence of nerve root impingement. Moderate right foraminal narrowing, progressed. Mild left foraminal narrowing, unchanged. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild disc bulging without significant change. Mild lateral recess narrowing and mild lateral foraminal narrowing, unchanged. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Slight progressive loss of disc height with disc bulging and disc uncovering similar to prior. No significant spinal canal stenosis. Moderate to severe left and mild right neuroforaminal narrowing without change.

Output: 1.Grade 1 anterolisthesis of L5 relative to S1 with bilateral L5 spondylolysis, unchanged.2.Mild progression of degenerative disc disease at multiple levels as discussed above. These findings result in at most mild narrowing of the spinal canal, most notable at L2-3 and L3-4.3.Moderate to severe neuroforaminal narrowing at L5-S1 is unchanged. Scattered additional areas of mild to moderate foraminal narrowing are also seen as above.


Instruction: Generate impression based on findings.

Input: 61-year-old woman with history of cellulitis, evaluate for osteomyelitis. There is significant subcutaneous soft tissue edema seen circumferentially around the lower half of the left leg within the area of ulceration and overlying bandage material along the anteromedial aspect of the distal tibia. There is no abnormality in the signal of the underlying tibia. There is no discrete fluid collection identified and no significant abnormal enhancement.A focus of abnormal signal in the lateral patellar facet is likely related to articular cartilage defect with a subchondral cyst.

Output: Soft tissue edema with ulceration over the anteromedial lower leg, but no evidence of osteomyelitis or underlying abscess.


Instruction: Generate impression based on findings.

Input: Diagnosis: Muscle weakness (generalized)Muscle weakness (generalized)Diagnosis Edits: Clinical question: r/o acute ischemic infarctSigns and Symptoms: right sided weaknessComments: GFR =14 MRI of the brainThere is a focus of diffusion restriction centered along the posterior limb of the left internal capsuleThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Similar lesions are also present along the brainstem.Punctate foci of SWI signal loss are present in the right cerebellum and right thalamus. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The right ICA is smaller compared to the left ICA throughout its course. The right A1 segment is smaller than the right A1 segment. There is a 2.5 mm ACOMA aneurysm present.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:The great vessel origins from the aortic arch and the aortic arch are not included on this exam. There is irregular stenosis at the proximal right ICA associated with decrease in caliber along the cervical right ICA. This suggests a >70% stenosis at the proximal right ICA. The imaging is somewhat degraded by pulsation. On the basis of NASCET criteria there is no significant stenosis at the left carotid bifurcation. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a small acute cerebral infarction centered along the left posterior limb of internal capsule.2.Findings suggest a >70% stenosis at the proximal right ICA. It is not adequately imaged on this exam. Additional investigation with CTA or with ultrasound may be of further benefit.3.There is a 2.5mm ACOMA aneurysm present.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Punctate lesions in the brain stem and thalami are likely related to prior lacunar infarcts.6.Microhemorrhages are present in the right cerebellum and the right thalamus. They are non-specific but could relate to hypertension.


Instruction: Generate impression based on findings.

Input: 41 year old with proven left DCIS presents for additional imaging of left breast. Recent breast MRI (10/7/15) demonstrated an extensive non-mass enhancement in the left breast anteriorly from the biopsy site. Two spot magnification views of the left breast were performed digitally. There are loosely clustered calcifications at anterior 12:00 position in the left breast, likely corresponding to the area of clumped non-mass enhancement on the MRI. With focused ultrasound, biopsy changes are detected at 1:00 position, 3 cm fro nipple. No other definite abnormal findings are detected with this ultrasound study.

Output: Loosely clustered calcifications at anterior 12:00 position in the left breast, likely corresponding to the area of clumped non-mass enhancement on the MRI. Stereotactic biopsy of those calcifications are recommended. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 54 year old male. Right knee pain and swelling. Evaluate for right knee medial meniscus tear. MENISCI: Blunting of the free edge of the posterior horn of the medial meniscus consistent with a partial radial tear. There is underlying globular signal abnormality in this horn consistent with intrasubstance degeneration. Lateral meniscus is normal in signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: Diffuse thinning of the patellofemoral compartment cartilage without focal defect. Mild thinning of the medial tibiofemoral compartment cartilage.Bone marrow signal intensity is within normal limits.LIGAMENTS: ACL, PCL, MCL, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Partial radial tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with hypocortisolism. Assess for pituitary adenoma. The overall size pituitary gland is within normal limits. No discrete pituitary lesions are seen. The posterior pituitary bright spot is slightly prominent but this is likely within normal limits. The pituitary stalk sits at midline and enhances normally. No abnormalities of the cavernous sinuses or Meckel's caves are suspected.No suprasellar lesions are seen. The visualized portions of the optic apparatus are unremarkable. Limited views of the brain demonstrate scattered white matter T2 hyperintense lesions which are nonspecific.

Output: No specific lesions of the pituitary gland are identified to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus [346.90], Reason for Study: ^Reason: Hx of migraine - but worsening headache. Check for mass lesion/AVM. Other test for MRA History: Headache No evidence of acute ischemic or hemorrhagic lesion on the 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, or abnormal contrast enhancement. There is a developmental venous anomaly on the right basal ganglia draining through the caudate vein. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.There is no evidence of intracranial arterial aneurysm. There is no evidence of significant luminal stenosis or irregularity of intracranial arterial system.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Developmental venous anomaly on the right basal ganglia.3. No evidence of intracranial arterial aneurysm. No intracranial arterial luminal stenosis.


Instruction: Generate impression based on findings.

Input: 38 year old man with history of a mechanical aortic valve replacement in 2009, recent TIA like symptoms and discordant left ventricular function on recent transthoracic echocardiogram versus transesophageal echocardiogram. He was referred for cardiac MRI to evaluate LV function. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 224 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 68 g/m2 (normal range 85+/-15), and the LV mass is 158 g (normal range 164+/-36). There is mild left ventricular hypertrophy (IVSd=11mm). There are no regional wall motion abnormalities present. There is a focal area of patchy late gadolinium enhancement in the basal inferolateral and anterolateral walls which is atypical for prior myocardial infarction. The native myocardial T1 time is borderline elevated in the mid ventricular septum (1060ms); however, in the basal inferolateral wall, the native myocardial T1 time is significantly elevated (1301ms). These findings are abnormal but not specific for a particular disorder. The differential diagnosis includes early cardiac amyloidosis, myocarditis, and other infiltrative processes. Repeat cardiac MRI study in 6-12 months to assess for changes may help clarify the diagnosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 226 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation. Posterior mitral valve leaflet motion is somewhat restricted.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size with hyperdynamic systolic function (EF = 69%) with mild concentric left ventricular hypertrophy (IVSd=11mm). There is a focal area of transmural, patchy late gadolinium enhancement in the basal inferolateral and anterolateral walls. The pattern is not consistent with prior myocardial infarction but the differential diagnosis includes early cardiac amyloidosis, myocarditis, and other infiltrative processes. Repeat cardiac MRI study in 6-12 months to assess for changes in this area may help clarify the diagnosis. 2. Normal right ventricular size with normal systolic function.3. Moderate biatrial dilation.4. Mild to moderate mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is mild undersurface fraying of the supraspinatus tendon which is superimposed upon mild tendinopathy. There is no evidence of a full-thickness rotator cuff tear.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint.Incidental note is made of an os acromiale.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is moderate to severe osteoarthritis of the glenohumeral joint with extensive subchondral cystic change and cartilage loss of the glenoid. BICEPS TENDON: There is mildly increased signal within the intra-articular portion of the long head biceps tendon reflecting tendinopathy although no full-thickness tear is appreciated ADDITIONAL

Output: 1. Mild undersurface fraying of the supraspinatus tendon with associated tendinopathy however there is no evidence of full-thickness rotator cuff tear.2. Moderate to severe osteoarthritis of the glenohumeral joint with extensive subchondral cystic change.3. Biceps tendinopathy.


Instruction: Generate impression based on findings.

Input: 39 year old woman with palpitations, near syncope, referred for evaluation of underlying infiltrative or inflammatory disease. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), the LVEDV is 224 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 98 ml (normal range 31+/-10), the LV mass index is 50 g/m2 (normal range 67+/-11), and the LV mass is 118 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a small amount of epicardial late gadolinium enhancement involving the basal inferior and inferolateral walls to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. The presence of late gadolinium enhancement in this region has been described in individuals with mitral valve prolapse. No evidence of myocardial iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 199 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 95 ml (normal range 35+/-13). There are no RV regional wall motion abnormalities.Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is bileaflet mitral valve prolapse with 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 56%. There is a small amount of epicardial late gadolinium enhancement involving the basal inferior and inferolateral walls to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. The presence of late gadolinium enhancement in this region has been described in individuals with mitral valve prolapse.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%.3. Mild dilation of the main pulmonary artery.4. Bileaflet mitral valve prolapse with mild mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Myoclonic encephalopathy: worsening myoclonus. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small area of encephalomalacia in the left occipital lobe. There is diffuse cerebral white matter T2 hyperintensity bilaterally. There are a few scattered punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is mild diffuse cerebral and cerebellar volume loss, especially posteriorly. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There are secretions in the left frontoethmoid recess.Brain MRA: There is an unchanged 5 mm diameter saccular aneurysm at the right middle cerebral artery bifurcation with a 3 mm wide neck. There is also an unchanged 6 mm long basilar tip aneurysm with a 3 mm wide neck and a mildly irregular contour. There is no evidence of significant steno-occlusive lesions.Neck MRA: There is an apparent high grade stenosis at the origin of the right vertebral artery. Otherwise, there is no evidence of significant steno-occlusive lesions elsewhere in the major neck arteries. There is a right thyroid nodule that measures up to at least 45 mm.

Output: 1. Small chronic left occipital lobe infarct, but no evidence of acute acute infarct. Nonspecific diffuse cerebral white matter T2 hyperintensity bilaterally may represent chronic small vessel ischemic disease and scattered punctate foci of susceptibility effect in the bilateral cerebral hemispheres may represent chronic microhemorrhages, perhaps related to amyloid angiopathy. 2. Mild diffuse cerebral and cerebellar volume loss, especially posteriorly, may be a manifestation of myoclonic encephalopathy.3. Unchanged subcentimeter right middle cerebral artery and basilar tip aneurysms.4. Apparent high grade stenosis at the origin of the right vertebral artery. Otherwise, no evidence of significant steno-occlusive lesions in the head and neck arteries.5. A nonspecific right thyroid nodule measures up to at least 45 mm. Thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Parkinson's disease [G20], Reason for Study: ^Reason: DBS protocol History: DBS protocol No evidence of acute hemorrhagic lesion.Since this scan does not include diffusion weighted image, acute ischemic stroke cannot be evaluated. However, there is no evidence of abnormal high signal intensity on T2 weighted image.Underlying brain shows mild brain atrophy, otherwise unremarkable. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening and opacifications of bilateral maxillary sinuses, ethmoid sinuses, sphenoid sinus and frontal sinus indicating pansinusitis. There is tubular T2 high signal lesion in the right inferior nasal meatus extending toward nasopharynx which could represent nasal polyp, thus clinical examination or dedicated imaging can be considered if clinically warranted.

Output: 1. No evidence of acute hemorrhagic lesion.2. Minimal brain atrophy, otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: Right hip pain, s/p labral repair evaluate for re tear of labrum PLEASE INJECT WITH KENALOG 40MG AT TIME OF ARTHROGRAM History: Right hip pain ACETABULAR LABRUM: There is a small fluid-filled linear cleft in the anterior superior right labrum, , seen best on series 801 image 11.ARTICULAR CARTILAGE AND BONE: There is prominence of the anterior femoral head/neck junction and approximately 71 degrees. The articular cartilage appears normal for the patient's age.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Small anterior superior labral tear.2. Prominence of the anterior femoral head/neck junction compatible with a cam deformity.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 2.6 x 4.5 x 3.9 cm Peripheral Zone: The peripheral zone is mildly thinned and diffusely low on T2-weighted imaging. No discrete lesion.Central Gland: In the right anterior base there is a 1.5 x 1.3 cm focus of signal abnormality on ADC (series 503/384) associated with increased signal intensity on high B value DWI images (series 509/400), faint T2-weighted mild hypointensity (series 901/20) and associated with early arterial enhancement and relative washout (series 1 701/2 730 and 2777). This signal abnormality is adjacent to the bladder base and has a broad interface with the adjacent prostate margin without frank tumor extension.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No definite extraprostatic extension. See description of right anterior base lesion above.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right anterior base 1.5 cm lesion is suspicious for prostatic adenocarcinoma and is amenable to MRI/ultrasound fusion biopsy.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial hemorrhage, abscess, mass. Signs and symptoms going altered mental status, short-term memory loss. Non-infused head CT:The examination again demonstrates extensive subcortical and periventricular diffuse areas of low-attenuation with no appreciable interval change since prior MRI examination of 3 -- 29 -- 11. Findings likely represent post therapy changes. A shunted right lateral ventricle with no change in the size of ventricular system since prior study. Prominence of cortical sulci for patient's stated age concerning for underlying parenchymal volume loss.No evidence of hemorrhage, edema, mass effect or midline shift. No hydrocephalus.

Output: 1.Shunt in the right lateral ventricle and stable ventricular system since prior exam.2.Post therapy changes of bihemispheric white matter.3.No detectable acute intracranial findings.4.Extensive opacification of paranasal sinuses with fluid levels within bilateral maxillary sinuses.


Instruction: Generate impression based on findings.

Input: a 53 years old female with history of coronary artery disease with a CABG in 2006 (LIMA to CX, RIMA to LAD) and 2008 (SVG to DG, RI and OM1) + PCI to LAD prox+mid and LM into CX. Now presenting with increasing angina, referred to cardiac MR for evaluation of ischemia. MEDICATIONS: Aspirin, Clopidogrel, Atorvastatin, Metoprolol, Amlodipine, Nitroglicerin First Pass PerfusionDuring hyperemia, there is a severe and extensive perfusion defect which involves the entire ventricle except the basal infero-septum and apical lateral wall. Viability/ Myocardial ScarThere was a small amount of non-transmural late gadolinium enhancement noted in the basal inferolateral segment suggesting that there is prior myocardial infarction. This segment has an intermediate probability of viabiltiy. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. There is akinesis of the inferolateral wall. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 82 ml (normal range 31+/-10), the LV mass index is 49 g/m2, and the LV mass is 101 g. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. Axillary lymphadenopathy is 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. Extensive myocardial ischemia as described above.2. A small, non-transmural myocardial infarction is noted in the basal inferolateral wall. This segment has an intermediate probabilty of viability. The remainder of the myocardium is free of myocardial infarction and is highly likely to be viable.3. Normal LV size and systolic function (LVEF 50%) with akinesis of most of the inferolateral wall.4. Normal RV size and systolic function (RVEF 57%).5. Mild biatrial dilation.6. Mild mitral and tricuspid regurgitation.7. Extra-cardiac findings as above. Findings conveyed to Dr. Nathan.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer to the spine, status post MVA with neck and back pain. For the purposes of counting, L5 is sacralized. There is widespread metastatic disease involving the imaged axial skeleton, with multiple vertebral compression fractures. In particular, there are severe compression deformities at T3 and T4, with focal kyphotic deformity and epidural extension of tumor, which results in spinal canal narrowing, as well as epidural extension and/or retropulsion of bone and/or tumor at T8 through T10 and T2, with impingement upon the thecal sac. There appears to be mild, but diffuse high signal within the lower thoracic spine cord. The paravertebral soft tissues are unremarkable.

Output: Widespread metastatic disease involving the imaged axial skeleton, with multiple vertebral compression fractures. In particular, there are severe compression deformities at T3 and T4, with focal kyphotic deformity and epidural extension of tumor, which results in spinal canal narrowing, as well as epidural extension and/or retropulsion of bone and/or tumor at T8 through T10 and T2, with impingement upon the thecal sac. Apparent mild, but diffuse high signal within the lower thoracic spine cord may represent edema. Please refer to the recent cervical spine MRI report for additional details.


Instruction: Generate impression based on findings.

Input: AMS. There is no evidence of acute intracranial hemorrhage or infarct. There are scattered areas of T2 hyperintensity in the cerebral white matter, which are nonspecific. There are multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is no evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants. CERVICAL SPINE

Output: 1. Multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres appear to correspond to treated metastases. However, assessment for metastatic disease is otherwise limited due to the lack of intravenous contrast.2. Multilevel degenerative spondylosis of the cervical spine and signal abnormality in the dens, which is otherwise incompletely characterized, but may be inflammatory in nature. However, assessment for metastatic disease is otherwise limited due to the lack of intravenous contrast.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Episodic vertigo and nystagmus. BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. Specifically, there is no brainstem or cerebellopontine angle lesion. There is no midline shift, herniation or abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. Cerebellar tonsils are in normal position without evidence of Chiari malformation. The major cerebral flow voids are intact. There is minimal, worse on the right, mucosal thickening in the paranasal sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable. The adenoids are enlarged.INTERNAL AUDITORY CANALS: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.

Output: 1.No evidence of intracranial mass, hemorrhage, or infarct.2.No abnormal mass or enhancement involving the brainstem, cerebellopontine angle cisterns, or inner ears.


Instruction: Generate impression based on findings.

Input: Male, 4 years old. Reason: eval for mass, trauma History: AMS There is mild to moderate enlargement of the lateral ventricles with a wavy configuration consistent with periventricular infarction. Findings correlate with prior MRI examination. There is evidence of cavum vergae which is stable from the previous exam. There is no evidence of intracranial hemorrhage, mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Findings compatible with periventricular leukomalacia, no acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: 19-year-old male with a history of lupus and left lower extremity osteonecrosis presents with worsening pain. Evaluate for AVN of the right knee. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Note is made of serpentine signal abnormality in the medial and lateral femoral condyles, most pronounced along the weightbearing surface of the lateral femoral condyle, consistent with avascular necrosis. There is extensive bone marrow edema type signal abnormality within the lateral femoral condyle.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Avascular necrosis of the distal right femur.


Instruction: Generate impression based on findings.

Input: Female, 16 years old, with pseudotumor cerebri, double vision and headaches. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.The pattern of parenchymal enhancement is within normal limits. No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The dural venous sinuses and deep venous structures are patent. The left transverse sinus is smaller than the right, but this is a common anatomic variation.Signal intensity of the bone marrow is unremarkable. Paranasal sinus mucosal inflammation is seen.

Output: 1.Unremarkable evaluation of the brain parenchyma.2.No evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: 60-year-old female with history of HCC status post TACE of a segment eight lesion (2011) ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with hypertrophy of the left lobe liver and fissural prominence. There is an ablation cavity in hepatic segment eight. There is a nonspecific small focus of arterial blush with indistinct margins measuring 0.7 x 1.0 cm adjacent to but separate from the resection cavity. No appreciable washout is evident. Delayed post contrast sequence demonstrates peripheral, continuous thin rim of enhancement around the ablation cavity with associated low T1 and mild T2 signal compatible with fibrosis/scarring. Nodular focus along the posterior aspect of the the ablation cavity (series 8, image 31) without associated arterial enhancement is favored to represent scarring but merits attention at follow up imaging.. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged cyst in the interpolar left kidney.RETROPERITONEUM, LYMPH NODES: Unchanged prominent periportal lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace bilateral pleural effusions.

Output: 1.Nonspecific faint blush of arterial enhancement adjacent but separate from the ablation cavity as described above. This finding merits a follow-up in 6 months.


Instruction: Generate impression based on findings.

Input: 48 year old woman with sarcoidosis, referred for interval evaluation of cardiac involvement. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function . The overall LV ejection fraction is 49%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 158 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10). Normal wall motion. There is late gadolinium enhancement in the basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Compared to prior MRI on 11/13/13, the extent of LGE has decreased.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 61 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall bilateral pleural effusions and atelectasis. Thoracic adenopathy. 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 normal in size with mildly reduced systolic function . The overall LV ejection fraction is 49%.2. There is late gadolinium enhancement in the basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%.4. Compared to prior MRI on 11/13/13, the LV and RV function has decreased and the extent of LGE has decreased.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.