Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: TIA/stroke History: R face droop dysarthria There are a couple of punctate restricted diffusion lesions on the left frontal lobe precentral gyrus and left parietal lobe post central gyrus without evidence of hemorrhagic conversion.Lacunar infarctions seen on bilateral basal ganglia.Underlying brain shows patchy and scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.There is no evidence of hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There is a small retention cyst on the right maxillary sinus.

Output: 1. Acute ischemic infarctions on the left precentral and post central gyri without evidence of hemorrhagic transformation.2. Redemonstration of multifocal scattered non specific small vessel ischemic disease and lacunar infarctions.Findings were discussed with Dr. Trueger of ER at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Clinical question: History of hydrocephalus with shunt with progressive lower extremity weakness, syrinx, evaluate for change. Signs and symptoms: Six-month follow-up of syrinx. Pre- and post enhanced cervical MRI:There are no prior exams for comparison.Examination demonstrates stable postoperative changes of Chiari decompression. Similar to prior exam dated is no significant expansion of thecal sac and there is highly suspected posterior adhesion of the dorsal aspect of the cervicomedullary junction of the cord to the surgical site. There is partial visualization of severely dilated fourth ventricle measuring maximum of 21 mm in AP axis compared to prior brain MRI examination (10-17-14) measurement of 25 mm. There is a catheter/stent lying along the dorsal aspect of enlarged fourth ventricle and the tip abutting the dorsal aspect of thecal sac without significant change since prior exam.Examination demonstrates a mildly expansile syrinx of cervical cord extending from the cervicomedullary junction of the cord inferiorly through the entire cervical cord and extending into the thoracic cord. There are no prior MRI of cervical spine for comparison. These findings however on sagittal T1-weighted images of brain MRI from above the demonstrated interval decreased caliber and with resultant better visualization of subarachnoid space in the upper cervical spine. The largest transaxial dimension of syrinx is at the upper cervical spine and measures approximately 6.5 x 7.5 mm. The syrinx at C7 measures at 5.5 x 4.5 mm. + There is no abnormal enhancement of the cord or the left middle meningeal.At C4-C5 there is a small central disc protrusion which effaces the ventral subarachnoid space and applied a subtle mass effect on the cord and mild central spinal stenosis. There is also moderate left and mild right neural foraminal compromise at this level. Degenerative changes at C6-C7 with uncovertebral hypertrophic changes (right greater than left) results in moderate to severe right neural foraminal compromise.There is slight wasting at the C5-C6 disc level (sagittal T2 STIR image 10) which may indicate a congenital incomplete fusion at this level and with resultant exaggerated degenerative changes immediately superior and inferior to this level as detailed.Pre and post enhanced thoracic MRI:There are no prior MRI of thoracic spine for comparison.There is normal signal intensity and anatomical alignment of vertebral column and without evidence of abnormal enhancement.There is a syrinx involving the entire length of the thoracic cord. The cervix measures at 4.3 x 2.8 at T1 level, slit like and measuring 5 x 0.8 mm at T7, slit like and measuring at 4.7 x 2 mm at T9, 5.5 x 2.4 mm at T10 level and 5.5 x 3.5 mm at L1 level. There is no evidence of abnormal enhancement of the cord or the leptomeninges.Pre and post enhanced lumbar MRI:There is termination of the cord at L2-L3 disc level similar to prior exam. There is a mildly expansile syrinx of the lower thoracic cord measuring 5.5 x 6.5 mm at L1 level which is minimally larger since prior study. The signal intensity of the cauda equina is within normal and without detectable abnormal enhancement.There is normal signal intensity and the alignment of vertebral column without abnormal enhancement.

Output: 1.Pre- and post enhanced MRI of cervical spine demonstrate stable postoperative changes of aortic decompression as detailed. Revisualization of dilated fourth ventricle with interval decrease in size when compared with prior brain MRI exam from 10-17-14. There is syrinx extending the entire length of cervical cord which demonstrate interval decreased caliber when compared with prior sagittal T1-weighted brain MRI from 10-17-14. There is degenerative changes at C4-C5 and including a central disc protrusion with resultant central spinal stenosis and at C6-C7 level with resultant significant neural foraminal compromise as detailed. Mild wasting at C5-C6 disc level suggestive of congenital incomplete fusion and with presumed accelerated degenerative changes at the levels immediately above and inferior to this level. No abnormal enhancement.2.Pre- and post enhanced MRI of thoracic spine demonstrate a syrinx extending the entire length of thoracic cord as detailed/measured above. There are no prior thoracic MRI images for comparison however when compared with prior lumbar MRI study (10-17-14) the lowermost extent of syrinx of the thoracic cord demonstrate no significant change in size or extend. No abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges.3.MRI of lumbar spine demonstrate termination of the cord at L2-L3 disc level similar to prior study. Normal signal intensity of cauda equina and without abnormal enhancement. Normal signal intensity and alignment of vertebral column and without abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: eval for meniscal tear History: R knee pain/effusion s/p fall MENISCI: There is increased signal intensity within the inner half of the posterior horn of the medial meniscus, just medial to the root of the meniscus, likely representing degenerative fraying, but we see no fluid-filled or otherwise unstable tear. There is globular signal within the lateral meniscus, particularly the body of the meniscus, suggesting intrasubstance degeneration, but we see no definite tear. ARTICULAR CARTILAGE AND BONE: There is mild to moderate degeneration of the articular cartilage of the patella, particularly along the median eminence and extending into the cartilage of the lateral facet with superficial fissuring. There is moderate to severe degeneration of the articular cartilage of the femoral trochlea with full-thickness defects and subchondral cysts particularly along the lateral facet. There is full-thickness delamination of the articular cartilage of the weightbearing portion of the medial femoral condyle just anterior to the posterior horn of the medial meniscus. There is a focal full-thickness cleft of the articular cartilage of the lateral femoral condyle just above the periphery of the posterior horn of the lateral meniscus with mild to moderate degeneration of the articular cartilage of the lateral femoral condyle more anteriorly. There are small osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. Edema along the MCL could represent a sprain in the correct clinical context. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Mild degenerative fraying of the free edge of the posterior horn of the medial meniscus, but we see no discrete meniscal tear.2. Tricompartmental articular cartilage degeneration most severely affecting the femoral trochlea.3. Edema along the MCL could represent a sprain in the correct clinical context.4. Small joint effusion and Baker's cyst.


Instruction: Generate impression based on findings.

Input: 71 year old female with frequent falls, instability. Evaluate for prior stroke, demyelinating disease. There is no restricted diffusion on DWI sequences to suggest acute ischemic infarction. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. There is a moderate patchy periventricular and subcortical white matter T2 and FLAIR hyperintense foci similar to prior study consistent with chronic small vessel ischemic disease. There is mild prominence of the ventricles and sulci consistent with mild age-related volume loss. The post contrast images are motion degraded. No large enhancing intracranial lesions are identified. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. No evidence of acute ischemic infarction or intracranial hemorrhage. 2. Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Episodes of falls, intermittent confusion, decreased proprioception, positive Romberg. OSH CT with "old tiny lacunar infarcts in bilateral basal ganglia" images not available. Evaluate for stroke or other pathology. There is no evidence of intracranial hemorrhage. There is periventricular and white matter T2/FLAIR hyperintensity which is nonspecific but likely related to small vessel ischemic changes. However, a confluent region of FLAIR/T2 signal abnormality noted along the anterior aspect of the body of the right lateral ventricle within the corona radiata. There is no conspicuous ex vacuo dilatation of the adjacent ventricle, although there is overall smaller size of the right lateral ventricles compared to the left, a normal variant. Additional focal T2/FLAIR hyperintensity in the basal ganglia bilaterally are likely from prior lacunar strokes. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of intracranial hemorrhage or acute infarct. 2.Mild-moderate chronic small vessel ischemic changes, with greater confluence along right corona radiata3.Additional chronic lacunar infarcts along the basal ganglia.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's headaches.


Instruction: Generate impression based on findings.

Input: 2-day-old male with apnea and multiple bradycardic events. Assess for bleed. Note is made of curvilinear hyperattenuation along the right and left tentorium consistent with a small subdural hematoma layering along the tentorium. Note is made of diffuse generalized hypoattenuation affects the entire right cerebral hemisphere, which may be related to technical artifact, however, if high clinical suspicion for acute ischemia, further evaluation with MRI could be considered. There is no evidence of intracranial mass. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.

Output: 1. Trace subdural hematoma layering along the tentorium. Close interval follow up examination is recommended. 2. Diffuse generalized hypoattenuation affects the entire right cerebral hemisphere, which may be related to technical artifact, however, if high clinical suspicion for acute ischemia, further evaluation with MRI could be considered.These findings and recommendations were discussed via direct phone call with Emily Weiss at 11:00 am on 4/13/13.


Instruction: Generate impression based on findings.

Input: Cramp of limb [729.82] / Pain in limb [729.5] / Sarcoidosis [135] / Brachial neuritis or radiculitis NOS [723.4], Reason for Study: ^Reason: eval for cause of right hand cramping pain x 1 month; hx of abnormal c-spine MRI and neurosarcoid, normal EMG. The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: central focal disc protrusion which abuts thecal sac, no change of the degree of disc protrusion since prior scan. C4-C5: central focal disc protrusion which abuts thecal sac, slightly progressed disc protrusion since prior scan. C5-C6: minimal central focal disc protrusion which abuts thecal sac, no change of the degree of disc protrusion since prior scan. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel disc herniations without spinal cord signal abnormality as described above.2. C45 central disc herniation appears to be slightly progressed since prior scan.3. Other levels including C34 and C45 disc herniations do not show any significant interval change since prior scan.


Instruction: Generate impression based on findings.

Input: 39 year old with history of papillary thyroid cancer, syncope and PVCs presenting for cardiac evaluation of syncope. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 147 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 57 ml (normal range 31+/-10). 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. Native T1 mapping show normal T1 times (1020 ms)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 55%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 143 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 65 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%. 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.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%. There are no MRI criteria for ARVD.


Instruction: Generate impression based on findings.

Input: 64 year old female with a history of cholangiocarcinoma of the distal common bile duct with elevated lipase and a history of pancreatitis. Evaluate for stone/duct stenosis. ABDOMEN:LIVER, BILIARY TRACT: Percutaneous biliary drainage catheter in place with the tip projecting at the level of the second portion of the duodenum, unchanged in position. There is mild intrahepatic biliary ductal dilation. There is moderate to severe extrahepatic biliary ductal dilation to the level of the distal common bile duct (51; series 701), adjacent to an ill defined mass in the region of the pancreatic head which demonstrates restricted diffusion and subtle delayed enhancement, measuring 4.3 x 3.0 cm (228; series 602). There is associated loss of the fat plane between the second portion of the duodenum and right psoas muscle and apparent extension to involve the right crus of the diaphragm. These findings are suspicious for residual or recurrent tumor in the setting of a known malignancy/cholangiocarcinoma. No common duct stones are identified. Focus of decreased T1 and T2 signal abnormality in the dome of the liver, consistent with the previously demonstrated hepatic dome calcification. Simple cyst in the right lobe of liver.SPLEEN: No significant abnormality noted.PANCREAS: Moderate to severe main pancreatic duct dilation to the level of the confluence with the common bile duct immediately adjacent to the aforementioned mass at the level of the distal common bile duct, appearing increased in diameter when compared to the prior study, when allowing for differences in technique.Multiple subcentimeter foci of fluid signal intensity are identified within the body and tail of the pancreas which are incompletely characterized and may represent branch type IPMNs or cysts. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple cysts are identified in the left kidney. Decreased T2 signal abnormality in the kidneys bilaterally can be seen in hemosiderin deposition.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach and proximal duodenum are dilated and filled with fluid and debris to the level of the junction of the second and third portions of the duodenum, with a transition point immediately adjacent to the level of the aforementioned mass within the expected region of the distal common bile duct. These findings are suspicious for tumor involvement/extension into the duodenum. Further evaluation with endoscopy could be considered if clinically indicated. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate-sized bilateral pleural effusions with underlying atelectasis/consolidation.

Output: 1.4.3 cm ill defined enhancing mass in the expected region of the distal common bile duct with resultant moderate to severe biliary and main pancreatic duct dilation, appearing increased when compared to the prior study. These findings are suspicious for residual or recurrent tumor in the setting of a known primary malignancy/cholangiocarcinoma.2. Dilation of the stomach and proximal portions of the duodenum to the level of the aforementioned distal common bile duct mass is suspicious for duodenal extension/involvement by tumor, with resultant gastric outlet obstruction. Further evaluation with endoscopy could be considered if clinically indicated. 3. Persistent bilateral pleural effusions. 4. Decreased T2 signal abnormality in the kidneys bilaterally is nonspecific but can be seen in hemosiderin deposition.5. Multiple subcentimeter foci of fluid signal in the pancreas may represent cysts versus branch type IPMNs.


Instruction: Generate impression based on findings.

Input: Altered mental status. The exam is markedly degraded by patient motion. There appears to be a punctate focus of restricted diffusion in the left paracentral lobule. There is mild nonspecific periventricular white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: The exam is markedly degraded by patient motion. Possible punctate focus of recent infarction in the left paracentral lobule versus artifact.


Instruction: Generate impression based on findings.

Input: Subcutaneous shoulder mass ROTATOR CUFF: There is redemonstration of tearing of the distal anterior fibers of the supraspinatus tendon near its insertion. There is also interstitial tearing of the supraspinatus at the level of the myotendinous junction. The infraspinatus, teres minor, and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Redemonstration of an ill-defined lesion within the subcutaneous tissues overlying the deltoid which has decreased from the prior exam.


Instruction: Generate impression based on findings.

Input: Memory difficulty No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is mild global parenchymal volume loss which appears slightly prominent for age. No hydrocephalus.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, including a relatively more prominent focus in the left frontal corona radiata and nonspecific. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is expansile, abnormal T1 hypointensity and enhancement involving the left skull base including the jugular tubercle extending into the upper left occipital condyle. There is a subcentimeter left parotid nodule, which is nonspecific, possibly small lymph node. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No intracranial mass or mass-effect. 2. Mild global parenchymal volume loss which appears prominent for age.3. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, including a relatively more prominent focus in the left frontal corona radiata. These are nonspecific but compatible with mild chronic small vessel ischemic changes, sequela of prior inflammation/infection, or less likely demyelination.4. Expansile, abnormal T1 hypointensity and enhancement involving the left skull base including the jugular tubercle extending into the upper left occipital condyle. Finding may represent a benign osseous lesions such as fibrous dysplasia, but recommend CT for further assessment to better exclude other processes including metastasis.


Instruction: Generate impression based on findings.

Input: Ms. Li is a 23 year old female with a personal history of right breast lumpectomy in 2015 for a borderline phyllodes tumor/ADH/FEA and recent left breast biopsy for fibroadenoma with minute focus of ADH. She presents for MR imaging evaluation. There is extreme amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this evaluation.There are a total of 9 lobulated enhancing masses identified bilaterally (left breast-6, right breast-3), some of which have increased T2 signal intensity and dark internal nonenhancing septations. Given their similar appearance and enhancement pattern, these all likely represent fibroepithelial lesions. For reference purposes, the biopsied fibroadenoma in the left superior breast measures approximately 1.3 x 1.7 x 1.1 cm (AP x ML x SI). Prior ultrasound measurements were 1.5 x 1.6 x 0.9 cm. Biopsy marker clip is seen within the central aspect of this fibroadenoma.No abnormal axillary lymph nodes are identified in either axillary region.

Output: Multiple lobulated enhancing masses seen bilaterally, all of which have similar appearance and enhancement pattern. These all likely represent fibroepithelial lesions.A short-term 6 month MRI follow-up is recommended in order to ensure stability of all of these masses.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: History of endometrial thickening. PELVIS:UTERUS, ADNEXA: The uterus measures approximately 8.0 x 6.7 cm in the sagittal plane.The endometrium/endometrial canal is thickened up to 2.0 cm with predominantly T2 weighted hyperintense heterogeneous signal with thin septations. There is no abnormal nodular postcontrast enhancement, however some of the septations may enhance as seen on the subtraction images. The inner myometrium/junctional measures approximately 4 mm in greatest thickness, within normal limits. It is distorted posteriorly by large fibroids. The largest fibroid is a right sided intramural/subserosal uterine body fibroid measuring 5.1 x 4.1 cm in the sagittal plane. A left-sided intramural/submucosal fibroid distorting the endometrial cavity measures 3.0 x 2.7 cm. Near the fundus there is a 2.0 x 1.9 cm submucosal fibroid.Nabothian cystic changes or small amount of fluid in the cervical canal.The parametrial soft tissues are unremarkable. The vaginal canal is unremarkable.Atrophic bilateral ovaries without a focal lesion.BLADDER: Partially distended urinary bladder without a focal abnormality.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disc disease at L5-S1.OTHER: No significant abnormality noted.

Output: 1.Endometrium/endometrial canal thickening up to 2 cm with possibly enhancing septations but no discrete nodular enhancement, findings may represent endometrial hyperplasia, however an early stage endometrial carcinoma cannot be excluded. Correlate with adequate endometrial biopsy/sampling.2.Several enhancing fibroids with the largest measuring 5.1 cm as described above, including submucosal fibroids.


Instruction: Generate impression based on findings.

Input: TIA: resolved slurred speech and leg weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered nonspecific cerebral white matter T2 hyperintense foci, which may represent chronic small vessel ischemia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Cervical-thoracic syrinx to T11 with growth. There are stable postoperative findings related to posterior fossa decompression and C1 laminectomy. The cerebellar tonsils remain low-lying and pointed in configuration. However, there is interval decrease in the extent and caliber of the cervicothoracic syringohydromyelia, measuring up to 4 x 9 mm in cross section, previously 8 x 12 mm. The cerebellar tonsils are stable in position and configuration. There is intact flow of CSF across the anterior foramen magnum, but relative paucity of flow across the posterior foramen magnum, which is unchanged. The vertebral column alignment is unchanged. There is no significant spinal canal stenosis. The vertebral body heights and disc spaces are intact. There paraspinal soft tissues are unchanged. There is unchanged diffuse mild prominence of the thyroid gland.

Output: 1.Stable postoperative changes of Chiari decompression since prior study with intact CSF flow across the foramen magnum anteriorly, but negligible CSF flow posteriorly. 2.Stable cervicothoracic syringohydromyelia that extends from the level of C2-3 to T9-T10, measuring up to 2 x 4 mm in cross section.


Instruction: Generate impression based on findings.

Input: 39 years Female (DOB:7/14/1976)Reason: assess for listhesis, nerve impingment History: assess for listhesis, nerve impingmentPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE 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 loss of disc space height, disc desiccation and endplate reactive change at this level. The endplate reactive change is high signal on T2 and low signal on T1. There is a mild disc bulge at this level. Disc material extends into the left neural foramen but does not efface the fat surrounding the exiting nerve root. Endplate reactive changes worse on the left versus the right side.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: There are degenerative changes present in the lower lumbar spine with a disc bulge at L5-S1 associated with some acute endplate reactive changes on the current exam. Inflammatory changes from endplate reaction are worse on the left versus the right side. There is no significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for infarction or other abnormality History: loss of motor and sensory function of left lower extremity. Brain MRI appears within normal limits. No intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. The ventricles and sulci are normal in size. There is no evidence of mass effect or herniation. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The pituitary gland is normal in size. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of intracranial metastatic disease. No evidence of acute infarct, hemorrhage, or mass effect.


Instruction: Generate impression based on findings.

Input: BRAIN: There are at least 15 white matter T2 hyperintense lesions in the bilateral cerebral white matter, and in the left midbrain. There is a mildly worsened left cerebral peduncle T2 hyperintense lesion on series 601 image 32. There is a T2 hyperintense lesion in the right periatrial white matter on series 601 image 45 which also appears mildly worsened. There are two new T2 hyperintense lesions in the left periatrial white matter on series 601 image 48. There is a new right inferior frontal white matter T2 hyperintense lesion on series 601 image 41. There is a new left superior frontal gyrus white matter T2 hyperintense lesion on series 601 image 59. The remaining white matter lesions are unchanged. Only one new left periatrial white matter lesions enhances suggesting active demyelination. The ventricles and sulci are unchanged.CERVICAL: Multiple patchy areas of ill-defined high T2 signal within the imaged portion of the cervical cord are again seen. There is a stable anterior medulla T2 hyperintense lesion. The lesion centered at C2 level appears slightly less prominent compared to the prior exam in craniocaudal extent. The lesion along the dorsal right aspect of the cord centered at C3-4 level appears smaller. No definite new lesion is identified in the cervical cord. There is no pathologic enhancement of the white matter lesions in the cord. The osseous marrow signal is benign. The alignment is within normal limits. There are mild multilevel degenerative changes with disk osteophyte complexes most prominent at C4-5 and C5-6 without significant spinal canal stenosis or neural foraminal stenosis.

Output: 1.Numerous (greater than 15) T2 hyperintense white matter lesions in the brain with multiple new lesions and a few worsening lesions. A single left periatrial white matter lesion enhances suggesting active demyelination.2.Multiple patchy areas of well-defined high T2 signal in the imaged cervical cord again seen slightly less prominence of the lesion centered at C2 level. No definite new cervical cord lesion or pathologic enhancement.


Instruction: Generate impression based on findings.

Input: 59-year-old female patient with past history of possible IBD and generalized abdominal pain. Evaluation is limited secondary to suboptimal distension of bowel due to the patient's inability to tolerate oral contrast.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: Inadequate distension of a majority of the small bowel for evaluation. A few loops of adequately distended ileum appear normal. There are no areas of abnormal enhancement or diffusion abnormality. No evidence of a small bowel obstruction.BONES, SOFT TISSUES: Rightward thoracolumbar scoliosis. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suboptimal evaluation of the bowel secondary to inadequate distension of small bowel. Within this limitation, no acute abdominal abnormality noted.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for any intraventricular hemorrhage, infectious causes or brain pathology. Signs and symptoms cord full-term female presenting with seizures (lip smacking and left arm twitching and flexing) on DOL one. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. The overall appearance of brain is within normal for patient's stated age of two days. Ventricular system remains within normal size. Calvarium is intact. Median cavities are pneumatized. No pneumatization of visualized sinuses. Follow up with an MRI is recommended if clinical symptoms persist.

Output: Negative CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral bone marrow signal is unremarkable. The vertebral body and disk heights are well-maintained. There is disc desiccation at L4-5 and L5-S1. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. At L2-3, there is mild facet hypertrophy and ligamentum flavum thickening without neural foraminal or spinal canal narrowing. At L3-4, there is mild facet hypertrophy and ligamentum flavum thickening without neural foraminal or spinal canal narrowing. At L4-5, there is a mild disc bulge with facet hypertrophy and ligamentum flavum thickening causing mild bilateral neural foraminal narrowing without spinal canal stenosis. However, there is no longer the large left paracentral disc protrusion. At L5-S1, there is a mild disc bulge with facet hypertrophy and ligamentum flavum thickening causing mild bilateral neural foraminal narrowing without spinal canal stenosis.

Output: Mild multilevel degenerative spondylosis without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status. Altered mental statusClinical question: R/O brain metastasisSigns and Symptoms: delirium, new weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is thickening of the left tentorial leaf along its medial aspectNo 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: There is mild and subtle nonspecific thickening of the left tentorial leaf along its medial aspect. Differential considerations may include the idiopathic thickening of the tentorial leaf though it could also be related to granulomatous or lymphomatous disorder. Metastasis would be unusual but can occasionally present as a dural based lesion as well. Please correlate with patient's clinical history. If clinically appropriate, a follow-up exam would be helpful.


Instruction: Generate impression based on findings.

Input: 48-year-old male status post thymic carcinoma resection. Evaluation for residual or recurrent disease. LUNGS AND PLEURA: Right upper and middle lobe subsegmental atelectasis and/or scarring, stable.MEDIASTINUM AND HILA: Stable postsurgical changes from mediastinal mass resection. Retrosternal homogeneous high T2 signal, most compatible with postsurgical fluid and similar in extent compared to prior CT. no abnormal restricted diffusion or enhancement to suggest residual or recurrent disease.CHEST WALL: Postsurgical changes from median sternotomy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.

Output: Postsurgical changes from mediastinal mass resection without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1] / Other specified postprocedural states [Z98.89], Reason for Study: ^Reason: s/p stent assisted coiling of right distal ICA aneurysm History: none, follow up There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is a linear tissue loss with the peripheral hemosiderin deposition on the left frontal lobe indicating prior ICH, no change since prior scan.Multiple scattered high signal intensities on periventricular white matter on FLAIR imaging indicating nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, acute hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of left frontal chronic ICH and minimal non specific small vessel ischemic disease since prior scan.


Instruction: Generate impression based on findings.

Input: 30 year-old male with perianal mass/wart. Status post excision of condyloma with flap closure on 1/9/08. Postop day 6. Presents with feculent material at wound. Evaluate for fistula communication or abscess formation. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There are multiple small to borderline enlarged retroperitoneal and mesenteric lymph nodes.BOWEL, MESENTERY: There are multiple mildly dilated loops of large and small bowel throughout the abdomen, probably due to ileus. This may be exacerbated by air swallowing and spasm in the sigmoid and rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The sigmoid and rectum are minimally distended, possibly due to spasm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There are bilateral surgical drains in the dorsolateral buttocks with subcutaneous soft tissue air and multiple superficial skin staples. These findings are compatible with history of recent surgical procedure. No abscess or fistula was found. There is subcutaneous fat stranding in the buttocks medially which may be due to a minimal cellulitis.In some cases, small fistulas are very difficult to demonstrate, especially with CT. If symptoms persist, MRI examination of the buttocks and perineum with Crohn's protocol may be helpful for further evaluation.

Output: No evidence of abscess or fistula. Recent surgical changes in the superficial buttocks, as described above. Ileus.


Instruction: Generate impression based on findings.

Input: 40 year old woman with Turner's syndrome, referred for cardiac imaging. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 120 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 62 g (normal range 114+/-24). No evidence of ventricular septal defect. 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 mildly dilated. No evidence of atrial septal defect.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 99 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 35 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation. The aortic valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. No evidence of thoracic aortic aneurysm. No evidence of aortic coarctation. Sinus of Valsalva: 31x31x31mmST Junction: 29x29mmAscending Aorta: 30x30mmRight coronary artery and left main coronary arteries originate normally from the appropriate sinuses.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. Normal LV size and systolic function (LVEF 60%) without underlying myocardial fibrosis, inflammation, or infiltration. 2. Normal RV size and systolic function (RVEF 65%).3. Trileaflet aortic valve.4. No evidence of thoracic aortic aneurysm or coarctation.5. No evidence of intra-cardiac shunt. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68-year-old female with acute on chronic knee pain. MENISCI: Complex tear of the posterior horn of the medial meniscus which includes a complete vertical component just medial to its root attachment, and an additional vertical tear (perhaps a small oblique/flap tear) affecting the inner third of the posterior horn more medially. Additional signal abnormality within the body of the medial meniscus is compatible with intrasubstance degeneration. Mild extrusion of the body of the medial meniscus.Signal abnormality within the body of the lateral meniscus is compatible with intrasubstance degeneration. No meniscal tear is evident.ARTICULAR CARTILAGE AND BONE: There is tricompartmental osteoarthritis with diffuse full-thickness cartilage loss along the lateral facet of the patella and marked thinning of the articular cartilage of the lateral trochlea. Small subchondral cysts and foci of edema type signal are likely degenerative in etiology. Near full-thickness loss of articular cartilage along the medial plateau of the tibia and moderate degeneration of the articular cartilage with clefts noted along the medial femoral condyle. Relatively mild degeneration of the articular cartilage of the lateral tibiofemoral compartment.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis most severely affecting the patellofemoral and medial tibiofemoral compartments.2.Complex tear of the posterior horn of the medial meniscus.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Bell's palsy [G51.0], Reason for Study: ^Reason: rule out stroke History: peripheral facial palsy41 years Female (DOB:12/3/1975)Reason: rule out stroke History: peripheral facial palsyPROVIDER/ATTENDING NAME: WILLARD W SHARP Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is no abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

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


Instruction: Generate impression based on findings.

Input: History of pancreaticoduodenal groove mass. 5/18/2015 FNA - GIST. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from Whipple procedure and hepaticojejunostomy. No biliary ductal dilatation. No focal suspicious liver lesion. Note is made of a segment 5/8 T2 hyperintense and nonenhancing 1 cm lesion compatible with a simple hepatic cyst. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from Whipple procedure. The main pancreatic duct is minimally prominent without a focal lesion.Physiologic response to secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from Whipple procedure.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes from Whipple procedure without evidence of metastatic disease or local residual or recurrent tumor. Physiologic response to secretin administration.


Instruction: Generate impression based on findings.

Input: 14-year-old male patient with history of pheochromocytoma, who presented to the ER with thumb pain and noted to have a soft tissue mass in the fifth digit on radiographs. A somewhat lobulated mass measures approximately 1.7 x 0.8 x 2.3 cm (transverse x AP x craniocaudal) centered dorsal to the fifth digit PIP joint and middle phalanx. This lesion demonstrates low T1 signal intensity and high T2 signal intensity with internal low T2 signal septae, which enhance. The underlying osseous cortex appears intact with normal bone marrow signal intensity. The extensor tendons are not clearly delineated within this region. The lesion displaces the normal blood vessels within the dorsum of the finger away from the bone. A linear transverse signal in the distal first metacarpal metaphysis corresponds to linear T2 signal compatible with a nondisplaced fracture with surrounding bone marrow edema.

Output: 1. Soft tissue mass about the dorsal surface of the fifth digit PIP joint most likely represents a lymphangioma. 2. Non-displaced transverse fracture of the first metacarpal.


Instruction: Generate impression based on findings.

Input: 78 years Male (DOB:1/4/1938)Reason: brain mass History: haPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is a heterogeneously enhancing mass involving the left periventricular white matter adjacent to the trigone the left lateral ventricle and extending to the left pre and postcentral gyri. It has heterogeneous signal characteristics on T2 with foci of low signal suggestive of blood products or calcifications. There is encasement of the trigone of the left lateral ventricle and adjacent body of the left lateral ventricle. Compared to the previous exam is relatively stable. Signal change extends into the left thalamus and left posterior limb of internal capsule.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions as well as lesions in the brainstem 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. The eyeball lenses are thin.

Output: There is a partially calcified mass present in the left peritrigonal white matter extending to left pre and postcentral gyri and left thalamus. This appears stable compared to the prior exam. Please note that this exam was performed the purpose of stereotactic guidance during surgery and is limited.Periventricular and subcortical white matter lesions and lesions in the brainstem of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: MCL sprain, medial meniscus tear History: LEFT KNEE PAIN MENISCI: There is deformity of the medial meniscus at the junction of the body and posterior horn with low signal intensity in the posteromedial gutter adherent to the peripheral fibers of the meniscus, likely representing a displaced flap fragment. The remainder of the posterior horn of the medial meniscus appears slightly attenuated with thin linear intrasubstance signal extending to the tibial articular surface, likely representing additional tearing. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is mild edema within the medial tibial plateau, beneath the torn body of the medial meniscus, which is likely degenerative in etiology. The articular cartilage of the medial tibial plateau subjectively appears diffusely thinned, but we see no focal fluid-filled defect. There is a small focus of degeneration of the articular cartilage of the medial facet of the femoral trochlea and minimal superficial degeneration of the articular cartilage of the lateral facet of the patella. LIGAMENTS: There is mild edema along the superficial band of the medial collateral ligament which could either represent a mild sprain or could relate to underlying medial compartment pathology described above. The lateral collateral ligament complex, anterior cruciate ligament and posterior cruciate ligament appear normal.EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal.ADDITIONAL

Output: 1.Tear of the medial meniscus as described above2.Mild edema along the MCL may reflect a mild sprain or simply be secondary to underlying medial compartment pathology.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Altered mental status.. There is a chronic left thalamic lacunar infarct with susceptibility indicating chronic microhemorrhage in this region. Just posterior lateral to this is a punctate focus of restricted diffusion suspicious for acute ischemia with artifact a less likely possibility.Examination is severely motion degraded however there is no intracranial mass or mass effect. There is a periventricular and subcortical T2/FLAIR hyperintensity scattered in the periventricular and subcortical white matter which is nonspecific but compatible with chronic small vessel ischemic disease and similar to prior. Susceptibility-weighted sequence is motion degraded and multiple scattered small foci of chronic microhemorrhage are better seen previously. Foci of T2 hyperintensity in the bilateral subinsular region, right greater than left, are similar to prior and may represent prominent perivascular spaces or chronic lacunar infarcts. No midline shift or herniation. No extra-axial collections. No hydrocephalus. There is moderate degree of global parenchymal volume loss. Calvarium and extracranial soft tissues are grossly unremarkable within the limits of motion degradation.

Output: 1. Examination is moderately motion degraded. There is suggestion of punctate focus of acute infarct adjacent to a chronic hemorrhagic left thalamic infarct.2. Moderate chronic small vessel ischemic disease. No evidence of intracranial mass or mass effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62-year-old female with worsening neck pain after falling in 2/2016. She also has gait imbalance. Axial sequences are degraded secondary to patient motion. Given this caveat:There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Complete loss of disc space with vertebral body osseous fusion at C6/7 is consistent with a history of prior neck surgery, and is stable in appearance.At the C2-C3 level, bilateral facet hypertrophy is evident which causes mild right neural foraminal stenosis, unchanged.At C3-C4, there is moderate narrowing of the left neural foramen secondary to bony degenerative changes, unchanged. At C4-C5, there is mild narrowing of the right foramen secondary to bony degenerative changes. Small posterior osteophyte causes minimal effacement of the thecal sac but no deformity of the cord or central stenosis. These findings are unchanged.At C5-C6, there is a large osteophyte eccentric to the right of midline with some flattening of the right side of the cord as well as narrowing of the neural foramen bilaterally secondary to bony degenerative changes. There is mild to moderate central stenosis, moderate to marked left neural foraminal stenosis, and mild right neural foraminal stenosis. These findings are unchanged. At the C6-C7 postoperative level, there is no evidence of central or foraminal stenosis, unchanged.At C7-T1, no evidence of central or foraminal stenosis, unchanged.

Output: 1.C2-C3: Mild right neural foraminal stenosis, unchanged.2.C3-C4: Moderate narrowing of the left neural foramen, unchanged. 3.C4-C5: Mild narrowing of the right foramen, unchanged.'4.C5-C6: Mild to moderate central, moderate to marked left neural foraminal stenosis, and mild right neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: 13-year-old male with chronic constipation, rule out tethered cord. Signs and symptoms: Long-standing constipation. Nonenhanced lumbar MRI:There is normal anatomical development of the visualized lumbosacral spine.There is normal signal intensity and anatomical alignment of vertebral column.There is normal termination of the cord at mid L1 level. There is normal signal intensity and morphology of cauda equina. There is no detectable fatty filum terminale.There is a tiny central linear T2 signal intensity in the lower most visualized thoracic cord likely representing central canal and of questionable clinical significance.There is anterior movement of the lower most visualized thoracic cord, conus and cauda equina on prone sagittal T2-weighted images. There is no detectable. Spinal soft tissue abnormalities.Expanded colon with low T2 signal intensity consistent with contrast within the bowel likely residual from prior GI study dated 5/26/2015.

Output: 1.Unremarkable lumbar MRI and in particular without evidence of tethered cord.2.Dilated colon with low T2 signal intensity content consistent with residual contrast from recent GI exam from 5-20 6-50.


Instruction: Generate impression based on findings.

Input: Ischemic stroke: right sided hemiparesis. There is restricted diffusion in the left hemipons and midbrain with associated high T2 signal. There are mild scattered foci of T2 hyperintensity in the cerebral white matter and other portions of the brainstem. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a well-defined subcentimeter T2 hyperintense lesion inferior to the right temporomandibular joint. There is partially-imaged periodontal T2 hyperintensity around tooth # 11, which may represent inflammatory changes.

Output: 1. Acute infarct in the left pons and midbrain upon a background of probable mild small vessel ischemic disease.2. A well-defined subcentimeter T2 hyperintense lesion inferior to the right temporomandibular joint, which may represent a synovial cyst or parotid cyst, for example, although this is incompletely characterized.Discussed with LUKAS, RIMAS at 9:50 AM on 5/18/15.


Instruction: Generate impression based on findings.

Input: A 24 year old female with a history of asthma and an upper respiratory tract infection on 10/2015, since then feeling shortness of breath and chest pain together with an increase in weight. A recent echocardiography showed low normal LVEF (52.7% biplane). A recent CT showed pulmonary artery size in the upper limit of normal. The patient was referred from the pulmonary hypertension clinic to rule out pulmonary vascular disease. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 141 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 77 ml (normal range 31+/-10). There is mild global hypokinesis with no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 146 ml (normal range 110+/-24), the RV end systolic volume index is 42 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. ShuntNo shunt to suggest an ASD was noted on first pass contrast imaging. PFO can be missed with this technique. No ASD noted noted with cine imaging.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is 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. No coarctation noted.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (24mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 45%. There is mild global hypokinesis with no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 46%. 3. No shunt was noted4. The main pulmonary artery is normal in size (24mm). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified cause of encephalitis, myelitis, and encephalomyelitis Lack of coordination There is generalized cerebellar atrophy present associated with some mild FLAIR signal hyperintensity. The inferior aspect of the vermis is atrophic.. A comparison CT study from 2008 also demonstrates cerebellar atrophy. The fourth ventricle appears relatively large. There is no associated contrast enhancement.Postcontrast imaging is degraded due to patient motion. There is no associated leptomeningeal enhancement.There is metallic artifact adjacent to the left parietal bone.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 demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is cerebellar atrophy present associated with signal hyperintensity along the cerebellum. The possibility of recurrence of cerebellitis is raised. Additionally, the general appearance of the cerebellum is suggestive of a Dandy-Walker variant.2.Metal artifact along the left parietal skull area is of unknown cause. It partly obscures visualization. Please correlate with clinical exam and clinical history.


Instruction: Generate impression based on findings.

Input: Right subclavian angiosarcoma status post treatment. There are post-treatment findings in the right supraclavicular region, but no evidence of measurable tumors in this region. There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The osseous structures are unchanged. The airways are patent. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the right supraclavicular region, but no evidence of measurable tumors in this region or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Fluid is incidentally noted in an aerated right petrous apex. The midline structures and craniocervical junction are within normal limits.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. No evidence of acute infarct.2. No evidence of flow-limiting stenosis or aneurysm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chronic hepatitis C. Alcoholic cirrhosis of the liver. ABDOMEN: LIVER, BILIARY TRACT: Nodular liver contour, caudate hypertrophy, and widening of the fissures are compatible with known cirrhosis. There is moderate hepatomegaly, measuring 22 cm in length. Numerous T1 hyperintense subcentimeter nodules are noted in both hepatic lobes, likely representing regenerative nodules.A central segment 8 lesion demonstrates arterial enhancement and washout on delayed phase imaging. The lesion measures 2.4 cm x 2.3 on arterial phase (series 12, image 33). Size on portal venous phase is not readily assessed given difficulty in separating tumor from peritumoral enhancement. On delayed images there is washout with capsule formation. The lesion including the capsule measures 3.0 by 2.6 cm on 3 minute post-contrast images (series 17, image 33). These findings meet criteria for hepatocellular carcinoma.A peripheral right hepatic lobe segment 5/8 lesion demonstrates early arterial enhancement and measures 1.1 x 1.1 cm (series 12, image 42), also showing washout on delayed phase (series 19, image 41). Findings meet criteria for hepatocellular carcinoma.There is an additional subtle segment 4 lesion adjacent to the gallbladder fossa demonstrating washout on delayed phase images. It measures 2.1 x 2.0 cm on 3 minute postcontrast images. No arterial enhancement is seen. These findings do not meet criteria but remain suspicious for hepatocellular carcinoma (4-5% of hepatocellular carcinomas are visible only on delayed images).A small, ill-defined arterially enhancing segment 8 lesion measures approximately 9 mm (series 12, image 50). No definite washout is observed. These findings do not meet criteria for hepatocellular carcinoma. Many lesions only demonstrating arterial enhancement are benign, but warrant attention on follow-up imaging.Other scattered T2 hyperintense lesions likely represent simple cysts.Sludge/stones noted in the gallbladder. Diffuse gallbladder wall edema, commonly seen in patients with chronic liver disease.Small volume upper abdominal ascites.SPLEEN: Mild splenomegaly is noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple cysts and other subcentimeter hyperintense lesions are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two hepatic lesions meet criteria for hepatocellular carcinoma. 2.A third segment 4 lesion demonstrates washout but no arterial enhancement. This does not meet criteria but remains highly suspicious for hepatocellular carcinoma (4-5% of hepatocellular carcinomas are visible only on delayed images).3.A fourth arterially enhancing segment 8 lesion is nonspecific though warrants attention on follow-up imaging.


Instruction: Generate impression based on findings.

Input: MRI brain: Brain parenchyma demonstrates scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is no evidence of restricted diffusion. No susceptibility changes to indicate intracranial hemorrhage. There is mild parenchymal volume loss involving the bilateral parietal lobes and cerebellum. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. There is mild-to-moderate opacification of the left mastoid air cells.MRA: There is asymmetric enlargement of the right inferior petrosal sinus as well as small vascular structures which may represent small arterial feeders from the ascending pharyngeal artery/external carotid artery branches medial to the internal carotid artery at the level of right occipital condyle.There is a questionable 2 mm enhancement at the level of right proximal cavernous segment of ICA (image 55, series 501) which is favored to be related to adjacent vessel rather than a tiny posterior directly aneurysm. No aneurysm is appreciable on outside conventional angiogram. Otherwise, intracranial internal carotid arteries are normal in course and caliber without flow-limiting stenosis or occlusion. The middle and anterior cerebral arteries unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.Please note MRA neck and MRV was not obtained during the study.Cervical spine: Please note examination is performed as MRI cervical spine as requested. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body are well-maintained. There are degenerative disc changes with loss of height of C5-C6 and C6-C7 disc spaces. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is facet arthropathy. No significant compromise to the spinal canal or neural foramina.C4-5: Mild osteophyte disc complex with ligamentum flavum thickening and mild facet arthropathy resulting in minimal narrowing of the spinal canal. There is minimal left neural foraminal narrowing.C5-6: Posterior osteophyte disc complex and ligamentum flavum thickening resulting in minimal right neuroforaminal narrowing. There is minimal spinal canal stenosis.C6-7: Minimal posterior osteophyte disc complex. There is ligamentum flavum thickening. There is is minimal spinal canal stenosis. Minimal bilateral neural foraminal narrowing.C7-T1: There is facet arthropathy and ligament flavum thickening resulting in minimal left neuroforaminal narrowing. No significant compromise to the spinal canal.Post contrast sequences demonstrates no abnormal enhancement or abnormal flow voids within the spinal canal. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Asymmetric enlargement of the inferior petrosal sinus with additional vascular structures medial to the internal carotid artery at the level of the right occipital condyle which may represent arterial feeders from external carotid artery branches (probably ascending pharyngeal artery) and corresponding to known dural AV fistula, which was better assessed on prior conventional angiogram. Allowing for slight differences in technique, there is no interval change since prior MRI/MRA.2. Mild chronic small vessel ischemic changes and mild volume loss. Brain parenchyma is otherwise unremarkable.3. Mild degenerative changes in the cervical spine as detailed above. No abnormal flow-voids within the spinal canal are appreciated.


Instruction: Generate impression based on findings.

Input: Meningioma treated with SRS. There are postoperative findings related to suboccipital craniotomy with extensive left cerebral and to a lesser extent cerebellar vermian and right cerebellar hemisphere encephalomalacia. There is no significant interval change in the mildly enhancing tumor along the medial left tentorium, which extends and likely invades the confluence of the sinuses. The lesion measures approximately up to 20 mm, previously also 20 SI mm. There are mild scattered nonspecific foci of cerebral white matter T2 hyperintensity, which are likely related to chronic micrangiopathy. There is no evidence of acute infarct. There is diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes. The major cerebral artery flow voids are grossly intact. There is a left maxillary sinus retention cyst.

Output: 1. Stable post-operative findings without significant interval change in the residual meningioma along the medial left tentorium that extends and likely invades the confluence of the sinuses and measures up to 20 mm. 2. Diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes, may represent Alzheimer disease.


Instruction: Generate impression based on findings.

Input: IPMN follow-up. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Unchanged left hepatic cystic lesion measuring 5.6 x 4.5 cm with thin septations, unchanged since 2013, with no solid component or enhancement.SPLEEN: No significant abnormality noted.PANCREAS: Within the pancreatic head there is a T2 hypointense focus measuring 9 x 6 mm (series 11, image 22), too small to characterize, unchanged since 2013. This is distinct from the adjacent duodenal diverticulum. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Periampullary duodenal diverticulum appears unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged minimally complex hepatic cystic lesion, for which differential considerations include complex cyst, ciliated hepatic foregut cyst, biliary cystadenoma and biliary hamartoma.2.Unchanged pancreatic head lesion, may represent branch type IPMN.


Instruction: Generate impression based on findings.

Input: 76 year old female patient with history of myelofibrosis with splenomegaly. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring 20 cm in the craniocaudal dimension. There is marked decrease in T2-weighted signal intensity compatible with iron deposition. No intra- or extrahepatic biliary ductal dilatation. No focal suspicious lesion is identified.SPLEEN: Marked splenomegaly measuring 20 cm in the craniocaudal dimension and 14 x 7 cm in the axial plane. The spleen is diffusely hypointense on T2-weighted imaging. There are stable punctate T2 hyperintense foci in the spleen. There are multiple presumed siderotic nodules. PANCREAS: Unchanged punctate cystic focus in the pancreatic head may represent a sidebranch IPMN. No pancreatic ductal dilatation.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: Bone marrow signal intensity is markedly decreased. OTHER: No significant abnormality noted.

Output: 1.Hepatosplenomegaly with significant iron deposition in the liver and spleen.2.Marrow signal abnormality compatible with history of myelofibrosis.


Instruction: Generate impression based on findings.

Input: Possible infection. Worsening back pain with DJD L5-S1, fevers, chills. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from straightening. Bone marrow signal is benign. The conus medullaris is borderline low at the L2-L3 level. Filum terminale appears within normal limits.There is moderate to severe loss of disc height at the L5-S1 level and to a lesser degree at the L2-L3 level. There is suggestion of vacuum phenomena at the L5-S1 level. There is no significant edema within L5-S1 disc space or endplates. There are also no significant inflammatory change or evidence of abscess in the epidural or paraspinous soft tissues.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc height loss and edema involving the endplates anteriorly which is on a degenerative basis. There is a disc bulge without significant spinal canal stenosis. There is minimal narrowing of the right neural foramen. Left neural foramen is patent. L3-L4: Disc bulge eccentric to the left with partial effacement of the left lateral recess and mild to moderate left neural foraminal stenosis. There is contact of the descending L4 and exiting L3 nerve roots. No significant spinal canal or right neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Moderate to severe disc height loss, vacuum phenomenon, fatty endplate marrow signal changes, as well as mild disc bulge which is eccentric to the right. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. No imaging findings to suggest infection in the lumbar spine. 2. There are multilevel degenerative changes with moderate to severe disc height loss at the L5-S1 level and suggestion of vacuum phenomena. There is no significant central spinal canal stenosis at any level. Disc bulge which is eccentric to the left at L3-L4 is associated with mild to moderate left neural foraminal stenosis and partial effacement of the left lateral recess. There is also mild to moderate right and mild left L5-S1 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/27/15, 3/21/14, 3/10/14), ultrasound images (4/27/15, 3/21/14, 3/20/14, 3/10/14), breast MRI (3/17/14) performed at St. Mary's Medical Center. DIGITAL BILATERAL MAMMOGRAPHIC IMAGES AND ULTRASOUND IMAGES OF RIGHT BREAST (3/10/14):The breast parenchyma is composed of scattered fibroglandular elements. There is an oval mass measuring approximately 15 mm at posterior upper inner quadrant in the right breast. A marker clip is identified approximately 2 cm superior to this mass. Benign-appearing calcifications are present immediately posterior to this mass.In the left breast, there is a circumscribed oval mass measuring 7 mm at posterior upper inner quadrant, with adjacent marker clip. This mass is presumably biopsied. No suspicious microcalcifications or areas of architectural distortion are noted in either breast. Ultrasound of the right breast failed to detect any sonographic correlate to the right breast mass on the mammogram.BREAST MRI (3/17/14):Imaging protocol is described in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a lobulated mass measuring 17 x 10 x 15 mm (AP x LR x CC) at posterior 2:00 position in the right breast. This enhancing mass corresponds to the mass seen on the prior mammogram. An 8 mm circumscribed, oval mass is present at central aspect in the left breast. Another small circumscribed mass measuring 6 mm is seen at posterior 11:00 position in the left breast, corresponding to the small mass seen on the prior mammogram. This is presumably a benign lesion.No abnormal axillary lymph nodes are identified in either axillary region.ULTRASOUND IMAGES (3/20/14):This is an MR directed ultrasound study for right and left breast. In the right breast, there is a 15 mm lobulated mass at 2:00 position, corresponding to the MR findings. In the left breast, there is a 10 mm oval mass at 12:00 position, corresponding to the mass seen on the MRI at central aspect in the left breast. The left breast mass appears benign.IMAGES FROM ULTRASOUND-GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (3/21/2014):Ultrasound guided biopsy with clip placement was performed for the right breast mass at 2:00 position. Postprocedural mammographic images show a marker clip at the superior-anterior peripheral aspect of the lesion. Biopsy result was fibroadenoma.DIGITAL BILATERAL MAMMOGRAPHIC IMAGES AND ULTRASOUND IMAGES OF RIGHT BREAST (4/27/15):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution.A proven fibroadenoma is again seen in the right breast at posterior upper inner quadrant with a marker clip. In the left breast at central aspect, there is a circumscribed mass measuring 8 mm. This mass likely corresponds to the enhancing mass seen on MRI.Ultrasound study for left breast detected a correlating mass, measuring 9 x 4 mm at 1:00 position. This is the same mass detected on the ultrasound study of 3/20/14. There are no interval changes.

Output: No mammographic evidence of malignancy. The patient is reportedly high risk for breast cancer. Annual MRI screening is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female 76 years old with pain and dilated pancreatic duct on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and smooth in contour. Within hepatic segment 8 is a 13 x 10 mm, round arterial enhancing lesion with no washout on delayed images. Mildly prominent common duct is likely related to age post cholecystectomy state. No intrahepatic biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Correlating to the CT is a markedly pancreatic duct dilated pancreatic duct measuring up to 7 mm with a transition point the mid pancreatic body (series 401, image 26). This may be related to a pancreatic stricture and although no discrete mass is identified, a malignant stricture cannot be excluded. Lobular tissue at the level of the stricture is favored to represent a normal pancreatic lobule (series 1004, image 223).There is atrophy of the pancreatic body and tail. Comparison made to prior CT where there were no calcifications to suggest chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Dextroscoliosis and degenerative changes of the lumbar spine.OTHER: No significant abnormality noted.

Output: 1.Atrophic pancreatic body and tail.2.Markedly dilated pancreatic duct with abrupt termination in the mid pancreatic body, atrophic changes of pancreatic parenchyma suggested. Findings are concerning for stricture and, although a discrete mass is not identified, a malignant stricture cannot be excluded. Correlation with EUS is recommended.


Instruction: Generate impression based on findings.

Input: Reason: eval for ligament tear History: one year hx of right shoulder pain Due to the patient's body habitus, the routine shoulder coil could not be used. A flex coil was utilized instead resulting in slightly suboptimal image quality.ROTATOR CUFF: There is thickening and intermediate signal intensity of the supraspinatus tendon indicating mild to moderate tendinosis and perhaps mild bursal surface fraying, but we see no discrete fluid-filled tear. The supraspinatus muscle appears intact. The tendinosis extends posteriorly to involve the anterior fibers of the infraspinatus, but otherwise the tendon appears normal. We see no fluid-filled tear. The infraspinatus muscle appears intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with edema of the surrounding capsular structures. There is a small amount of fluid within the subacromial/subdeltoid bursa suggesting a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the labrum is limited due to the aforementioned technical factors as well as lack of intra-articular contrast. There is intermediate signal intensity within the superior labrum which may represent degeneration, but we see no fluid-filled tear. The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint, but no large effusion.BICEPS TENDON: Given the limitations of a non arthrogram study, the tendon of the long head of the biceps is unremarkable. ADDITIONAL

Output: 1. Rotator cuff tendinosis without evidence of a full-thickness rotator cuff tear.2. Acromioclavicular joint osteoarthritis.3. Small amount of fluid within the subacromial subdeltoid bursa may represent a mild bursitis.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize the mid-gland medial aspect of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the mid-gland medial aspect of the prostate.Upon confirmation of the tip of the needle within the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.Subsequently, DynaCad was used to localize the apex medial focus within the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the apex medial aspect of the prostate.Upon confirmation of the tip of the needle within the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.Subsequently, DynaCad was used to localize the apex left lateral focus within the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the apex left lateral aspect of the prostate. Upon confirmation of the tip of the needle within the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.Each set of cores was placed into separate formalin filled sterile specimen cups. The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 15 cc.

Output: Successful core-biopsies of the three prostate gland lesions, a 1.0 cm mid gland medial focus, a1.3 cm apex medial focus, and a 1.7 cm apex left lateral lesion.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of HCV cirrhosis and HCC status post resection ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated cirrhotic morphology with residual prominence and hypertrophy of the left lobe.Postsurgical changes of a segment 5 hepatectomy with heterogenous T2 signal in the surgical bed is again noted measuring 3.1 x 2.3 cm, previously 3.7 x 2.5 cm. There is a small amount of subcapsular fluid overlying the resection cavity, also decreased. Decreased extent of diffusion restriction, now with peripheral curvilinear focus at the anterior aspect of the cavity. No abnormal enhancement is evident. SPLEEN: Top normal splenic size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked stenosis/occlusion of the proximal celiac trunk with collateralization is again noted. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from surgical material in the anterior abdominal wall. OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of a segment 5 resection with decrease in size of the resection cavity. No evidence of local recurrence.


Instruction: Generate impression based on findings.

Input: Degenerative disease of the cervical spine Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spinal curvature and minimal retrolisthesis at the C5-C6 level. Alignment is otherwise maintained. Bone marrow signal is benign.There is susceptibility effect related to interbody graft at the C5-C6 level which obscure the ventral thecal sac on the sagittal images. The cervical spinal cord has grossly normal signal characteristics and overall morphology with apparent T2 hyperintensity at the C5-C6 level which is likely artifactual.Mild degenerative changes are seen in the cervical spine including mild multilevel facet arthropathy in the cervical spine and visualized upper thoracic spine. Individual levels in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex and mild bilateral uncovertebral hypertrophy. No significant spinal canal or neural foraminal stenosis.C5-6: Disc prosthesis with associated susceptibly artifact slightly limiting evaluation. There is uncovertebral hypertrophy. Mild right-sided neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis. C6-7: There is a disc bulge and annular fissure. There is moderate narrowing of the left neural foramen related primarily to the disc bulge with small contribution of uncovertebral hypertrophy and left-sided facet arthropathy. There is no significant spinal canal or right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Postsurgical changes at the C6-C7 level with susceptibility artifact from disc prosthesis slightly limiting evaluation of this level. Hardware position is better assessed on prior radiographs. Degenerative changes are seen with mild right C5-C6 and moderate left C6-C7 neural foraminal stenosis. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: History of perianal abscess now with worsening pain and urinary obstruction. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstration of a small rim-enhancing fluid collection posterior to the anal sphincter which measures 1.8 x 1.1 cm (series 6 image 168), previously 1.5 x 1.0 cm. There is surrounding soft tissue edema and thickening of the adjacent rectal wall compatible with prior. No associated fistula is evident. BONES, SOFT TISSUES: Presacral soft tissue edema.OTHER: No significant abnormality noted.

Output: 1.Interval increase in size of perianal abscess with increasing adjacent soft tissue edema/proctitis.


Instruction: Generate impression based on findings.

Input: 63 year old female with breast cancer s/p chemotherapy, hx of atrial flutter s/p ablation. Referred for MRI for assessment of function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%. The LVEDV is 129 ml (normal range 109+/-23), LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), LVESV is 49 ml (normal range 31+/-10), and LV end systolic volume index is 27 ml/m2 (normal range 18+/-5). The LV mass is 53 g (normal range 114+/-24) and the LV mass index is 29 g/m2 (normal range 67+/-11). 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.The native T1 myocardial relaxation time is within normal range. There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%. The RVEDV is 141 ml (normal range 110+/-24), the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVESV is 63 ml (normal range 35+/-13), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%.2.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%. 3.There is no evidence of late gadolinium enhancement suggesting no fibrosis or inflammation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.