Instruction: Generate impression based on findings.

Input: Clinical question: History of spinal osteomyelitis c/b neutropenia on Oxacillin; assess for interval change. Signs and symptoms: Osteomyelitis assess for change. Pre and post enhanced lumbar spine MRI: Examination status post anterior fusion with maintained normal anatomical alignment similar to prior exam. There is evidence of placement of intervertebral disc spacers at L4-L5 and L5-S1 disc levels without change in the position or signal intensity.T2/T2 STIR hyperintensity of L4, L5 and S1 vertebrae are again demonstrated and without convincing evidence of interval change.On post enhanced images enhancement of L4, L5 and S1 vertebral bodies are again noted without significant change of their extent however the enhancement may be slightly less conspicuous since prior study.There is however interval decreased epidural thickening and enhancement posterior to L5-S1 and S2 levels since prior exam suggestive of interval improvement.Extensive spinal soft tissue thickening is again noted. Prevertebral soft tissue thickening with enhancement anterior to the vertebral body of L5 demonstrate interval improvement and measuring approximately 17 mm compared to prior study measurement of 25 to 28 mm. A vertically oriented long thin rim enhancing collection anterior to the vertebral bodies of L4 and extending inferiorly to L5-S1 disc level is again noted without convincing evidence of interval change. Finding is more likely to represent a postoperative postoperative change however possibility of an abscess cannot be entirely excluded.There is no evidence of spinal stenosis at any level and no detectable abnormal enhancement of the cord, conus or the cauda equina.

Output: 1.Postoperative changes of anterior fusion at the L4, L5 and S1 levels with stable normal anatomical alignment of vertebral column.2.Marrow signal T2/T2 STIR hyperintensity of L4, L5 and S1 levels demonstrate no significant change, however the enhancement appears slightly less conspicuous.3.There is noticeable interval decreased epidural thickening and enhancement posterior to the vertebral bodies of L5 through S2 since prior exam and interval decrease in prevertebral soft tissue thickening suggestive of interval improvement.4.A vertically oriented thin rim-enhancing lesion anterior to L4 to S1could represent post operative finding without interval change. Possibility of an abscess however cannot be entirely excluded.5.There is no detectable abnormal enhancement of the cord, conus or the cauda equina.


Instruction: Generate impression based on findings.

Input: Chiari malformation with headaches and back pain. Cervical Spine: There is an enlarged and partially-empty sella. The cerebellar tonsils are low lying and 9 mm, there is apparent low obex positioning, and there is paucity of cerebrospinal fluid flow across the foramen magnum, both anteriorly and posteriorly. There is no evidence of syringohydromyelia. There is straightening of the normal cervical lordosis. The vertebral body heights and intervertebral disc spaces are grossly preserved. There bone marrow signal is unremarkable. There is mild degenerative spondylosis in the cervical spine, which is most pronounced at C3-4, where there is a prominent disc osteophyte complex that slightly indents the spinal cord. The paraspinal soft tissues are unremarkable. Thoracic Spine: The alignment of the thoracic spine is normal. The vertebral body heights and intervertebral disc spaces are preserved. There are no significant degenerative changes. There is no spinal canal stenosis or neural foraminal narrowing in the thoracic spine. The vertebral bone marrow signal is normal. The spinal cord signal and morphology is normal. The paraspinal soft tissues are unremarkable.

Output: 1. Partially-empty sella, low lying cerebellar tonsils and obex position, and paucity of cerebrospinal fluid flow across the foramen magnum, suggestive of pseudotumor cerebri perhaps superimposed upon Chiari 1 malformation.2. No evidence of syringohydromyelia. 3. A disc osteophyte complex at C3/4 slightly indents the spinal cord.


Instruction: Generate impression based on findings.

Input: Wrist pain and contralateral Kienböck's malacia. LIGAMENTS: Limited view of the ligament complexes of the carpal bones are seen without intra-articular contrast. Within this limitations, no specific evidence of ligamentous injury.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: The tendons appear intact without signal change or significant edema.BONES: There is minimal negative ulnar variance. The lunate demonstrates tiny proximal degenerative cysts without edema or specific evidence of osteonecrosis. There is mild medial subluxation of the lunate.ADDITIONAL

Output: Minimal negative ulnar variance with degenerative lunate cysts yet no specific radiographic evidence of avascular necrosis.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with acoustic neuroma, presenting with tinnitus. An 8 x 7 x 6 mm enhancing nodule is present contained within the left IAC. No involvement of the CP angle cistern is demonstrated. No additional enhancing lesions are observed. Ventriculomegaly is again seen, likely reflecting underlying volume loss.

Output: Findings compatible with a left IAC schwannoma.


Instruction: Generate impression based on findings.

Input: Pain. Continued pain after near fall on 2/22/2015. MENISCI: There is a complex tear extending from the inferior to superior articular surface of the body of the lateral meniscus with extension into the posterior horn. There is minimal fraying of the inner edge of the medial meniscus, which is otherwise intact. ARTICULAR CARTILAGE AND BONE: There is increased T2 signal in the posterior lateral tibial plateau compatible with edema.There is near full thickness or full thickness loss of articular cartilage along the anterior and far posterior lateral femoral condyle. There is near full thickness to full-thickness thinning of the articular cartilage of the posterior lateral tibial plateau. Generalized thinning is noted of the weight-bearing portion of the medial femoral condyle articular cartilage. There is heterogeneity and near full thickness degeneration of the lateral facet of the patella articular cartilage.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tear of body and posterior horn of the lateral meniscus.2. Chondromalacia as described above.


Instruction: Generate impression based on findings.

Input: Ms. Flores is a 37 year old female with known right breast cancer undergoing neoadjuvant chemotherapy. She presents today for MRI evaluation to assess for response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.A vascular port is present in the left medial chest wall.There has been an interval decrease in enhancement of known malignancy in the right breast, 3:00 location. At present, there are a few faint enhancing foci seen in this area, spanning approximately 2.1 x 0.5 x 1.4 cm (AP x ML x SI), previously measuring 1.8 x 2.0 x 2.1 cm. Susceptibility artifact from biopsy marker clip is seen centrally within these foci.No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Few residual enhancing foci in the right central breast, spanning approximately 2.1 cm in the AP dimension. Biopsy marker clip is located centrally within these foci.If breast conservation therapy is desired, a bracketed wire localization targeting the mammographically seen biopsy marker clip/density/calcifications can be performed. The span of density/calcifications approximates the MR findings, measuring approximately 2.3 cm in the AP dimension.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Stage IV neuroblastoma, received 4 cycles of chemotherapy, assess response. Brain:The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement within the brain. There is no diffusion abnormality in the brain. No extra-axial fluid collection is identified. There is heterogeneous bone marrow signal throughout the skull with a few areas of focal signal abnormality such as in the left frontal bone and right occipital bone where there is enhancement suspicious for metastases. No significant change since prior. No large calvarial lesions or evidence of epidural tumor.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is moderate mucosal thickening in the right sphenoid sinus which is new since prior. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is heterogeneous but predominantly diffusely low T1 marrow signal as before. Small focus of contrast enhancement is present along the posterior and right aspect of the odontoid of the C2 vertebra. There is an enhancing lesion present between the spinous processes of C7 and T1 measuring 12 x 8 mm on sagittal STIR images, similar to prior. No new or enlarging osseous, epidural, or paraspinous lesion is appreciated in the cervical spine.The cervical spinal cord has normal signal characteristics and overall morphology.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. There is mild loss of vertebral body height at T6 and T10, compatible with pathologic fracture similar to prior. There is a heterogeneous signal present within the upper thoracic vertebrae. There is T1 signal hyperintensity throughout the vertebrae most prominent at T1, T5, T10, T11 and T12. There is contrast enhancement within T6, T8, and T10 centrally similar to prior.There are multiple enhancing posterior paraspinous soft tissue lesions present along the thoracic spine similar to prior. Most prominent of these is at the T2-T4 levels measuring approximately 13 x 27 mm in the sagittal plane, sagittal STIR image 11. Mild tumor extension into the left T4-5 neural foramen and left lateral epidural space is again seen. Minimal dorsal epidural tumor at the T8 level is also again evident without significant mass effect. The thoracic spinal cord has normal signal characteristics and overall morphology. No new or enlarging metastatic osseous lesion, epidural tumor, or paraspinous mass is appreciated.There is no significant disk bulge or herniation throughout the thoracic spine. No significant spinal canal stenosis at any level.Lumbar spine:The lumbar vertebral bodies are normal in overall alignment and height. The conus medullaris and distal spinal cord are normal. There are contrast enhancing foci present at L4. T1 hyperintensity involving the upper lumbar and lower thoracic vertebra compatible with prior radiation.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. There are marrow replacing lesions present within the iliac bones and sacrum similar to prior. An enhancing lesion is present in the left half of the sacral spinal canal, which is incomplete visualized on today's examination. The tumor involvement along the left sacral nerve roots, particularly surrounding the foraminal and extraforaminal left S1 nerve root was present on prior studies but incompletely imaged. Epidural tumor involving the left lateral aspect of the spinal canal at the S2 vertebral level appears slightly less conspicuous than on prior study from 7/28/2016, but may reflect slight differences in technique.No new or enlarging epidural tumor new osseous lesion or new paraspinous lesion is appreciated.

Output: 1. No significant change in osseous and paraspinous metastases, similar to prior examination from 8/29/2016. Metastatic lesions at T4-5 and T8 levels again demonstrate minimal epidural extension. Neural foraminal tumor is most conspicuous at the left T4-T5 level similar to prior. No evidence of mass effect on the cord or high-grade spinal canal stenosis at any level.2. No evidence of intracranial metastatic disease. Heterogeneous marrow of the calvarium with foci of enhancement as before.3. Partially visualized epidural tumor within the left sacral spinal canal and sacral neural foramina are grossly stable but incompletely imaged on current and prior studies.


Instruction: Generate impression based on findings.

Input: HIE: perinatal depression, subgaleal hemorrhage, s/p cooling. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses are grossly unremarkable. There is mild subgaleal and subcutaneous fluid posteriorly, right more than left.

Output: 1. No evidence of acute infarction.2. Small scalp hematoma.


Instruction: Generate impression based on findings.

Input: There are interval postsurgical changes of a left frontotemporal craniotomy. There appears to be a partial resection primarily involving the left anterior temporal lobe, when compared to the outside postoperative CT. There are expected postoperative changes including a small left extra-axial collection and fluid filled resection cavity primarily in the left anterior temporal lobe. There is T1 shortening on postcontrast T1 sequences centered in the basal ganglia, which is suspected to represent residual enhancing tumor rather than only T1 shortening related to postoperative blood products. There is improvement in mass effect with persistent effacement of the left lateral ventricle. There is interval decrease in rightward midline shift measuring 5 mm, previously 13 mm. Previously seen uncal herniation is no longer evident. There is interval decrease in surrounding T2/FLAIR hyperintensity, which still extends superiorly into the left centrum semiovale and corona radiata. Nonspecific focus of T2 hyperintensity in the left pons is unchanged.

Output: Examination limited to sequences for treatment planning and an immediate postoperative MRI is not available. Based on outside postoperative CT, there appears to have been resection of primarily the left anterior temporal component of the tumor and without significant tumor resection in the left basal ganglia; would suggest correlation with operative history. The T1 shortening on the postcontrast sequence in the basal ganglia is therefore favored to represent enhancing residual tumor rather than intrinsic T1 shortening from blood products.


Instruction: Generate impression based on findings.

Input: Balance and intermittent vertigo. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are retention cysts in the bilateral maxillary sinuses.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. In particular, the cerebellum appears to be unremarkable.


Instruction: Generate impression based on findings.

Input: Pain and edema dorsomedial midfoot and calcaneus after increased time on feet. Evaluate for stress fracture of navicular and calcaneus. Right ankle/midfoot: There is diffuse subcutaneous edema involving the ankle that extends distally along the dorsolateral aspect of the foot. I see no focal bone marrow edema to suggest a stress fracture. Specifically, the signal intensity of the calcaneus and navicular is normal. There is a small amount of fluid within the ankle and subtalar joints, but no large effusion. I see no osteochondral defects. Ankle ligaments appear normal. Ankle tendons appear normal. There is a peroneus quartus, a normal variant. There is mild edema of the flexor hallucis longus and extensor digitorum longus muscles which is nonspecific. There appears to be a small accessory muscle that lies medial to the flexor hallucis longus.Left ankle/midfoot: There is diffuse subcutaneous edema involving the ankle that extends distally along the dorsal aspect of the foot. On the fluid sensitive sequences, there are small scattered ill-defined patchy foci of mild edema-type signal within the talus, navicular, calcaneus, and base of the second metatarsal which are nonspecific, but may in part be degenerative in etiology; I see no linear focus of signal abnormality to suggest a stress fracture. Increased signal intensity on the fluid sensitive sequences within the distal tibial diaphysis isn't fully imaged on this study and may simply represent residual red marrow, but I cannot exclude the possibility of marrow edema. I see no linear focus of signal abnormality to suggest a stress fracture. There is a small amount of fluid within the tibiotalar and subtalar joints but no large effusion. I see no osteochondral defect. Ankle ligaments are unremarkable. Ankle tendons are unremarkable. There is a peroneus quartus, a normal variant. There is mild edema-type signal involving the flexor hallucis longus muscle which is nonspecific. I see no fluid collections to suggest an abscess.

Output: Nonspecific subcutaneous edema and other findings as described above without stress fracture evident. Increased signal intensity within the left distal tibial diaphysis is incompletely imaged on this study and may simply represent residual red marrow; however if there is clinical concern for tibial stress fracture, dedicated tibial/fibular MRI may be considered.


Instruction: Generate impression based on findings.

Input: 25 year old man with history of Tetrology of Fallot, s/p repair and bioprosthetic pulmonic valve placement, referred for CMR for follow up. General Anatomy: Tetrology of Fallot s/p complete repair (with VSD closure and transannular RVOT patch).Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19). 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 mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 116 ml/m2 (normal range 82+/-16), the RVEDV is 239 ml (normal range 142+/-31), the RV end systolic volume index is 86 ml/m2 (normal range 31+/-9), and the RVESV is 178 ml (normal range 54+/-17). There is hypokinesis proximal to the RVOT. No shunts are noted visually or on first pass contrast. Qp/Qs is not abnormal.Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveA bioprosthetic pulmonic valve is present. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a right sided aortic arch with a mirror image 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 (27mm). There are no significant stenoses of the main or first order branch of the pulmonary arteries.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are present. 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. Post Tetrology of Fallot repair with no significant shunts2. The right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 25%. The RV end diastolic volume index is 116 ml/m2 and the RVEDV is 239 ml.3. A bioprosthetic pulmonic valve is present with mild pulmonic 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: 16 years Female (DOB:11/30/1999)Reason: low back pain for 3 yrs History: low back pain for 3 yearsPROVIDER/ATTENDING NAME: HOLLY J BENJAMIN HOLLY J BENJAMIN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are minimal degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 73-year-old female with bilateral adrenal masses, mildly elevated metanephrines ABDOMEN: Examination is limited due to lack of IV contrast.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal gland nodules are again noted, restricting diffusion.The right lateral nodule measures approximately 3.8 x 2.0 cm. The lesion is multiseptated with fluid fluid levels. The left adrenal gland nodule measures 3.0 x 2.2 cm and demonstrates drop in signal on out of phase images consistent with microscopic fat.KIDNEYS, URETERS: Numerous subcentimeter T2 hyperintensities are presumably renal cysts. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Probable hemangioma in the mid thoracic vertebral body.OTHER: No significant abnormality noted.

Output: 1.Examination is limited due to lack of IV contrast. 2.Indeterminate multiseptated right adrenal gland nodule with fluid fluid levels. 3.Left adrenal gland nodule demonstrates drop in signal on out of phase images compatible with a microscopic fat-containing adenoma.


Instruction: Generate impression based on findings.

Input: Male, 77 years old, presenting with asymmetric left sensorineural hearing loss. The visualized brainstem is within normal limits. The 7th and 8th cranial nerve complexes are unremarkable. No pathologic enhancement is seen within the IACs, along the cranial nerves or in the CP angles. The fluid-filled structures of the inner ears demonstrate normal morphology.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:9/29/1946)Reason: new onset headaches - r/o mass History: headachePROVIDER/ATTENDING NAME: SUSAN HONG SUSAN HONG The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No intracranial mass lesion or other cause for the patient's headache is identified. The MRI of the brain is age-appropriate.


Instruction: Generate impression based on findings.

Input: Reason: bilateral shoulder pain History: bilateral shoulder pain ROTATOR CUFF: There is mildly increased signal intensity within the supraspinatus tendon, which is consistent with tendinopathy. Additionally, there is a focal area of higher signal intensity partially traversing the articular side of the supraspinatus tendon near its insertion on the greater trochanter, which is consistent with a partial-thickness tear. The infraspinatus, teres minor and subscapularis muscles and tendons appear to be intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears to be intact and the glenohumeral joint is within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Tendinopathy and partial-thickness tear of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: Unsteadiness on feet [R26.81], Reason for Study: ^Reason: rule out stroke, metastatic disease History: 89yoF with remote large left MCA stroke with the residual milileft hemiparesis presenting with new right sided ataxia rendering her unable to ambulate There is a focal high signal intensity on diffusion-weighted imaging on the right temporo-occipital lobe which does not show definitive diffusion restriction but shows subtle high signal intensity on T2/FLAIR images. Constellation of findings indicate possible late subacute ischemic infarction.There is encephalomalacia on the left frontotemporal parietal lobe including left insular cortex indicating left MCA territorial chronic ischemic infarct, unchanged since prior scan.Scattered patchy T2/flair high signal intensity lesions on bilateral periventricular white matter indicating nonspecific small vessel ischemic disease, unchanged since prior scan.There is no evidence of acute hemorrhagic lesion.Significant metallic susceptibility artifacts on the left frontal area, unchanged. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Subtle high signal intensity on the right temporo-occipital lobe may indicate late subacute ischemic infarction.2. Chronic left MCA territorial ischemic infarction involving left frontal, parietal, temporal lobes and insular cortex, unchanged.3. Non specific small vessel ischemic disease, unchanged.


Instruction: Generate impression based on findings.

Input: A 35 year old female with know lung sarcoidosis with complaints of atypical chest pain referred to stress cardiac MRI for further evaluation.MEDICATIONS: none First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 143 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 55 ml (normal range 31+/-10), the LV mass index is 38 g/m2, and the LV mass is 67 g. There are no regional wall motion abnormalities present. No findings suggesting cardiac sarcoid involvement.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 59%, the RV end diastolic volume index is 97 ml/m2 (normal range 69+/-14), the RVEDV is 167 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 61%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. No MRI findings of cardiac sarcoidosis.4. Normal RV size and systolic function (RVEF 59%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58 years, Female, ovarian cancer, screening for metastasis for clinical trial.. There is no intraparenchymal mass or abnormal parenchymal or meningeal enhancement to suggest intracranial metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass effect, midline shift, or herniation. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic and/or posttreatment-related changes changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.There is large expansile, infiltrative enhancing lesion with predominantly low T1 and T2 signal involving majority of the clivus including the basisphenoid and basiocciput extending into the occipital condyles, right greater than left and also involving much of the right inferior lateral aspect of the occipital bone.

Output: 1. Expansile, infiltrative osseous lesion involving majority of the clivus and the right lateral occipital bone is suspicious for osseous metastasis. An alternative possibility of a benign osseous expansile lesion (such as fibrous dysplasia) is a consideration and would suggest CT to exclude this possibility or correlate with bone scan are other head imaging if available.2. No evidence of brain metastases.


Instruction: Generate impression based on findings.

Input: NECK: There are extensive postoperative findings related to right orbital and sinonasal exenteration with myocutaneous flap reconstruction. There marked interval decrease in size of the enhancing lesion in the roof of the left posterior nasopharynx along the surgical margin, now measuring up to approximately 5 mm, previously 15 mm. In addition, the previously demonstrated punctate right temporal scalp subcutaneous tissues nodule is no longer apparent. The right temporal fossa enhancing lesion with an adjacent underlying calvarial defect has decreased in size, measuring up to 5 mm, previously 9 mm. Likewise, the right squamosal temporal bone calvarial lesion with extension into the overlying scalp has decreased in size, now measuring up to approximately 4 mm, previously 6 mm. The right mandibular body lesion is also smaller, measuring 14 mm in the anteroposterior dimension, previously 16 mm, such that the lesion no longer protrudes through the anterior cortical defect. There is unchanged asymmetric enhancement in the right foramen rotundum. There are persistent obstructed secretions in the frontal and sphenoid sinuses with new mucosal thickening and fluid level in the left maxillary sinus. There is nonspecific high T2 signal in the right mastoid air cells. There is no evidence of significant lymphadenopathy in the neck. The thyroid and salivary glands appear unchanged.BRAIN: There is no abnormal intraparenchymal enhancement, acute infarct, mass, herniation, or midline shift. There are unchanged scattered T2 hyperintensities in the subcortical and periventricular white matter, which are nonspecific. The ventricles and sulci are unchanged.

Output: 1.Interval decrease in size of the metastases in the skull and mandible, left posterior nasopharynx along the surgical margin, and in the right scalp have decreased in size, consistent with response to therapy.2.Persistent mild asymmetric enhancement in the right foramen rotundum may be post-treatment in nature.3.No evidence of intraparenchymal brain metastases.4. Findings suggestive of acute left maxillary sinusitis with otherwise persistent obstructed secretions associated with the exenteration flap.


Instruction: Generate impression based on findings.

Input: 35 year-old female with new diagnosis of malignancy of unknown origin presenting with dyspnea and tachycardia. Abdominal mass on palpation. Evaluate for PE and neoplasm. PULMONARY ARTERIES: Technically adequate pulmonary embolus examination without evidence of filling defect to indicate pulmonary embolus.LUNGS AND PLEURA: Left-sided pleural effusion with adjacent compressive atelectasis. Scattered bilateral micronodules too numerous to count.MEDIASTINUM AND HILA: Left upper lobe round soft tissue density mass measures 2.1 x 2.1 cm (image 59/159) series 9, within the left perihilar region region demonstrates mass effect on the left mainstem bronchus and left segmental pulmonary artery.CHEST WALL: Scattered, nonspecific axillary lymph nodes. Destructive lesions of third and fifth anterior ribs. Destructive lesions involve the scapula bilaterally. Multiple lytic lesions throughout the thoraco- lumbar spine consistent with metastatic disease. Expansile lytic lesion within the vertebral body T7 demonstrates posterior expansion into the central canal and may be further evaluated with MRI as clinically warranted.UPPER ABDOMEN: Ill-defined hypodense lesion within the left lobe of the liver with correlated with abdomen and pelvis CT performed same day consistent with metastatic lesion. Multiple retroperitoneal lymph nodes.For further evaluation of the abdomen and pelvis please see dedicated abdomen and pelvis CT report performed same day.

Output: 1. No evidence of pulmonary embolus as clinically questioned.2. Left-sided large pleural effusion.3. Multiple scattered micronodules likely represent lymphangitic spread.4. Left parahilar mass causes mild adjacent compression of the left segmental pulmonary artery and left bronchus.5. Multiple bony and hepatic metastases as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Neck pain. History of hereditary hemorrhagic telangiectasia. There is lack of the usual cervical lordosis. There is minimal disc-osteophyte formation at C4-5 and C5-6 with mild effacement of the anterior thecal sac cerebrospinal fluid and mild narrowing of the neural foramina at C4-5. There is also prominence of the facet joints at C7-T1 with narrowing of the bilateral neural foramina. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Minimal disc-osteophyte formation at C4-5 and C5-6 with mild effacement of the anterior thecal sac cerebrospinal fluid and mild narrowing of the neural foramina at C4-5. 2. Prominence of the facet joints at C7-T1 with narrowing of the bilateral neural foramina.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB:10/9/1956)Reason: Pt with complaints of diplopia on extreme right gaze; transient events of dizziness History: see abovePROVIDER/ATTENDING NAME: TAO XIE TAO XIE MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate T2 and FLAIR hyperintense foci are present in the brainstem. These are stable and compared to the prior exam.A punctate T2 and FLAIR hyperintense lesion is present in the right cerebellar hemisphere measuring approximately 7 mm in diameter. This could represent an old lacunar infarct.No foci of diffusion restriction are present in the brain parenchyma.There are multiple punctate subcortical foci of susceptibility effect identified on susceptibility imaging. There is also a punctate focus of susceptibility present within the midbrain. Several foci of susceptibility effect are present in the cerebellar hemispheres.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a mottled appearance to the marrow of the visualized osseous structures.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . There is asymmetry in the size of the cavernous sinuses with the right being slightly larger than the left especially along its posterior aspect. This is nonspecific and likely simply reflects anatomic variant.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is a mild degree of microhemorrhages distributed in predominantly subcortical white matter and also brainstem and cerebellum which do not have a specific pattern of distribution.4.Findings are compatible with old lacunar infarct in the right cerebellar hemisphere.5.There is no evidence for an orbital mass6.No intracranial lesion is identified which can explain the patient's diplopia on extreme right gaze. Perhaps it is below the threshold of detection on the current exam.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is small right foraminal disc protrusion involving the right neural foramen with mild foraminal stenosis. No significant spinal canal or left neural foraminal stenosis.L5-S1: There is a small left paracentral and foraminal disc protrusion with mild effacement of the left lateral recess. However no significant spinal canal or neural foraminal stenosis is appreciated. Paraspinous soft tissues are within normal limits. Mild facet arthropathy is seen in the lumbar spine relatively worse at the L5-S1 level.

Output: 1. Minimal degenerative changes in the lumbar spine including mild right neural foraminal narrowing at L4-L5 related to small disc protrusion. Otherwise there is no significant spinal canal or neural foraminal stenosis.2. Mild facet arthropathy, relatively worse at the L5-S1 level, which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: History of lung and thyroid cancer who presented with left-sided leg weakness and inability to walk. There is diffuse patchy and punctate cerebral white matter T2 hyperintensity, which has slightly increased in extent since 2014. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles, sulci, and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid within the left mastoid air cells.

Output: Slight increase in the extent of cerebral white matter signal abnormality, which is nonspecific, but may represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial metastases or acute infarct.


Instruction: Generate impression based on findings.

Input: 78-year-old female with bilateral renal cysts. Evaluate for interval change. Limited evaluation of the solid parenchymal organs due to the lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Limited evaluation due to the lack of intravenous contrast. Multiple small simple renal cysts are present bilaterally. Multiple T1 hyperintense cysts are also again noted, similar in size, and compatible with hemorrhagic cysts versus proteinaceous fluid. The largest T1 hyperintense lesion measuring 2.7 x 2.4 cm is again noted in the left upper renal pole (axial series 10 image 56). No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A right lower quadrant ostomy is partially visualized, and there is a stable parastomal hernia of transverse colon superiorly (series 2 image 17). No bowel obstruction.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted.

Output: Stable bilateral renal cysts. Some are simple and others demonstrate T1 hyperintense signal compatible with hemorrhage versus proteinaceous fluid. The lack of intravenous contrast limits further evaluation.


Instruction: Generate impression based on findings.

Input: Clinical question: Cervical spine degenerative changes noted on CT. Signs and symptoms: Neck pain. Pre and post enhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise. Incidental note is made of a well demarcated T1 hypointense and T2 hyperintense rounded lesion with rim of enhancement on the right and is believed to arise from the right tonsil (axial T2 series 701 image 30, axial post enhanced series 1/2/2001 images 26 through 32). This finding is associated with an adjacent enhancing solid component which is best appreciated on post contrast series. This mass measures at 22.5 x 17 mm in transaxial dimensions on axial post enhanced series image 29.C3-C4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C4-C5 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C5-C6 demonstrate moderate disc disease and a central disc extrusion with mild inferior herniation posterior to the body of C6. The disc results in mass effect, flattening deformity and posterior displacement of the cord and moderate central spinal stenosis. Degenerative changes at this level also results in moderate left neural foraminal compromise. There is no detectable signal abnormality of the cord.C6/C7 demonstrate moderate disc disease and loss of disc height, a small central disc protrusion is noted, moderate asymmetric left uncovertebral hypertrophy and mild on the right results in significant left and moderate right neural foraminal compromise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord to T4 level is unremarkable.Findings on this exam and including mass of the right tonsil were discussed by phone with Dr. Elisabeth Blair at the time of review of the study.

Output: 1.Partially cystic and partially solid enhancing mass of the right tonsil as detailed/measured above.2.Degenerative changes at C5-C6 and with a large extruded/migrated disc fragment results in moderate central spinal stenosis.3.Degenerative changes at C6/C7, a small central disc protrusion and asymmetric (L>R) uncovertebral hypertrophic changes with resultant significant left and moderate right neural foraminal compromise without central spinal stenosis.4.No detectable signal abnormality of cervical or upper most visualized thoracic cord.5.No detectable abnormal enhancement to vertebral column or the leptomeninges to suggest metastatic disease.


Instruction: Generate impression based on findings.

Input: History of pancreatic cancer status post 12 cycles of chemotherapy. Evaluate for response. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity.Cholelithiasis without acute cholecystitis. Normally distended gallbladder. Punctate segment 3 cystic focus is too small to characterize but is unchanged and likely a cyst (series 3 image 19)No suspicious liver lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: Poorly defined pancreatic uncinate process soft tissue measures approximately 1.8 x 1.7 cm (series 12/35). The soft tissue encases the adjacent SMA and moderately narrows the SMV portal vein confluence. The portal vein is patent. There is pancreatic atrophy distally. Adjacent to the pancreatic tail there is an unchanged soft tissue nodule measuring approximately 1 cm (series 12/62).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and too small to characterize hyperintensities.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: Mild interval decrease in the pancreatic head lesion and nodule near the pancreatic tail. The difference in size likely represents a combination of treatment response and modality technical differences. No new sites of disease.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Viral meningitis, unspecified [A87.9], Reason for Study: ^Reason: please r/o structural abnormality vs infiltrate History: Headache Redemonstration of relatively homogeneously enhancing dural based lesion indicating meningioma likely representing en plaque type. The lesion involves sella, bilateral cavernous sinus, Meckel's caves and retroclival region. Diffuse dural enhancements along bilateral tentorium are also seen. These findings do not show any significant interval change especially in terms of thickness and configuration since prior scan.There is a right frontal burr hole with underlying frontal lobe focal encephalomalacia, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No significant interval change of skull base en plaque type meningioma in terms of its extent, estimated size and enhancement pattern since prior scan.2. No acute ischemic or hemorrhagic lesion.3. No change of right frontal burr hole and underlying brain biopsy track related parenchymal changes since prior scan.


Instruction: Generate impression based on findings.

Input: Male, 37 years old, with history of spina bifida, tethered cord, hydrocephalus and gait difficulties. Evaluate for tethered cord, syrinx. Brain:Bilateral parietal approach ventricular catheters are in stable position terminating along the lateral ventricular bodies. Irregular ventricular margination and T2 hyperintensity with cystic spaces along the margins of the ventricles, particularly at the level of the left atrium, are unchanged. The ventricles remain largely decompressed.Chronic cerebral dysmorphism is unchanged including atrophy and perhaps partial agenesis of the corpus callosum and anomalous cortical development along the cingulate gyri. A severely dysmorphic single-lobed cerebellum is also unchanged.The previously stented basilar aneurysm is not adequately assessed on this examination. No new intracranial lesions are seen including no evidence of parenchymal edema, mass effect or restricted diffusion. No evidence of any new intracranial fluid collection is seen.C-spine:The cervical lordosis is mildly reversed. Vertebral body height and morphology are unremarkable. No concerning marrow replacement or marrow edema is seen.The spinal cord becomes slender at lower cervical levels, but is otherwise normal in morphology. No discrete cord signal abnormality is detected.Small disc osteophyte complexes are evident at multiple cervical levels, similar to prior, causing no significant spinal canal stenosis. Mild left foraminal narrowing is seen at C4-5 and C5-6 secondary to uncovertebral and facet hypertrophy.No significant interval change is seen in these cervical spine findings.T-spine:Evidence of laminectomy is again seen beginning at T5 and continuing at least to the T10-11 levels.A mild scoliotic curvature of the thoracic spine is seen. Vertebral bodies are well aligned in the sagittal plane.Vertebral body height is normal. There may be mild posterior vertebral body scalloping through the mid thoracic spine with corresponding areas of thecal sac dilatation or ectasia. No evidence of concerning marrow replacement or marrow edema is seen.The spinal cord remains diffusely thinned suggesting atrophy. At lower thoracic levels, the cord assumes a triangular configuration which may reflect some degree of adhesive traction. Ultimately, the cord flattens and spreads along the posterior aspect of the thecal sac. These findings have not significantly changed.Small disc protrusions at T7-8 and T8-9 may be new from the prior examination. No significant spinal canal or neuroforaminal stenosis is seen.Cystic degeneration of the left kidney is again seen. The overall size of the kidney has decreased substantially from the prior examination.L-spine:Imaging of the lumbar spine is significantly motion degraded.Spinal alignment is anatomic allowing for a mild scoliotic curvature. The vertebral body heights are normal. No concerning marrow signal abnormality is seen.Continuing from the thoracic region, the spinal cord remains thinned and spread along the posterior aspect of the thecal sac. At the L1 level, it resumes a more rounded conformation and continues inferiorly to the L5-S1 level where it thins and eventually blends with the posterior margin of the thecal sac. The posterior elements in this region are deficient allowing the distal thecal sac to closely approach the skin surface.Disc bulging at L2-3 has progressed mildly. This contributes along with facet hypertrophy to a significant spinal canal stenosis and at least moderate right neuroforaminal narrowing.Disc bulging has also progressed at L3-4 where it contributes with posterior element hypertrophy to a mild spinal canal narrowing and moderate right foraminal narrowing.

Output: 1.No significant interval change in chronic/congenital anomalies of the brain and cerebellum. No new intracranial lesions are seen. The shunted ventricular system is unchanged in size and configuration.2.The gross morphology of the spinal cord, as well as findings compatible with tethered cord, are unchanged. No new intraspinal lesions are seen.3.Mild progression of degenerative findings at several levels as discussed above.


Instruction: Generate impression based on findings.

Input: 37-year-old female with fever and back pain. Evaluate for discitis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. No evidence of discitis-osteomyelitis or epidural or paraspinous collections to suggest abscess. Diffuse low T1 marrow hypointensity is seen which is nonspecific. Scattered foci of T1 and T2 hyperintensities are nonspecific and compatible with foci of fat or small hemangiomas. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Minimal degenerative changes are seen in the lumbar spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is a minimal disc bulge, minimal facet hypertrophy and minimal ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina.L5-S1: There is a minimal disc bulge, minimal facet hypertrophy and minimal ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina.

Output: 1.No evidence of discitis-osteomyelitis or epidural or paraspinous collections to suggest abscess. 2.Diffuse low T1 marrow hypointensity which is nonspecific but can be seen with marrow reconversion related to chronic illnesses, chronic anemias, as well as marrow proliferative disorders3.Minimal degenerative changes without significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 48-year-old male with right hand edema, erythema, pain despite being on clindamycin. Rule out osteomyelitis or abscess. There is decreased T1 and increased T2 signal abnormality affecting the entire second and third metacarpals as well as the base of the fourth metacarpal with enhancement on postcontrast sequences, consistent with osteomyelitis. There is also decreased T1 and increased T2 signal abnormality affecting all of the carpal bones and distal radius with associated enhancement, also suspicious for osteomyelitis.There is extensive diffuse edema type signal abnormality most pronounced along the dorsal aspect of the hand which extends anteriorly. There is diffuse increased signal abnormality within the musculature of the hand concerning for myositis. There is a focal fluid collection with associated peripheral enhancement on postcontrast sequences within the soft tissues along the dorsal aspect of the first carpometacarpal joint which is difficult to measure but is approximately 5.1 x 0.9 cm and is suspicious for abscess formation (7; series 16). There is an additional focus of heterogeneous increased T2 signal abnormality with peripheral enhancement in the soft tissues along the dorsal aspect of the distal ulna which measures 1.9 x 0.7 cm (22; series 16) which is suspicious for phlegmon or early abscess formation. An additional subcentimeter focal fluid collection along the dorsal aspect of the distal ulna with peripheral enhancement is also suspicious for abscess formation (19; series 16). The findings can be confirmed with ultrasound examination if considering drainage.

Output: Findings consistent with extensive subcutaneous edema and osteomyelitis of the hand and wrist. There are multiple focal fluid collections about the wrist which are suspicious for abscess formation, as described above.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: structural lesion? History: seizure No evidence of acute ischemic or hemorrhagic lesion on the scan.Multiple bihemispheric white matter scattered FLAIR/T2 high signal intensity lesions are redemonstrated which are nonspecific, unchanged since prior scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement.2. Nonspecific scattered white matter FLAIR/T2 high signal intensity lesions, unchanged.3. No structural lesion on the scan.


Instruction: Generate impression based on findings.

Input: Back pain in a healthy woman with a history of MVA. The vertebral column alignment is within normal limits. Disc desiccation is noted at the L3-4 and L4-5 levels. There is mild anterior wedging of the L1 vertebral body but there is no marrow edema to indicate an acute process. There is a moderate edema involving the superior endplate of L4. The remaining vertebral bone marrow signal elsewhere is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. T12-L1: There is a tiny disc bulge but no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is a mild disc bulge with mild facet arthropathy as well as a left foraminal zone disc extrusion which causes mild to moderate left neural foraminal stenosis and effacement of the left lateral recess. There is mild right neuroforaminal and mild central canal stenosis at this level. L4-5: There is a mild disc bulge and mild facet arthropathy which causes mild left neural foraminal stenosis. There is no significant right neuroforaminal or central canal stenosis. L5-S1: There is a mild disc bulge and mild to moderate facet arthropathy but no significant compromise to spinal canal or neural foramina.

Output: 1.Mild edema involving the superior endplate of the L4 vertebral body which is likely degenerative.2.Mild anterior wedging of the L1 vertebral body without adjacent edema or other evidence to suggest an acute process.3.Degenerative changes most prominent in the L3-4 region where a bulging disc, facet arthropathy and left foraminal disc extrusion causing mild to moderate left neural foraminal stenosis as well as some effacement of the left lateral recess.


Instruction: Generate impression based on findings.

Input: Newly diagnosed prostate cancer. Staging exam. Pathology dated 5/13/2016: Prostatic adenocarcinoma 3+3 R2, 3+3 L3-L5, PELVIS:PROSTATE:Prostate Size: 4.6 x 5.1 x 5.2 cmPeripheral Zone: The peripheral zone demonstrates diffusely heterogeneously mildly to moderately T2 weighted hypointense signal intensity without associated decreased ADC signal intensity, low suspicion. There are several scattered more focally T2 weighted hypointense foci throughout the peripheral zone including a left apex lesion measuring 8 x 6 mm (series 401/9).Central Gland: Mild changes of BPH. Note is made of a cystic lesion just cranial to the base of the prostate, likely a mullerian duct remnant cyst. In the right anterior apex there is a 1.6 x 1.3 cm well-defined heterogeneously hypointense lesion (series 401/12) demonstrating arterial enhancement which may represent a BPH nodule but is indeterminate.Seminal Vesicles: No evidence of seminal vesicle tumor involvement.Extracapsular Extension: No evidence of extracapsular extension of tumor.BLADDER: Distended urinary bladder with trabecular thickening and a dorsal diverticulum.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Heterogeneous peripheral zone severely limits evaluation and may be due to prostatitis with mildly suspicious index lesions described above. 2.Right apical central gland lesion most likely represent a BPH nodule.


Instruction: Generate impression based on findings.

Input: Male, 29 years old, with right back and arm pain, history of Crohn's disease. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. No evidence of any abnormal marrow enhancement is detected.The visualized spinal cord shows normal signal intensity throughout. No evidence of pathologic parenchymal or leptomeningeal enhancement is seen. No epidural lesions are suspected.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Unremarkable. C5-6: Left facet arthropathy. Mild posterior disc-osteophyte complex formation. Mild left foraminal narrowing. C6-7: Left facet arthropathy. Mild posterior disc-osteophyte complex formation. Mild left foraminal narrowing.C7-T1: Unremarkable.

Output: Mild degenerative findings are seen with no areas of high-grade spinal canal or foraminal compromise. No inflammatory lesions of the osseous spine or spinal cord are suspected.


Instruction: Generate impression based on findings.

Input: Continued right forearm and hand numbness and weakness following right shoulder arthroscopy on 5/14/15 using a single shot interscalene block. There is mild diffuse high T2 signal and swelling centered in the right posterior triangle, but also extending into the right axilla and portions of the anterior neck along the fascial planes. The right brachial plexus appears to be grossly intact. There are partially-imaged right shoulder postoperative findings and effusions. The cervical spine appears to be unremarkable.

Output: Mild diffuse high T2 signal and swelling centered in the right posterior triangle may be procedure-related and may consist of edema and/or hemorrhage. The right brachial plexus otherwise appears to be grossly intact. Please refer to the separate shoulder MRI report for additional details.


Instruction: Generate impression based on findings.

Input: Clinical question: Sciatica, right S1 radiculopathy on the MG. Signs and symptoms: Right posterior lower back pain. Pre and post enhanced brain MRI:Examination at T11-T12, T12-L1, L1-L2, L2-L3, L3-L4 and L4-L5 levels are unremarkable with the exception of mild degenerative changes. No spinal stenosis or neural foraminal compromise and no detectable abnormal enhancement.L5-S1 demonstrate mild disc disease and loss of disc height, mild bilateral (R>L) facet and ligamentum flavum hypertrophy. Additionally there is a large central and right para median disc extrusion with resultant mass effect on the thecal sac with subtle indentation and significant right lateral recess compromise and including mass effect on the right S1 nerve root is laterally and posteriorly displaced. No central spinal stenosis or neural foraminal compromise. There is expected enhancement of extruded disc.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina without abnormal enhancement. Unremarkable paraspinal soft tissues.

Output: 1.At L5-S1 level there is a central and rightward disc extrusion with resultant compromise of right lateral recess, mass effect and posterior displacement of right S1 nerve root as detailed. No spinal stenosis or neural foraminal compromise at this level. Mild degenerative changes however are noted at this level.2.Unremarkable pre and post enhanced lumbar MRI otherwise.


Instruction: Generate impression based on findings.

Input: Meningioma. Follow-up. The small posterior frontal falcine meningioma has not changed compared to the most remote available examination from January 2014. In the axial plane, it measures 14 mm x 10 mm. Craniocaudally, it measures 12 mm. It shows suggestion of central calcification manifested by central low signal on susceptibility weighted imaging and less intense central contrast enhancement. The mass causes no significant mass-effect. The adjacent brain parenchyma shows no abnormal signal. The superior sagittal sinus is separate from the tumor and patent.The nonspecific T2-hyperintensity in the frontoparietal white-matter has not changed and probably reflects chronic microvascular ischemia. Otherwise, the brain shows no abnormality. The ventricles and the other CSF-containing spaces are normal. The dural venous sinuses are patent as well as the major intracranial arteries. There is no gross orbital abnormality. There is no destructive skull lesion.

Output: No significant change in size of small falcine meningioma dating back to January 2014.


Instruction: Generate impression based on findings.

Input: 45 year old woman with history of non-ischemic cardiomyopathy of unclear etiology with dual chamber ICD and repeated ICD shocks for VT, history of VT ablation, abnormal PET/CT referred for cardiac MRI to evaluate for etiologies of her cardiomyopathy. Pre- and post-ICD interrogation was performed. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 135 ml/m2 (normal range: 65+/-11), the LVEDV is 237 ml (normal range 109+/-23), the LV end systolic volume index is 95ml/m2 (normal range 18+/-5), the LVESV is 168 ml (normal range 31+/-10), the LV mass index is 26g/m2 (normal range 67+/-11), and the LV mass is 44 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is no evidence of an iron overload state. There is extensive late gadolinium enhancement involving much of the interventricular septum in a "mid-wall stripe pattern." This finding is not typical of prior myocardial infarction and suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. Additionally, the inversion time needed to null the "normal" myocardium was significantly lower than usual suggesting that we may be underestimating the burden of late gadolinium enhancement. On T2-weighted imaging, the lateral wall had increased signal suggesting the presence of myocardial inflammation. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 53ml/m2 (normal range 69+/-14), the RVEDV is 92ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 35ml (normal range 35+/-13). An ICD lead is noted in the right ventricle.Right AtriumThe right atrium is not well seen.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is posterior mitral leaflet tethering with at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve is not well seen.Tricuspid ValveThe tricuspid valve is not well seen.AortaThere is a left sided aortic arch with a likely normal brachiocephalic branching pattern. The aortic root is grossly normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is grossly normal in size. Venous AnatomyIntracardiac device leads are seen in the SVC. The SVC and IVC drain normally into the right ventricle.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a defibrillator can present with associated artifact. There are trivial bilateral pleural effusions. 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. Severe left ventricular dilation with severely reduced systolic function (LVEF 29%) with extensive late gadolinium enhancement involving much of the interventricular septum in a "mid-wall stripe pattern." This finding is not typical of prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Additionally, the inversion time needed to null the "normal" myocardium was significantly lower than usual suggesting that we may be underestimating the burden of late gadolinium enhancement. On T2-weighted imaging, the lateral wall had increased signal suggesting the presence of myocardial inflammation. Taken together with the patient's cardiac PET results, these findings support the diagnosis of sarcoidosis in the acute inflammatory stage. However, the differential diagnosis is not limited to cardiac sarcoidosis.2. Normal RV size and systolic function (RVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: left ankle injury 3 weeks ago persistent swelling and pain History: pain and edema TENDONS: There is a small amount of fluid within the peroneus longus tendon sheath. The peroneal tendons appear intact. The flexor and extensor tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The proximal fibers of the ATFL are not well visualized and likely disrupted. The PTFL appears intact. The calcaneofibular ligament appears intact. There is loss of the normal fatty striation of the visualized components of the deep component of the deltoid ligament indicating prior injury or sprain. The distal tibiofibular syndesmotic complex appears intact.ARTICULAR SURFACES AND BONE: There is increased bone marrow signal abnormality within the medial aspect of the body of the talus. Additionally, there is apparent cortical disruption along the medial aspect of the posterior facet of the talus which may represent a small nondisplaced fracture (image 25 and 26; series 901).ADDITIONAL

Output: 1. Bone marrow edema within the body of the talus as well as cortical irregularity along the medial aspect of the posterior facet of the talus, which may represent a small nondisplaced fracture.2. Disruption of the ATFL.3. Loss of the normal fatty striation of the deep component of the deltoid ligament indicating a sprain or prior injury.


Instruction: Generate impression based on findings.

Input: Right hearing loss, dizziness. Examination is motion degraded. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is mild global parenchymal volume loss commensurate with age. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Brain MRI is motion degraded but demonstrates no evidence of intracranial mass or mass-effect. Mild chronic small vessel ischemic changes are seen; brain parenchyma is otherwise unremarkable for age. 2. Please note patient was heavily sedated and excessively moving. Additional requested MRI IAC and MRA studies were not obtained and patient will be rescheduled.


Instruction: Generate impression based on findings.

Input: 25 year old female with a history of doxorubicin exposure as a child and new development of LV dysfunction. Referred for cardiovascular MRI to evaluate cardiomyopathy for infiltration, inflammation, or scar. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is global dilation and hypokinesis. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 146 ml/m2 (normal range: 65+/-11), the LVEDV is 262 ml (normal range 109+/-23), the LV end systolic volume index is 106 ml/m2 (normal range 18+/-5), the LVESV is 190 ml (normal range 31+/-10), the LV mass index is 52 g/m2 (normal range 67+/-11), and the LV mass is 94 g (normal range 114+/-24). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 469 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 89 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is mildly thickened and there is no significant aortic regurgitation or stenosis.Mitral ValveThe mitral valve is mildly thickened and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial disease.Extracardiac FindingsSmall cyst noted in the superior pole of the right and left kidneys.

Output: 1. Left ventricle is severely dilated with severely reduced systolic function (LVEF 28%). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Right ventricle is normal in size with mildly reduced systolic function (RVEF 48%)3. Mildly thickened mitral valve with mild regurgitation.4. Mild thickening of the aortic valve leaflets.


Instruction: Generate impression based on findings.

Input: Ms.Georgy Ann Peluchiwski, 48 years old, submitted outside studies for review. She has a family history of breast cancer in her sister diagnosed at 43, cousin at 36, and grandmother at 60.Images performed at Northwestern Memorial Hospital submitted for review: Mammogram 11/3/2015MRI breast 1/15/2016MRI guided biopsy imaging 1/21/2016Postprocedure mammogram 1/21/2016Images submitted for comparison:Mammogram 11/3/2014, 5/6/2013 MAMMOGRAM 11/3/2015:Two standard views with tomosynthesis were obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Tomosynthesis imaging is not reviewable.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. MRI BREASTS 1/15/2016:Multisequence sagittal and axial MRI breast with and without contrast were performed as per outside MRI breast protocol. The breasts are composed of scattered fibroglandular tissue. There is mild background parenchymal enhancement. Kinetic analysis is not possible.Right breast:In the central right breast, far posterior depth, there is a clumped nonmass enhancement measuring 1.2 x 0.5 x 2.3 cm (AP x ML X SI). No additional suspicious enhancement is identified in the right breast.Left breast:No suspicious enhancement is identified in the left breast. Incidental note is made of the 7 mm enhancing mass with T2 high signal in the upper outer left breast, middle depth, which likely corresponds to the small intramammary lymph node seen on older mammograms.Visualized axilla is unremarkable.A 5 mm high T2 signal area in the liver without associated enhancement likely represents a benign process such as a cyst or hemangioma.MRI GUIDED BIOPSY OF RIGHT BREAST 1/21/2016: Previously identified nonmass enhancement in the right posterior breast is the target for the biopsy. The targeting appears appropriate.POST PROCEDURE MAMMOGRAM 1/21/2016: A clip is placed in the the central right breast posterior depth, expected position.PER OUTSIDE PATHOLOGY:A. Right upper outer breast clumped nonmass enhancement; MRI guided core needle biopsy:- Invasive ductal carcinoma, grade 2- Ductal carcinoma in situ, grade 3, solid type with lobular extension and prominent lymphocytic reaction.- Fragments of skeletal muscle.

Output: MRI detected 2.3 cm biopsy proven malignancy in the central and posterior right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion.PHARYNX/LARYNX: There is redemonstration of minimal posttreatment changes, with no significant asymmetry in soft tissues. The nasopharynx, oropharynx, and hypopharynx are unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable.ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: There is a large mucosal retention cyst in the left maxillary sinus with a smaller one on the right. There is mild scattered mucosal thickening in the remainder of the paranasal sinuses. There is prominent lower leftward nasal septal deviation with a prominent bony spur.

Output: No MR evidence of local regional tumor recurrence or cervical adenopathy, with mild motion limitation.


Instruction: Generate impression based on findings.

Input: 15-year-old female with a headache with 5 out of 10 pain, dizziness, sensitive to light and sound for 3 -4 days after concussion. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate to/flair hyperintensities in the left frontal lobe, which most likely represent gliosis along normal variant prominent perivascular spaces. The brain parenchyma otherwise appears unremarkable. There is a small area of extra-axial CSF signal intensity along the anterior right temporal pole probably represents a small arachnoid cyst. 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 upper limit of normal small bilateral occipital scalp lymph nodes bilaterally, presumably reactive. There is partial left sphenoid opacification.

Output: No evidence of acute intracranial abnormality. Small probable incidental right middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Pituitary tumor status post surgery: surveillance. There are postoperative findings related to transsphenoidal pituitary surgery. The previously demonstrated tiny lesion within the right pituitary gland is nearly imperceptible. 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. There is a small left maxillary sinus retention cyst. 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 nearly imperceptible.


Instruction: Generate impression based on findings.

Input: Prostate cancer, status post docetaxel. Right perianal/gluteal numbness. Obstructive uropathy. PELVIS:PROSTATE/SEMINAL VESICLES: Interval decrease in size of the prostate and reference measurement right pelvic soft tissue nodule. There is soft tissue enhancement of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: Reference measurement left external iliac lymph node and adjacent thickening of the right internal obturator muscle have decreased in the interval. The right internal obturator muscle measures 1.3 cm in thickness compared to 2.5 cm on the 2/2/2016 CT exam, and contrast enhancement is suggestive of metastatic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Persistent cortical thickening and trabecular expansion of the right hemipelvis with scattered areas of T2 hyperintensity and contrast enhancement suggesting a mixed appearance of Paget's disease and metastatic lesions. Additional metastatic foci are suspected in the sacrum and left posterior ilium.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 7/12/2016 11:30:00)LEFT PELVIC LYMPH NODE: 0.7 x 0.4 cm (Image 85, Series 9); 0.4 x 0.4 cm on prior (6/29/2016) (Image 131, Series 201).RIGHT PELVIC SOFT TISSUE MASS: 1.8 x 2.0 cm (Image 67, Series 9); 2.8 x 2.6 cm on prior (6/29/2016) (Image 139, Series 201).

Output: 1.Interval decrease in size of the prostate, right pelvic soft tissue nodule, and right internal obturator muscle thickness. Contrast enhancement of the right internal obturator muscle suggests metastatic disease.2.MRI features suggesting a mixed appearance of Paget's disease and metastatic lesions within the right hemipelvis. Additional foci of osseous metastasis are suspected in the sacrum and left posterior ilium.


Instruction: Generate impression based on findings.

Input: Male 27 years old Reason: TFCC tear History: wrist pain, instability. Numerous foci of signal void are noted in the soft tissues of the wrist particularly dorsally suggesting metallic susceptibility artifact related to prior surgery.TRIANGULAR FIBROCARTILAGE COMPLEX: We see no fluid signal intensity traversing the triangular fibrocartilage complex to indicate full thickness tear. There is thickening and increased signal intensity within both of the ulnar bands of the articular disk suggesting degeneration. There is also a small focus of abnormal signal intensity within the adjacent subchondral marrow of the distal ulna which is likely degenerative in etiology and overall the findings are similar to outside hospital MRI of 2013.LIGAMENTS: Evaluation of the intrinsic ligaments of the wrist is limited due to lack of intra-articular contrast. There is a small lobulated collection of near fluid signal intensity along the dorsal margin of the scapholunate ligament suggestive of a small ganglion but we otherwise see no specific findings to suggest tear of the scapholunate or lunotriquetral ligaments.TENDONS: The tendons appear normal. BONES: There is a focus of edema type signal within the ulnar and proximal aspect of the lunate bone volarly which is new compared to prior study. A small cystlike focus of abnormal signal is noted within the proximal triquetrum. These findings and nonspecific and we see no gross overlying cartilage defects. The remainder of the bone marrow signal is normal.

Output: 1. Findings suggestive of degeneration of the ulnar fibers of the articular disk of the triangular fibrocartilage complex but no discrete fluid filled tear.2. Small foci of bone marrow signal intensity as described above could reflect sequela of ulnar abutment but we see no discrete tear of the radial aspect of the triangular fibrocartilage complex nor do we see any articular cartilage defects.


Instruction: Generate impression based on findings.

Input: Female 40 years old; Reason: left lobe mass 12 cm on CT scan, compatible with giant hemangioma. Several other mass lesions. Need to confirm these are hemangiomas. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Prominent liver (measures up to 20 cm in craniocaudal dimension, likely due in part to Reidel lobe) and left lobe extends peripherally into left upper quadrant. Dominant left lobe mass measures 12.1 x 7.9 cm, demonstrates peripheral puddling in arterial phase with subsequent centripetal progression of enhancement, appearance consistent with a giant hemangioma. Multiple additional smaller lesions with similar enhancement characteristics seen in both lobes, again consistent with hemangiomas. There is also a hepatic segment 6 lesion measuring 3.1 x 3 cm, image 67 series 1101, which demonstrates fairly homogeneous arterial enhancement with near isointensity demonstrated on subsequent portal venous phase and lesion is essentially isointense on delayed imaging. Constellation of findings consistent with an FNH (focal nodular hyperplasia). Lesion is mildly T2 hypointense and minimally T1 hypo- to isointense. SPLEEN: 0.8 cm lesion in the spleen, image 59 series 1101, appearance suggestive of a small hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ill-defined focal heterogeneous enhancement (measures 1.7 x 1.4 cm) seen at level of right lower rib cage, near or at inferiormost costochondral junction, image 76 series 1101.

Output: 1. Left-sided giant hepatic hemangioma with additional smaller bilobar hemangiomata present. 2. Hepatic segment 6 lesion with imaging characteristics consistent with an FNH.3. Ill-defined focal heterogeneous enhancement seen at level of right lower rib cage, near or at inferiormost costochondral junction, may reflect subacute rib fracture with surrounding callus formation but correlation with patient's clinical history and physical examination for point tenderness recommended and further assessment with CT imaging is recommended if there is clinical concern for underlying lesion.


Instruction: Generate impression based on findings.

Input: This study is a moderately degraded due to motion artifacts.There is a redemonstration of hyperintense foci of T2/FLAIR in the periventricular white matter and in the subcortical region. These foci are also seen in the corona radiata, in the basal ganglia, and in the pons. There are no significant change since the previous study in the number of the hyperintense foci and in size.No abnormalities noted on the diffusion and in the susceptibility sequences.Ventricular size is normal. No midline shift. There is mild age related volume loss. The basal cisterns are patent. Small amount of scattered fluid is seen in the mastoids.There is a T1/T2 hyperintense probable Tornwaldt or mucous retention cyst along the midline posterior nasopharynx, not seen on the prior exam.There is normal flow voids in the major intracranial vascular structures. The midline structures and the craniocervical junction are within normal limits. Prostheses noted in the left globe, unchanged.

Output: There are no changes since the previous study of 6/23/2015. No acute abnormality with stable white matter disease.


Instruction: Generate impression based on findings.

Input: 51-year-old female with numbness, evaluate for demyelinating disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 39 year old female status post left lumpectomy for invasive ductal carcinoma in 2012. Patient received chemotherapy, radiation and Herceptin. History of right reduction mammoplasty with keloid formation. History of benign right breast biopsy showing fat necrosis. No current breast complaints. Family history of breast carcinoma in her maternal aunt in her 40s. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A marker clip artifact is seen in the right outer breast.A scar from prior surgery is present in the left axilla.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 43-year-old man with hypertension, altered mental status in the setting of ESRD. There is no evidence of intracranial hemorrhage or mass. Subtle low attenuation is present in the subcortical white matter. This is nonspecific and most likely signifies age-indeterminate small vessel ischemia. In the proper clinical setting, this finding could also represent sequela of PRES.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are diffusely sclerotic, possibly indicating renal osteodystrophy. There is groundglass opacification and sclerotic bone formation around the left chamber of the frontal sinus. This is most suggestive of fibrous dysplasia but could be better evaluated with MRI.

Output: 1. Widespread subcortical white matter hypoattenuation -- this finding is nonspecific and most likely represents age-indeterminate small vessel ischemic disease. This could also represent sequela of PRES. If clinically indicated, MRI could provide further evaluation.2. Groundglass opacification and bony remodeling involving the left chamber frontal sinus -- possibly representing fibrous dysplasia. This finding could also be better evaluated with MRI.


Instruction: Generate impression based on findings.

Input: There is extensive abnormality throughout the right frontal and anterior parietal lobes with areas of cortical thickening, polymicrogyria, and numerous foci of heterotopic gray matter extending from the cortex to the right lateral ventricle ependymal surface. There is extension of polymicrogyria along the superior aspect of the right sylvian fissure. The right lateral ventricle is dysmorphic and dilated. Although no definite cleft is visualized, there is suggestion of mild dimpling of a small portion of the lateral margin of the right lateral ventricle towards a confluent area of abnormal grey matter, and therefore it is possible that this could be on the spectrum of closed lip schizencephaly.The hippocampi are symmetric and normal in appearance. There is no evidence of mass or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The midline structures and craniocervical junction are within normal limits.

Output: Extensive right frontal and anterior parietal polymicrogyria and heterotopic gray matter extending to the right lateral ventricle ependymal surface.


Instruction: Generate impression based on findings.

Input: 32 year old male with history of Crohn's disease. 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: Wall thickening and mucosal hyperenhancement are noted within the rectosigmoid colon, along an approximately 18 cm long segment which extends to the proximal anus (series 9, image 34 and series 19, image 36). Associated mesenteric hypervascularity and fibrofatty proliferation are also noted. Findings are compatible with active inflammatory bowel disease. Submucosal fat deposition in this colonic segment indicates an additional component of chronic inflammation. No free fluid, drainable collection, or fistula. The terminal ileum is not optimally assessed due to underdistention but demonstrates mucosal hyperenhancement along an approximately 9 cm segment in the right lower quadrant (series 14, image 19). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening and mucosal hyperenhancement are noted within the rectosigmoid colon, along an approximately 18 cm long segment which extends to the proximal anus (series 9, image 34 and series 19, image 36). Associated mesenteric hypervascularity and fibrofatty proliferation are also noted. Findings are compatible with active inflammatory bowel disease. Submucosal fat deposition in this colonic segment indicates an additional component of chronic inflammation. No free fluid, drainable collection, or fistula. The terminal ileum is not optimally assessed due to underdistention but demonstrates mucosal hyperenhancement along an approximately 9 cm segment in the right lower quadrant (series 14, image 19). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Wall thickening and mucosal enhancement involving an 18 cm segment of rectosigmoid colon, as well as surrounding inflammatory changes. Findings are compatible with active on chronic inflammatory bowel disease. No evidence of fistula formation or abscess. 2.Mucosal hyperenhancement along a segment of terminal ileum may also represent active disease, but evaluation in this area is limited by lack of bowel distention.


Instruction: Generate impression based on findings.

Input: Clinical question: Stage IIIc melanoma restaging. Signs and symptoms: Melanoma. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates normal anatomic cord morphology and normal signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease.Normal signal intensity of the calvarium and unremarkable images through the orbits and without detectable abnormal enhancement.On paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: Negative pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Syncope and gelastic seizure like episodes. Evaluate for secondary causes of seizures. No abnormal signal is seen on the T2, FLAIR or diffusion weighted images.No foci of cortical dysplasia or heterotopic gray matter. The hippocampi are normal in morphology. No mass lesion is evident.There is no evidence of intracranial hemorrhage or edemaThe ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Normal brain MR without findings to suggest an epileptogenic focus.


Instruction: Generate impression based on findings.

Input: 83 years, Male, lung cancer, memory problems. There is a 1.5 x 1.5 x 1.4 cm (AP x transverse by craniocaudal dimensions) lesion centered on the hypothalamus with local mass effect on the anterior inferior aspect of the third ventricle and partial effacement of the superior aspect of the interpeduncular cistern. Mamillary bodies may be compressed or infiltrated with the lesion. Lesion also abuts the optic tracts.Remainder of the brain demonstrates no additional mass or evidence of mass effect, midline shift, or herniation. There is no hydrocephalus. There is mild to moderate degree of global parenchymal volume loss, commensurate with patient's advanced age. There are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic disease.Small right maxillary sinus mucus retention cysts. Bilateral lens implants. Bone marrow signal and remainder of the extra cranial soft tissues are grossly unremarkable.

Output: Evaluate of metastatic disease is limited without intravenous contrast, which patient refused. There is a 1.5 x 1.5 x 1.4 cm lesion centered on the hypothalamus with local mass effect. Differential is broad in the absence of contrast and includes benign and malignant etiologies including metastasis. Comparison with prior studies would be helpful if postcontrast imaging is not performed. No additional masses elsewhere in the brain are present.