Instruction: Generate impression based on findings.

Input: 49 year old with hypertension, LV dysfunction and family history of NICM presenting for evaluation. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 118 ml/m2 (normal range: 74+/-15), the LVEDV is 287 ml (normal range 142+/-34), the LV end systolic volume index is 75 ml/m2 (normal range 25+/-9), the LVESV is 181 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). The left ventricular systolic dysfunction is global with a septal bounce consistent with left bundle branch block. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native T1 time is in borderline range at 1100 ms. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 98 ml/m2 (normal range 82+/-16), the RVEDV is 236 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 120 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%. 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 low normal systolic function. The overall RV ejection fraction is 49%.


Instruction: Generate impression based on findings.

Input: 68 year old with biopsy proven invasive lobular carcinoma in the right breast. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, there is a large hematoma at 9:00 position, measuring 24 x 34 x 23 mm (all measurements: AP x LR x CC). Surrounding this hematoma, there is a clumped non-mass enhancement segmentally, measuring 99 x 52 x 40 mm, at 8:00 - 10:00 position, likely an extensive ILC.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Segmentally distributed non-mass enhancement in the right breast at 8 - 10 o'clock position, likely extensive ILC. Biopsy related hematoma is present within the non-mass enhancement.2. No MRI evidence of malignancy in the left breast or wither axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for chondromalacia Patella History: anterior knee pain MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact. ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus as well as posteriorly. There is relative sparing of the lateral tibiofemoral compartment. There is a focal near full-thickness articular cartilage cleft along the medial facet of the patella with delamination. There is focal partial-thickness articular cartilage degeneration along the lateral facet of the patella. There is increased bone marrow signal abnormality within the posterior aspect of the medial tibial plateau which may be degenerative in etiology although this could represent a bone contusion in the correct clinical context. There is no convincing cortical disruption to suggest a fracture.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis of the left knee as well as a full-thickness articular cartilage cleft and delamination along the medial facet of the patella. 2. Bone marrow signal abnormality within the posterior aspect of the medial tibial plateau may be degenerative in etiology, although this could represent a direct bone contusion, particularly if there is a history of trauma. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:5/7/1975)Reason: patient with mild cervical-thoracic scoliosis with worsening thoracic back pain and new heaviness/clumsiness of the right arm - evaluate for nerve compression, spinal stenosis or other History: back painPROVIDER/ATTENDING NAME: GEORGE W WEYER GEORGE W WEYER Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild loss of disc space height, endplate osteophyte formation or disc bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Some small foci of T1 signal hyperintensity within the thoracic spine are present which could represent focal fatty replacement or hemangioma.There is a mild dextrocurvature to the thoracic spine.

Output: 1.There are some degenerative changes present in the cervical spine without significant compromise to spinal canal or neural foramina.2.There is no significant compromise to the thoracic spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 64 years Male (DOB:1/28/1952)Reason: etiology of neck pain History: neck painPROVIDER/ATTENDING NAME: THOMAS J. KELLY SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion at this level which mildly impresses on the left-sided exiting nerve root.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present this level.At C6-7 there is a disc bulge present associated with some ligamentum flavum hypertrophy. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level. There is narrowing of the neural foramina bilaterally at this level and encroachment of the right-sided exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are some degenerative changes present in the cervical spine worse at C6-7 where there is a mild to moderate degree of spinal stenosis and encroachment of the right-sided exiting nerve roots within the neural foramen.


Instruction: Generate impression based on findings.

Input: 20-year-old female patient with endogenous insulin-mediated hypoglycemia. Evaluate for insulinoma. ABDOMEN:LIVER, BILIARY TRACT: No suspicious appearing hepatic lesion. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. No lesion seen within the pancreatic parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of a pancreatic lesion, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Male, 20 years old, with intractable epilepsy, presurgical planning evaluation. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Passive visual stimulation produces cortical activity centered on the calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is strongly left dominant on all tested paradigms. Putative Broca's area activity is seen within the left inferior frontal gyrus, mostly pars opercularis. Putative Wernicke's area activity is seen along the posterior aspect of the left superior temporal gyrus. This area of activation is slightly more superiorly positioned than what is typically seen, as it falls closer to the sylvian fissure than to the superior temporal sulcus. However, it is consistently visualized on all three language paradigms and there are no other foci of activation to indicate Wernicke's area.

Output: 1.Technically successful functional MRI for presurgical assessment of sensorimotor and language functionality.2.Sensorimotor cortical activation maps as expected along the pre- and post-central gyri. Visual cortical activation maps as expected in the occipital lobes.3.Language is left dominant with Broca's and Wernicke's areas identified as above.


Instruction: Generate impression based on findings.

Input: 25 years Male (DOB:7/11/1991)Reason: Eval for demyelinating disease History: muscle spasmsPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Asymmetry of the signal within the cerebellar peduncles is present on both the T2 and FLAIR MRI images. There is no associated T1 signal change in the same area.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.A vague signal hyperintensity within the right middle cerebellar peduncle is a nonspecific. This can could potentially represent demyelinating disease.2.This is a limited exam.


Instruction: Generate impression based on findings.

Input: 59-year-old female presents with left-sided facial /hand numbness There is a focus of restricted diffusion in the right thalamus with associated T2 hyperintensity, no hemorrhage, and no associated mass effect. No intracranial mass or mass-effect elsewhere in the brain. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. More prominent T2/FLAIR hyperintensity in the pons may also reflect small vessel ischemic disease, however, prior osmotic demyelination remains a consideration. Small focus of signal abnormality and volume loss in the right occipital cortex may be related to prior infarct or other injury. There are also scattered punctate foci of susceptibility in the deep white matter of the bilateral cerebral hemispheres, nonspecific, but consistent with chronic microhemorrhages. Major flow-voids are preserved. Sella is grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Note is made of pthisis bulbi involving the right globe.

Output: 1. Acute right thalamic infarct.2. Chronic small vessel ischemic disease. Pontine signal abnormality may also be related to chronic small vessel ischemic disease although remote osmotic demyelination is an additional consideration. Scattered chronic microhemorrhages in a nonspecific distribution also noted. There is also a small focus of signal abnormality in the right occipital cortex which may be related to prior ischemia or other injury.3. Pthisis bulbi involving the right globe.


Instruction: Generate impression based on findings.

Input: Syrinx spine, 4th ventricle stent with hydrocephalus: yearly follow up. Brain: There are postoperative findings related to Chiari decompression with a fourth ventricular stent in position. There is persistent dilatation of the fourth ventricle and mild periventricular T2 hyperintensity. The third and lateral ventricles are nearly collapsed, with bilateral transoccipital ventricular catheters in position. There is an unchanged subcentimeter focus of high T2 signal in the left posterolateral pons. There is high T2 signal suggestive of gliosis and cavitation surrounding the right transfrontal surgical tract. There is no evidence of acute infarction or hemorrhage. There is no midline shift. The calvarium and orbits are unchanged.Spine: There is a persistent holocord syrinx that measures up to 7 mm in width. There is multilevel degenerative spondylosis, which is most pronounced at C4-C5, where a disc-osteophyte complex mildly indents the spinal cord. There is also moderate left and mild right neural foraminal compromise at this level. In addition, degenerative spondylosis at C6-C7 with uncovertebral hypertrophy results in moderate to severe right neural foraminal narrowing. There is no significant spinal canal narrowing at the other cervical spine levels or in the thoracic spine. There is normal vertebral bone marrow signal and the alignment of vertebral column is unchanged. The paraspinal soft tissues are unremarkable, aside from postoperative alterations in the upper cervical region posteriorly.

Output: 1. Postoperative findings related to Chiari decompression and fourth ventricular stenting with persistent dilatation of the fourth ventricle, while the third and lateral ventricles are nearly collapsed, with bilateral transoccipital ventricular catheter in position. 2. Unchanged nonspecific subcentimeter lesion in the left posterolateral pons. 3. Persistent holocord syrinx.4. Degenerative spondylosis in the cervical spine.


Instruction: Generate impression based on findings.

Input: 18 year-old male with sickle cell crisis and severe headache There is no evidence of intracranial hemorrhage, mass or edema. Crowding of the foramen magnum with the cerebellar tonsils extending inferiorly off the image corresponding to a Chiari 1 malformation as seen on the previous MRI.There is a subtle hypoattenuation in the region of the right external capsule, also seen on the previous MRI without surrounding gliosis or edema, and appears to represent prominent CSF space.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality. Chiari 1 malformation is again noted.


Instruction: Generate impression based on findings.

Input: 64-year-old female presents with left shoulder pain. ROTATOR CUFF: There is thickening and generalized increased signal intensity of the supraspinatus tendon indicating moderate tendinosis. Anteriorly within the tendon, there is an insertional tear that disrupts the bursal surface fibers. The tear involves just over 50% of the tendon and is approximately 1 cm in AP dimension. The supraspinatus muscle appears intact. The aforementioned tendinosis extends posteriorly to involve the infraspinatus tendon. There are small cysts in the underlying humeral head, however, no discrete infraspinatus tendon tear is identified. There is mild fatty atrophy along the myotendinous junction, but otherwise the infraspinatus muscle appears normal. The teres minor tendon and muscle appear normal. There is mild increased signal intensity in the distal subscapular tendon which may reflect mild tendinosis, however the muscle appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with a small collection of fluid signal intensity dorsal to the articulation which may reflect a cyst. There is a small amount of fluid within the subdeltoid bursa, likely reflecting the aforementioned rotator cuff tear. The coracohumeral ligament appears slightly thickened, however, the patient's arm is internally rotated and therefore the significance of this is uncertain.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. There is intermediate signal intensity within the superior labrum suggesting degeneration with a small lobular collection of fluid signal intensity anteriorly that may represent a paralabral cyst. The remainder of the labrum appears normal for age. There is a small amount of fluid in the joint containing intermediate signal intensity suggesting mild synovitis. There is also fluid in the subcoracoid bursa containing small foci of intermediate signal intensity suggesting a bursitis and internal debris.BICEPS TENDON: There is thickening and increased signal intensity in the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular groove indicating moderate tendinosis.

Output: 1. Rotator cuff tendinosis and tearing as described above.2. Osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: headache, right neck arm numbness and heaviness There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Acom artery is patent but bilateral Pcom arteries are not seen.

Output: Normal brain MRI and brain MRA.


Instruction: Generate impression based on findings.

Input: 40-year-old with strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are stable well circumscribed masses bilaterally, consistent with fibroadenomas. The mass in the right breast at 3 o'clock measures 12 x 7 x 9 mm, previously measured 11 x 7 x 7 mm. The mass in the right breast 12 clock position measures 8 x 10 x 7 mm, previously measured 9 x 10 x 9 mm. Mass in the left breast at the 8:00 position, measures 15 x 10 x 9 mm, previously measured 15 x 12 x 10 mm. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Ssudden hearing loss in left ear, history of chemoradiation for esophageal cancer. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is mild fluid signal in the bilateral mastoid air cells, left more than right. The bilateral middle ears also appear unremarkable. There are bilateral lens implants. There is scattered cerebral white matter T2 hyperintensity in the imaged portions of the brain.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. Mild nonspecific fluid signal in the bilateral mastoid air cells, left more than right, which may represent effusions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 34-year-old female with history of brain trauma and double vision, ear fullness, and tinnitus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. Partially empty sella is again noted. Redemonstrated is mild distention of the optic nerve sheaths with fluid. On available thinner section imaging, there is minimal bilateral optic nerve head elevation, also appreciated on axial T2-weighted images. No diffusion restriction or abnormal enhancement is noted along the optic nerve head within the limitations of this study which was not protocoled for evaluation of orbits.There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Redemonstration of partially empty sella and mild fluid distention of the optic nerve sheaths with bilateral optic nerve head elevation. Findings are again compatible with pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Male, 67 years old. R shoulder pain, difficulty with overhead activities ROTATOR CUFF: There is no evidence of rotator cuff tear. A small focus of signal void is seen on all sequences in the area of the distal infraspinatus tendon, compatible with calcific tendinopathy. The rotator cuff muscles have normal bulk.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is fragmentation of the anterior labrum, which is likely degenerative in etiology. There is no significant joint effusion.BICEPS TENDON: The biceps tendon is normal in morphology and course, without evidence of injury.ADDITIONAL

Output: 1.No evidence of rotator cuff tear. A small focus of calcific tendinopathy is noted within the distal infraspinatus tendon.2.Fragmentation of the anterior labrum is likely degenerative in etiology.


Instruction: Generate impression based on findings.

Input: 34-year-old male, evaluate for osteomyelitis of the second metatarsal head and second toe of the left foot There is a defect in the plantar skin beneath the second metatarsophalangeal joint presumably representing the patient's known ulcer. Abnormal signal intensity extends from the ulcer to the underlying second metatarsal head and base of the second proximal phalanx. The signal abnormality also tracks along the flexor tendon apparatus of the second digit, with distention of the tendon sheath, likely representing septic tenosynovitis. The tenosynovitis extends from the second DIP joint to the level of the proximal diaphysis of the second metatarsal, and the flexor tendon sheath is distended by heterogeneous near-fluid signal intensity. Increased signal intensity within the plantar musculature of the forefoot and along the remaining flexor tendons beneath the midfoot suggests edema. Additional edema is present within the dorsal soft tissues along the midfoot. On the fat-suppressed T2 images there is edema in the head of the second metatarsal and in the proximal, middle, and distal phalanges of the second toe. The signal intensity appears relatively normal on T1 weighted images, however, favoring reactive osteitis rather than osteomyelitis. Edema about the base of the first TMT joint likely represents degenerative osteoarthritis. Mild osteoarthritis also affects the first metatarsophalangeal joint. Mild hallux valgus deformity.

Output: 1. Soft tissue ulceration and findings compatible with septic tenosynovitis of the flexor tendon apparatus of the second toe.2. Signal abnormality in the bones of the second toe and proximal phalanx of the third toe as described above, felt to more likely represent reactive osteitis rather than osteomyelitis.Findings discussed with Dr. Zmuda (pager 3330) at the time of dictation.


Instruction: Generate impression based on findings.

Input: Left cerebellopontine angle epidermoid: dizziness and nystagmus. There are postoperative findings related to left suboccipital cranioplasty with diffuse encephalomalacia in the left cerebellar hemisphere. There is a non-enhancing T2 hyperintense lesion with relatively low diffusivity in the left cerebellopontine angle cistern that measures 14 x 19 mm, previously 12 x 17 mm. There is mild mass effect upon the brainstem. There is no midline shift or herniation. There are a few scattered foci of T2 hyperintensity in the cerebral white matter, which may represent chronic small vessel ischemic disease. There is no evidence of acute infarction or hemorrhage. The major cerebral flow voids are intact. The left facial, vestibulocochlear, and trigeminal nerves are not well-delineated. There is extensive atrophy of the left masticator and facial expression muscles due to denervation. There is a persistent fluid collection superficial to the cranioplasty mesh that measures up to 20 mm in thickness. There is an enhancing subcentimeter right temporal scalp nodule.

Output: 1. Postoperative findings in the left posterior fossa with slight interval increase in size of the epidermoid centered in the left cerebellopontine angle cistern. 2. Persistent pseudomeningocele overlying the left cranioplasty site.3. Nonspecific enhancing subcentimeter right temporal scalp nodule.


Instruction: Generate impression based on findings.

Input: left lower quadrant pain, back pain. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The 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. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. . L4-L5: minimal disc dessication. diffuse bulging of disc with bilateral ligamentum flavum thickening results minimal to mild spinal stenosis at this level. no neuroforaminal narrowing or spinal stenosisL5-S1: diffuse bulging of disc, otherwise unremarkable.

Output: 1. Minimal to mild spinal stenosis at the level of L45 with diffuse bulging of disc.2. Diffuse bulging of disc at the level of L5S1.


Instruction: Generate impression based on findings.

Input: 57-year-old female with questionable lesion in the right lateral hepatic lobe obscured by steatosis. Evaluate for hepatic disease. ABDOMEN:LIVER, BILIARY TRACT: Segment 6/7 wedge shaped T2 hyperintense, T1 intermediate signal lesion measuring 1.3 x 1.1 cm ((series 8, image 28) which demonstrates enhancement on all phases. This lesion does not represent focal fat. Hepatic steatosis. Scattered subcentimeter cysts are present.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: Susceptibility artifact from the stent in the descending colon. Mildly enlarged mesenteric nodes adjacent to the descending colon are again noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 6/7 hepatic lesion demonstrates enhancement on all phases. This lesion does not meet the diagnostic criteria for metastatic focus. Given arterial enhancement which persists on all phases and matches the blood pool, this is likely a flash filling hemangioma.2.Susceptibility artifact from the stent in the descending colon. Mesenteric lymph nodes adjacent to the descending colon are again noted.


Instruction: Generate impression based on findings.

Input: Male, 26 years old. Reason: Right leg pain with activity. Per Epic note, concern for popliteal artery entrapment syndrome. Limited evaluation of the menisci, articular cartilage and bone, and ligaments in this nondedicated study. A dedicated MRI of the knee can be obtained if clinically warranted. There is no abnormal deviation of the popliteal artery. There is no abnormal insertion or aberrant lateral slips of the gastrocnemius. No fibrous band is evident. The right popliteal artery appears slightly more diminutive relative to the left popliteal artery (series 1505, image 12). In addition, the right popliteal vein appears slightly more diminutive relative to the left popliteal vein (series 601, image 61), however, these findings are of unclear clinical significance. There is mild generalized atrophy of the muscles of the right calf when compared to the left. There is no significant change in the patency or caliber of the arteries of the imaged right lower extremity when in neutral, plantar flexion, or dorsiflexion position.

Output: No findings to suggest popliteal artery entrapment syndrome.


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC to brain status post SRS. The peripherally-enhancing left parietal lobe lesion is unchanged in size, measuring up to 4 mm in diameter. There is also an unchanged punctate focus of susceptibility effect in the right occipital lobe. There are scattered nonspecific punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is also unchanged nonspecific scattered T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is an unchanged small right face skin excrescence.

Output: Unchanged treated small left parietal lobe lesions and scattered nonspecific punctate foci of susceptibility effect in the bilateral cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up. Signs and symptoms: None. Pre-and post enhanced pituitary MRI:Examination redemonstrates a previously known pituitary microadenoma in the right paramedian inferior pituitary. There is interval decreased size of microadenoma since prior exam. It measures approximately 4.6 mm in transverse axis coronal T2-weighted images compared to prior study measurements of 7.3-mm. The lesion demonstrates no enhancement and on post enhanced images measures approximately 4.9 mm compared to prior study measurements of 6.6-mm. Decreased size results in decreased superior bulge of the pituitary gland. The pituitary stalk remains in midline and with normal pattern of enhancement. The basal cistern and the suprasellar visual complex are unremarkable. Bilateral cavernous sinuses and the straight normal signal intensity and pattern of enhancement.

Output: 1.Interval decreased size of patient's known pituitary microadenoma as detailed/measured above.2.Interval decreased superior bulge of pituitary gland secondary to decreased size of microadenoma.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Female, 4 years old, with neck pain, headaches and sleep issues. Evaluate for Chiari malformation. The cerebellar tonsils are markedly elongated and peglike in shape and they descend up to 18 mm below the level of the foramen magnum. On conventional images, there is significant crowding through the foramen magnum. On CSF flow imaging, attenuation of flow is demonstrated ventrally through the foramen magnum as well as dorsally at the level of the mid cervical spine. Apparent flow related signal overlaying the cerebellar tonsils probably relates to tonsillar motion rather than CSF flow.No evidence of restricted diffusion is seen. No edema or mass effect is detected. Brain parenchymal morphology and signal characteristics are otherwise within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.Ill-defined T2 hyperintensity is seen within the spinal cord at the C2-3 level. More inferiorly, dilatation of the central canal of the spinal cord is demonstrated at C6-7.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The intervertebral discs are preserved and there is no compromise of the spinal canal or neural foramina.

Output: 1.Findings are seen compatible with Chiari I malformation. The CSF space at the level of the foramen magnum is markedly crowded. The remainder of the brain is within normal limits.2.Ill-defined T2 signal abnormality within the spinal cord at the C2-3 level may represent edema or syrinx formation. More discrete prominence of the central canal of the spinal cord is also seen at C6-7. The remainder of the spinal evaluation is within normal limits.


Instruction: Generate impression based on findings.

Input: Evaluate for ATFL tear and peroneal or tibialis tendinitis. Ankle pain for 16 months. Ligaments: The posterior talofibular ligament, calcaneofibular ligament and anterior talofibular ligament are intact. The deltoid ligament complex is normal in appearance.Tendons: The flexor and extensor tendons are intact. The Achilles tendon is normal in appearance.Bones/ Soft tissue: Bone marrow signal is normal. No fracture is identified. No ankle joint effusion is identified.Other: None

Output: Normal MRI of the ankle.


Instruction: Generate impression based on findings.

Input: 19 years, Female, headache, facial pain. History of Chiari decompression. Additional history per EMR, also history of craniosynostosis reconstruction in 1997 and pseudotumor cerebri. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are mildly dysmorphic but unchanged and without evidence of hydrocephalus. There are postsurgical changes of suboccipital craniectomy and resection of posterior arch of C1 for Chiari decompression. Unchanged encephalomalacia involving the inferior left cerebellar hemisphere. Unchanged contour of the calvarium with prior reconstruction for craniosynostosis. Sella and orbits are grossly unremarkable. There is mild opacification involving the right frontal sinus.There is unchanged appearance of the craniocervical junction compared to 10/19/2013, with marked improvement in previously seen posterior fossa crowding related to Chiari I seen on preoperative imaging from 2013, and no significant crowding on the current study. The dorsal cerebellar surface abuts the dura as before suggestive of scarring. CSF flow sequence demonstrates preserved biphasic flow ventrally, and also biphasic flow dorsally at the foramen magnum which terminates near the obex similar to prior.Cervical spine: The cervical spine is in normal alignment aside from mild straightening which may be positional. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal without evidence of syrinx. There is trace prominence of the central canal at the C5 and C6-C7 levels and present on prior studies.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. No significant change in postsurgical changes of Chiari I decompression. No significant residual crowding in the posterior fossa. CSF flow sequence demonstrates robust biphasic flow ventrally and also posteriorly to the level of the obex.2. Trace prominence of the central canal in the lower cervical cord similar to prior and nonspecific. No evidence of a discrete syrinx.


Instruction: Generate impression based on findings.

Input: History of spinal stenosis and worsening lower extremity pain and weakness. Evaluate for progression. Examination is mildly motion degraded. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris is grossly intact and terminates at L1 level. Again seen is moderate levoscoliosis which can be better assessed with standing radiographs. No significant spondylolisthesis.There are multilevel degenerative changes including disc desiccation throughout the lumbar spine with loss of disc height. There is severe disc height loss at the L4-L5 level and associated endplate changes which have progressed since 5/18/2011. There is mild increase in edema at the L4 and L5 endplates. Individual levels as below:At L1-2 there is mild disc bulge, ligamentum flavum thickening and facet arthropathy without significant spinal canal stenosis. There is minimal bilateral neural foraminal stenosis.At L2-3 there is a disc extrusion with mild superior migration along the right ventral thecal sac which is increased in the interval. There is also bilateral facet arthropathy and ligamentum flavum thickening. There is moderate spinal canal stenosis at this level which is slightly progressed. There is also moderate bilateral neural foraminal stenosis right worse than left, which is similar to prior on the right and slightly worse in the interval on the left.At L3-4 there is disc bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening resulting in moderate spinal canal stenosis slightly worse in the interval. There is moderate to severe right and moderate left neural foraminal stenosis, similar to prior.At L4-5 there is severe spinal canal stenosis related to disc bulge, dorsal annular fissure, advanced facet arthropathy, and ligamentum flavum thickening. There is mild progression of these changes compared to prior. There is severe right and moderate left neural foraminal stenosis which is similar to prior.At L5-S1 there is disc bulge, ligamentum flavum thickening, and advanced facet arthropathy resulting in moderate to severe spinal canal stenosis similar to prior. There is also severe left and moderate right neural foraminal stenosis similar to prior.There is interval increase in paraspinous enhancement at the L3-L4 and L4-L5 levels which is likely related to facet arthropathy. Paraspinous soft tissues are otherwise unremarkable. No suspicious enhancing lesions. Small bilateral renal cysts incidentally noted.

Output: 1. Compared to 5/18/2011 there is mild progression of advanced degenerative changes in the lumbar spine. There is severe spinal canal stenosis at L4-L5, moderate to severe spinal canal stenosis at L5-S1, and moderate spinal canal stenosis at L2-L3 and L3-L4.2. There is significant neural foraminal stenosis at L2-L3, L3-L4, L4-L5, and L5-S1 levels as detailed above where there may be impingement of the exiting nerve roots.3. There is lumbar levoscoliosis which can be further assessed with standing radiographs.


Instruction: Generate impression based on findings.

Input: Lumbar stenosis. Low back pain with bilateral leg radiation. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are grossly maintained aside from mild anterior compression deformities involving the L1 and L3 vertebral bodies, without edema. There is also mild levocurvature of the distal thoracic spine and mild levocurvature of the lumbar spine as seen on the coronal localizer sequence. There is mild reversal of lumbar lordosis. Bone marrow signal is benign with mild edematous marrow signal changes evident at L4-L5 and to a lesser degree at additional levels superiorly and inferiorly. The conus medullaris is normal in position at the L1-L2 level. Vacuum disc phenomena is noted at multiple levels.Multilevel degenerative changes are seen throughout the spine, as described below:T11-T12: Mild disc bulge, ligamentum flavum thickening, and prominent facet arthropathy. There is mild to moderate spinal canal stenosis with subtle T2 hyperintensity in the left ventral aspect of the cord at this level suspected. There is severe right neural foraminal stenosis.T12-L1: No significant spinal canal or neural foraminal stenosis. Ligamentum flavum thickening and facet arthropathy.L1-L2: There is severe spinal canal stenosis related to disc bulge, facet arthropathy, ligamentum flavum thickening, and prominence of the dorsal epidural fat. There is mild to moderate bilateral, right greater than left, neural foraminal stenosis.L2-L3: There is severe spinal canal stenosis related to disc bulge, facet arthropathy, and ligamentum flavum thickening, particularly the right aspect of the spinal canal. There is effacement of the lateral recesses, right greater left. There is mild right and mild to moderate left neural foraminal stenosis.L3-L4: There is severe spinal canal stenosis related to disc bulge, facet arthropathy, and ligamentum flavum thickening. There is mild to moderate right and severe left neural foraminal stenosis. L4-L5: There is severe spinal canal stenosis related to disc bulge, facet arthropathy, and ligamentum flavum thickening. Bilateral lateral recesses are effaced. There is moderate right and moderate to severe left neural foraminal stenosis.L5-S1: There is disc osteophyte complex which effaces the left S1 root in the lateral recess. There is no significant central canal stenosis otherwise. There is moderate to severe bilateral neural foraminal stenosis. There is an abdominal aortic aneurysm which is partially imaged.

Output: 1. Advanced degenerative changes throughout the lumbar spine with severe spinal canal stenosis from L1-L2 to the L4-L5 levels. There is also effacement of the left lateral recess at the L5-S1 level although there is no significant central canal stenosis at this level. 2. There is also mild to moderate spinal canal stenosis at the T11-T12 level. Subtle T2 signal abnormality in the left aspect of the cord is suspected.3. Multilevel neural foraminal stenoses as detailed above.4. Mild anterior wedging of the L1 and L3 vertebral bodies compatible with mild chronic compression fractures. No associated edema.5. Partially imaged abdominal aortic aneurysm.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis presenting with lower extremity weakness. Extensive increased T2 white matter signal centered in the periventricular white matter with a radiating morphology compatible with the history of multiple sclerosis. Similar to prior, the lesions have variable mild to marked low T1 signal. Compared to prior this is more extensive and confluent compatible with mild disease progression. Discrete new lesions are identified in the left precentral gyrus, right superior frontal gyrus, and mesial left temporal lobe. No definite lesional enhancement is present on the postcontrast images.There is no evidence of intracranial hemorrhage or mass. Mild generalized cerebral volume loss similar to prior. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: White matter signal abnormality primarily within the periventricular white matter compatible with the history of multiple sclerosis. Compared to 2011, there has been slight interval progression of disease burden with scattered small new lesions and increase in size of the prior lesions.


Instruction: Generate impression based on findings.

Input: 18 year old female with syncope and possible right ventricular dilation referred to evaluate for ARVD and other causes of syncope. Left VentricleThe left ventricle is severely dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 136 ml/m2 (normal range: 65+/-11), the LVEDV is 219 ml (normal range 109+/-23), the LV end systolic volume index is 55 ml/m2 (normal range 18+/-5), the LVESV is 88 ml (normal range 31+/-10), the LV mass index is 72 g/m2 (normal range 67+/-11), and the LV mass is 117 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in volume.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 136 ml/m2 (normal range 69+/-14), the RVEDV is 220 ml (normal range 110+/-24), the RV end systolic volume index is 62 ml/m2 (normal range 22+/-8), and the RVESV is 100 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in volume. 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. Normal origin of the coronary arteries.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 FindingsEvidence of spine surgery noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with normal systolic function (LVEF 60%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Severe RV dilation with normal systolic function (RVEF 54%) without evidence of focal aneurysm or wall motion abnormality. No cardiac MRI evidence of ARVD.3. Normal biatrial volume.4. Normal coronary artery origins. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: New focal myoclonus in left leg Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine which are suboptimally evaluated due to motion degradation on multiple sequences. Individual levels as described below:C2-3: Minimal disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and ligamentum flavum thickening. Mild spinal canal narrowing. Neural foramina are patent.C4-5: Small disc osteophyte complex with mild narrowing of the left neural foramen related to uncovertebral hypertrophy and facet arthropathy. Right neural foramen is patent. There is also mild spinal canal stenosis.C5-6: Disc osteophyte complex and ligamentum flavum thickening with mild to moderate spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and mild facet arthropathy.C6-7: Disc osteophyte complex and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is mild left and minimal right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina. Bilateral perineural cysts incidentally noted.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Right parotid gland is absent or completely replaced with fat. There is partial opacification of the bilateral mastoid air cells. Maxillary sinus opacification with fluid levels again seen.

Output: 1. Multilevel degenerative changes in the cervical spine relatively worse at the C5-C6 level where there is mild-to- moderate spinal canal stenosis and mild-to-moderate bilateral neural foraminal stenosis. 2. Mild spinal canal stenosis also present at the C3-C4, C4-C5, and C6-C7 levels. No higher grade spinal canal stenosis or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: History of IVC sarcoma status post resection 10/8/2014 ABDOMEN:LIVER, BILIARY TRACT: The previously described nonspecific focus in segment 8 now demonstrates a peripheral rim of enhancement and measures approximately 1.0 cm with associated restricted diffusion, highly suspicious for metastatic disease. Additionally there is a new punctate enhancing focus in the more peripheral aspect of segment 8. There are several additional punctate foci of restricted diffusion with associated T2-weighted mild hyperintensity and abnormal postcontrast enhancement (series 4 image 75, 77, and 80) in segment 4A and 7. Stable left hepatic lobe subcentimeter hemangioma. SPLEEN: The spleen is normal in size and morphology without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The punctate focus of restricted diffusion along the anterior aspect of the crus of the right hemidiaphragm is unchanged. The mildly enhancing soft tissue surrounding this focus is difficult to accurately measure and is not significantly changed (series 9, image 152).The low-density focus along the right posterolateral margin of the IVC is nonenhancing and likely represents postsurgical fluid, unchanged.No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Abdominal wall postsurgical changes.OTHER: No significant abnormality noted.

Output: Increasing size of previously noted liver lesion and several new punctate liver lesions as described are suspicious for metastatic disease. Stable postsurgical changes of the resection bed.


Instruction: Generate impression based on findings.

Input: 51-year-old woman status post open cholecystectomy for cholecystitis on 9/30/2015, now with transaminitis and possible choledocholithiasis. Please note that this examination was incomplete and only includes limited T2 and diffusion-weighted sequences.ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal an signal and morphology. The patient is status post cholecystectomy. There is no gross intrahepatic biliary duct dilatation. The common duct measures up to 7 mm in diameter (series 4, image 26).SPLEEN: Spleen appears normal.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post gastric bypass and a drainage catheter in the left upper quadrant is seen within the gastric remnant. A left lower quadrant ostomy is noted.BONES, SOFT TISSUES: There is a large ventral abdominal wound. Left flank soft tissue edema is noted.OTHER: Bilateral lung base opacities are noted.

Output: 1.Incomplete examination without gross intra or extrahepatic biliary duct dilatation.2.Pulmonary opacities noted, better seen on subsequent chest imaging.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left frontal lobe surgery for resection of recurrent left frontal lobe mass. There has been interval expansion of heterogenously enhancing tumor posteriorly to the surgical cavity, with extension of tumor across the midline via the corpus callosum. The degree of surrounding T2 hyperintensity has slightly increased as well. There are nonspecific punctate foci of susceptibility effect in the right parietal region. The ventricles and the basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is no evidence of acute infarct.

Output: Interval progression of the left frontal lobe glioblastoma with extension across the midline via the corpus callosum.


Instruction: Generate impression based on findings.

Input: 51 years, Male, known intracranial lesions. Examination is obtained for surgical planning and limited to 3-D T2 and postgadolinium T1-weighted images, which are motion degraded. Again seen are numerous peripherally enhancing lesions throughout the bilateral cerebral hemispheres as well in the posterior fossa including the left anterior cerebellar hemisphere. Additional foci of enhancement in the posterior fossa along the posterior wall of the fourth ventricle and the left pons may be artifactual or related to small additional lesions which are not adequately evaluated on the motion degraded study.These lesions have increased in size since 10/13/2016. For example a left occipital lesion previously measuring approximately 20 mm in the AP dimension, now measures 25 mm. There is also increased mass effect with these lesions particularly within left frontal lesion which is associated with increased effacement of the left lateral ventricle and downward mass effect on the anterior callosal body. There is no significant midline shift or herniation. No hydrocephalus.Postsurgical changes of right frontal craniotomy related to prior biopsy. Enhancing lytic lesion involving the left parietal calvarium is again seen seen. Additional smaller left sphenoid/temporal bone lesion better seen on prior CT. Major flow-voids are preserved. There is distention of the optic sheaths likely reflecting elevated intracranial pressure. There is moderate opacification of the bilateral mastoid air cells.

Output: 1. Motion degraded exam limited to sequences for operative planning. Since prior MRI from 10/13/2016, there has been enlargement of numerous peripherally enhancing intracranial lesions throughout the cerebral hemispheres with mild involvement of the posterior fossa. Lytic calvarial lesions involving the left parietal bone and at the junction of the left greater wing of the sphenoid and squamous temporal bone also again seen, the latter which is better seen on recent CT. There is increase in local mass effect. Differentials again include metastatic disease and infection.2. Distention of the optic sheaths likely reflecting elevated intracranial pressure.


Instruction: Generate impression based on findings.

Input: Left leg numbness and tingling. There is straightening of the vertebral column in the sagittal plane. The vertebral body heights are preserved. There is multilevel degenerative spondylosis. At T12-L1 and L1-L2, there is mild facet arthropathy, but no significant spinal canal or neural foraminal stenosis. At L2-L3, L3-L4 and L4-L5, disc bulges, mild ligamentum flavum thickening, and mild facet arthropathy result in mild spinal canal and neural foraminal stenoses. At L5-S1, a left paracentral disc extrusion narrows the subarticular recess and posteriorly displaces the traversing left S1 nerve root. Otherwise, the disc bulge and the facet arthropathy result in mild central spinal canal and mild bilateral neural foraminal stenosis. In addition to multilevel degenerative, there is suggestion of mild congenital spinal canal stenosis. The tip of the conus medullaris is located at the lower L1 level, which is normal. A 1 cm well-circumscribed, homogeneously T2-hyperintense, T1-hypointense lesion along the anterior aspect of the left kidney may represent an exophytic renal cyst, but is not completely assessed.

Output: Multilevel degenerative lumbar spondylosis is most pronounced at L5-S1, where a left paracentral disc extrusion displaces the traversing left S1 nerve root. Furthermore, the disc bulges superimposed on congenitally narrow spinal canal result in mild spinal canal and neural foraminal stenoses at L2-L3 through L4-L5.


Instruction: Generate impression based on findings.

Input: 36-year-old with triple positive breast cancer status post systemic therapy. There is extreme amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. High T2 signal fluid is noted in bilateral retroareolar ducts. RIGHT BREAST: Interval decrease in degree of enhancement and extent of enhancement of the segmental nonmass enhancement in the central lateral right breast, which now enhances only as a few scattered enhancing foci. On the current exam, these extend over 4.7 x 2.1 x 4.3 cm previously 6.9 x 3.3 x 5.3 cm (on 3/10/15), originally 9.3 x 6.6 x 5.3 cm. No new areas of abnormal enhancement. A few medial foci of enhancement are again seen. Please refer to mammograms regarding extent of calcifications. In the right axilla, there is a lymph node with normal morphology. No abnormal lymph nodes.LEFT BREAST: The previously seen retroareolar lobulated rim enhancing mass with nipple involvement appears only as faint non-mass enhancement, currently measuring 0.6 x 0.6 cm previously 1.1 x 1.2 x 1.2 cm (on 3/10/15), originally 2.9 x 2.0 x 2.8 cm. Interval decrease in size and degree of enhancement of 6 o'clock position far posterior depth previously seen spiculated heterogeneously enhancing mass which extended near the fascia overlying the pectoralis muscle. Faint residual linear enhancement now measures 2.7 cm AP previously 3.2 x 2.8 x 1.7 cm (on 3/10/15), originally 5.6 x 3.7 x 2.7 cm.Nonenhancing biopsy proven 1.3 cm fibroadenoma in 1:30 position, mid depth is unchanged. Previously seen enhancing 1.2 cm rounded mass in the 2 o'clock position, posterior depth does not demonstrate enhancement on the current examination, although remains visualized on T2 sequence. No abnormal lymph nodes are seen in the left axilla.

Output: Near complete resolution of abnormal enhancement in each breast. Please refer to the mammogram report regarding extent of bilateral calcifications. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 40 year-old female with left biopsy proven invasive carcinoma in anterior 9 o'clock dominant mass with adjacent smaller satellite mass posteriorly and extensive segmental non-mass enhancement. Patient on neoadjuvant chemotherapy. On postcontrast images, mild parenchymal enhancement is seen bilaterally.Compared to prior outside MRI, there is significant decrease in size and enhancement of the patient's known 9 o'clock anterior index mass, immediately posterior satellite mass, and extensive segmental posterior non-mass enhancement in the left breast. Residual anterior enhancement, which surrounds the biopsy clip, measures 20 x 31 x 30 mm, previously measuring 104 x 59 x 51 mm.Compared to prior examination, there is new left nipple inversion.There is also new superficial focus of enhancement along the left lateral breast skin, which may represent an epidermal inclusion cyst given the high T2 signal seen at this site.No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1.Significant interval decrease in size and enhancement of patient's biopsy proven invasive carcinoma of the left breast.2.New left nipple inversion. New left enhancing lateral skin lesion, which may represent an epidermal inclusion cyst. Correlation with physical exam is recommended for both of these findings. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Pain In Right ArmClinical question: eval for RUE radiculopathySigns and Symptoms: R shoulder / upper arm pain not relieved by intraarticular GH steroid The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are some minor degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 17 year-old female with syncope. Sent for CMR to rule out structural heart disease Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 124 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 58 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 72 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of left ventricular hypertrophy.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 69 ml (normal range 35+/-13). No RV wall motion abnormalities and no aneurysms seen.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. No systolic anterior motion of the anterior mitral valve leaflet.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch. 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 (20 mm)Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 53%2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 50%. No RV akinesia or dyskinesia noted. 3. No CMR criteria for arrythmogenic right ventricular dysplasia. No evidence for hypertrophic cardiomyopathy.


Instruction: Generate impression based on findings.

Input: Personal history of right mastectomy for inflammatory breast cancer in 2012. There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.The patient is status post right mastectomy.No abnormal enhancement is seen in either the left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region. A mildly prominent left axillary tail node is not significantly changed.

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


Instruction: Generate impression based on findings.

Input: History of end-stage renal disease, hepatitis C, alcoholic cirrhosis, hypertension, GERD, cervical myelopathy status post C3 C7 anterior cervical discectomy and fusion complicated by epidural hematoma requiring decompression now with lower extremity weakness, decreased sphincter tone. Evaluate for lumbar myelopathy and cord compression. The vertebral column alignment is within normal limits. There is mild anterior wedge deformity of the T12 vertebral body. The remaining vertebral body heights are preserved. There is moderate loss of disc height at T11-T12 and T12-L1. There are Schmorl's nodes at T12-L1 and L3-L4. The vertebral bone marrow signal is heterogeneous and diffusely hypointense. There is congenital narrowing of the spinal canal with superimposed mild epidural lipomatosis in the lower lumbar and sacral spinal canal. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Partially imaged are multiple small cysts within the bilateral kidneys.T12-L1: Minimal disc bulge, thickening of the ligamentum flavum, and bilateral facet arthropathy.  L1-L2: Minimal disc bulge, thickening of the ligamentum flavum, and bilateral facet arthropathy.L2-L3: Minimal disc bulge, thickening of the ligamentum flavum, and bilateral facet arthropathy. L3-L4: Mild disc bulge, thickening of the ligamentum flavum, and bilateral facet arthropathy, contributing to mild bilateral foraminal stenosis. L4-L5: Mild disc bulge with central disc protrusion and annular fissure, thickening of the ligamentum flavum, and bilateral facet arthropathy, contributing to mild bilateral neural foramen stenosis. L5-S1: Disc bulge with annular fissure, thickening of the ligamentum flavum and bilateral facet arthropathy, contributing to mild to moderate bilateral neural foramen stenosis.

Output: 1. Multilevel degenerative spondylosis of the lumbar spine with bilateral foraminal stenoses at L4 though S1, as well as congenital narrowing of the spinal canal with superimposed mild epidural lipomatosis in the lower lumbar and sacral spinal canal. 2. Findings related to renal osteodystrophy and cystic end-stage kidney disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of supraglottic laryngeal cancer. Status post chemo/RT ending on 2 -- 8 -- 08. CT of the soft tissues of the neck with infusion:Images through the skull base and including cavernous sinuses remain normal. Paranasal sinuses and mastoid air cells are unremarkable.Images through the neck demonstrate extensive post therapy changes. Soft tissue thickening (right greater than left) is again identified with no interval change since prior exam as well as a study from 2 -- 3 -- 2009.Significant soft tissue thickening at the level of left cuneiforms sinus with mass effect is again identified. This finding is similar in appearance to the immediate prior study from 7 -- 5 -- 2009 as well as to -- 3 -- 2009. No distinct measurable tumor is identified however possibility of residual tumor within these regions cannot be entirely ruled out. Stable appearance of this findings on two prior consecutive studies is not suggestive of recurrence of tumor. Two entirely exclude recurrence of disease in this case an MRI is recommended.There is no evidence of any pathologic adenopathy in the neck. Limited images through the apices of the lungs and mediastinum are negative. No evidence of osseous metastatic lesions.CT of brain with infusionNo evidence of metastatic disease to the brain or the leptomeninges. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium is intact. 80 cc of Omnipaque 350 was utilized for the above studies.

Output: 1.Negative CT of brain and calvarium for metastatic disease. Normal CT of brain.2.Extensive post therapy changes. Soft tissue thickening in the supraglottic/glottic regions remains stable since prior two studies. Further follow-up with an MRI is recommended to entirely exclude possibly two of residual tumor.3.No evidence of pathologic adenopathy in the neck.


Instruction: Generate impression based on findings.

Input: 57-year-old female with hypertension, diabetes, heroine use with seizures. Altered mental status. There is no evidence of intracranial hemorrhage, mass or midline shift. Questionable subcortical white matter hypodensities may represent small vessel ischemic disease, and an MRI may be considered for further evaluation if clinically indicated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute abnormality. Questionable small vessel changes, MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: AUB, Recent h/o hysteroscopic myomectomy w/ myosure. Evaluate for adenomyosis History: AUB, pelvic pain PELVIS:UTERUS, ADNEXA: The uterus anteverted and anteflexed in position and is normal in size with reference measurements below. The endometrial stripe is not abnormally thickened. There are multiple (at least 3) intramural fibroids the largest of which is in the left anterior uterine body which causes mass effect on the endometrial canal with reference measurements below. There is heterogeneously increased T2 signal within the myometrium as well as poor definition of the junctional zone as well as a lobular contour of the uterus which are nonspecific but can be seen with adenomyosis. No intrinsic T1 shortening is identified to suggest blood products.A NuvaRing device is noted within the vaginal fornix.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.INDEX LESION MEASUREMENTS (Current exam date/time: 9/22/2016 14:35:07)UTERUS: 5.8 cm (Image 43, Series 401); 5.0 x 8.7 cm (Image 42, Series 901).RIGHT OVARY: 3.2 cm (Image 24, Series 601); 2.9 x 1.9 cm (Image 28, Series 801).LEFT OVARY: 3.1 cm (Image 25, Series 601); 2.5 x 1.7 cm (Image 27, Series 801).INTRAMURAL FIBROID: 1.7 x 2.3 cm (Image 20, Series 801).

Output: 1.Multiple uterine fibroids as described above.2.Findings suggestive of adenomyosis.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, with history of multiple sclerosis, right hand tingling, memory loss, balance issues. No restricted diffusion is seen. Moderate scattered foci of periventricular and subcortical white matter T2 hyperintensity are noted. No evidence of edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Prominence of the sulci and ventricles is demonstrated compatible with underlying parenchymal volume loss. Of note, the temporal horns are of particular prominence which may reflect preferential medial temporal lobe atrophy. On limited postcontrast imaging, no enhancing lesions are seen.

Output: 1.No definite acute intracranial abnormality is seen.2.Scattered white matter lesions are noted which may represent chronic microvascular ischemic disease or, given the history, demyelinating disease.3.Generalized cerebral atrophy is seen, though this appears to be particularly conspicuous in the medial temporal lobes. Correlation with clinical features of Alzheimer disease should be made.


Instruction: Generate impression based on findings.

Input: 55 year-old man with paroxysmal atrial fibrillation. Previously aborted/failed ablation. Referred for cardiac CMR. There is a history of absence of the left upper lobe of the lung. This has resulted in rotation and displacement of the heart towards the left lower mediastinum. This displacement made it difficult to obtain the standard imaging planes for volume, ejection fraction and late gadolinium enhancement evaluation, limiting overall assessment. This is a technically challenging examination. Left VentricleThe left ventricle appears to be of normal size with low normal systolic function. The overall LV ejection fraction is ~50%, the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVEDV is 180 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 87 ml (normal range 47+/-19). There are no obvious 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 compressed on the views provided. Assessment is complicated by positioning of the heart.Right VentricleThe right ventricle is of normal size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 216 ml (normal range 142+/-31), the RV end systolic volume index is 56 ml/m2 (normal range 31+/-9), and the RVESV is 126 ml (normal range 54+/-17).Right AtriumThe right atrium appears enlarged on axial views. The assessment is complicated by the positioning of the heart.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 is not well seen.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic sinus of valsalva measures 45 x 45 x 42 mm. The sinotubular junction measures 40 x 39 mmThe ascending aorta measures 36 x 37 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Left upper pulmonary vein measures = 20 x 14 mmLeft lower pulmonary vein measures = 27 x 15 mmRight upper pulmonary vein measures = 16 x 15 mmRight lower pulmonary vein measures = 17 x 17 mmPulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumPortions of the pericardial sac can be seen on the post contrast e-thrives. However, on dynamic cine images a pericardial silhouette is not seen. Cannot rule out congenital absence or partial absence of the pericardial sac.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. Technically challenging examination. History of absence of the left upper lobe of the lung resulting in significant rotation and displacement of the heart towards the left lower mediastinum making it difficult to obtain the standard imaging planes for volume, ejection fraction and late gadolinium enhancement assessment. 2. The left ventricle appears to be of normal size with low normal systolic function. The overall LV ejection fraction is ~50%. No late gadolinium enhancement.3. The right ventricle is of normal size with mildly reduced systolic function. Calculated RV ejection fraction is 42%4. Only small portions of the pericardial sac can be seen. On dynamic cine images a pericardial silhouette is not seen. Cannot rule out congenital absence or partial absence of the pericardial sac.5. See above measurement for pulmonary veins and aorta.


Instruction: Generate impression based on findings.

Input: 35-year-old with history bilateral breast cancers. Prior benign MRI guided biopsy of the left breast. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Postsurgical changes in each breast are noted. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: There is a STIR and T2 -hyperintense epidural collection extending from mid-T8 to mid-T11 levels. On post-contrast imaging, there is irregular nodular peripheral enhancement with septation. There is enhancement and thickening of the dura extending from T6 to L1. No additional abnormal epidural collections are identified and the leptomeninges do not enhance. There is mild enhancement in the articular facets of T9, T10, and T11, particularly on the left. There is no definite cortical destruction. This dorsal collection compresses and flattens the spinal cord anteriorly and there is questionable, mildly increased cord signal seen at the T11 and T12 levels immediately inferior to the area of compression. No additional areas of cord signal abnormality are noted. Vertebral body heights are preserved and alignment is normal.Multiple cystic collections are again seen in the pelvis, better evaluated on CT from 3/9/15 and subsequent ultrasound.

Output: 1.Epidural collection from T8 to T11 levels with adjacent dural thickening suspicious for an abscess however less likely possibility of a resolving hematoma cannot be entirely excluded..2.Mild marrow enhancement in the adjacent T9, T10, and T11 articular facets which may be reactive in etiology but osteomyelitis cannot be excluded.3.Preliminary findings before post-contrast imaging discussed with Dr Vasenina by phone at 12:00 on 3/11/15.


Instruction: Generate impression based on findings.

Input: Clinical question: Acute delirium, no clear precipitant; please evaluate for acute process from recent MRI on 1 -- 29 -- 15 Nonenhanced brain MRI: Examination demonstrate no evidence of an acute or new finding since prior study. Examination re-demonstrate prominence of cortical sulci and mildly of the supratentorial ventricular system as well as cerebellar and vermian folia for patient's stated age of 37 consistent with underlying parenchymal volume loss. There is no evidence of interval change since prior MRI exam from 1 -- 29 -- 15. Signal void of intracranial vasculature is identified.The signal intensity of the intracranial venous sinuses is within normal.Calvarium and soft tissues of the scalp are unremarkable.Images through the orbits and paranasal sinuses as well as mastoid air cells are unremarkable.

Output: 1.No evidence of an acute or new finding since prior MRI exam from 1 -- 29 -- 15.2.Findings suggestive of parenchymal volume loss without interval change as detailed.


Instruction: Generate impression based on findings.

Input: Reason: ro partial biceps tendon tear History: biceps pain LIGAMENTS: The proximal fibers of the radial collateral ligament proper appear thickened and are of increased signal intensity which may reflect a chronic tear. The ulnar collateral ligament appears normal.TENDONS: The tendon of the long head of the biceps appears normal as does the brachialis. The common flexor tendon appears intact. There is increased signal intensity within the anterior undersurface fibers of the common extensor tendon compatible with a partial-thickness undersurface tear.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the elbow with small defects of the articular cartilage and subchondral cysts within the distal humerus and proximal ulna.SURROUNDING STRUCTURES: There is mild increased signal intensity within the brachioradialis, supinator, and to a lesser degree the pronator teres muscles. We see no masses. There is no fatty atrophy.ADDITIONAL

Output: 1. Normal-appearing biceps tendon without tear.2. Increased signal intensity within the anterior fibers of the common extensor tendon suggesting a partial thickness undersurface tear / mucoid degeneration with thickening and increased signal intensity of the underlying proximal fibers of the radial collateral ligament proper which may also reflect an underlying chronic tear. The current clinical significance of this finding is uncertain.3. Mild edema type signal within the brachioradialis, supinator, and pronator teres muscles without clear etiology.


Instruction: Generate impression based on findings.

Input: s/p left schwannoma of cranial nerve XI, s/p resection 2012, eval for recurrence, surveillance The patient is status post removal of a left neck mass previously extending from the left jugular foramen inferiorly. There is no evidence for local recurrence. The left jugular vein is not readily identified at the level of the tumor site. The lower half of the left jugular vein is identified.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. There are number of lymph nodes scattered in the soft tissues of the neck which measure up to 9 mm in diameter. These do not meet the size criteria for lymphadenopathyWithin the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses demonstrate an opacity in the left maxillary sinus which was also present on the prior exam and likely represents a mucous retention cyst. The mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:2/23/1961)Reason: eval for stroke--CODE STROKE History: r sided weakness, slurred speechPROVIDER/ATTENDING NAME: JAMES J WALTER JAMES J WALTER Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.There is some facet hypertrophy present on the right side at C2-3Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.The CT angiogram examination is suboptimal for the evaluation of intracranial occlusion or intracranial aneurysm.2.There is no evidence for acute intracranial hemorrhage mass effect or edema. CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.


Instruction: Generate impression based on findings.

Input: 53-year-old male with right-sided unilateral intraocular pressure increase. Rule out intracranial mass Lucency through the greater wing of the sphenoid bone is seen and may be related to volume averaging. No intraconal abnormalities are identified. No infiltration of the retro-orbital fat. The globes are intact.Subcortical low attenuation regions seen in the right frontal and and right posterior peri-ventricular area areas. These are nonspecific and an MRI is recommended for further evaluation. There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration.The skull base is radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Two subcortical areas of low-attenuation are seen in the right frontal and right posterior periventricular areas. Findings are nonspecific and an MRI is recommended for further evaluation.2. No acute intraconal abnormalities are seen. Small lucency through the greater wing of the sphenoid bone at the inferior orbital surface may be related to volume averaging. Clinical concern remains, a dedicated CT of the orbits may be considered.


Instruction: Generate impression based on findings.

Input: 58 year-old female with abdominal pain and a history of chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: Liver contour is normal. 1.4 x 2.5 cm lesion in segment 8 with hyperintense T2 signal and discontinuous peripheral nodular arterial enhancement with progressive enhancement, compatible with an hemangioma. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is dilated with non visualization of the distal duct near the ampulla, appearing similar to the prior study. There is diffuse atrophy of the pancreas consistent with the stated history of chronic pancreatitis. No abnormal mass or filling defect visualized, however previous CT done 5/2013 demonstrates a large calcification at this point. The previously described stricturing of the main pancreatic duct at the level of the pancreatic body and tail, appears similar to slightly less pronounced when compared to the prior study. No masses seen or cystic communicating lesions seen. Splenic vein is patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Persistent dilated main pancreatic duct with non visualization of the distal duct near the ampulla, which is nonspecific but may be a sequela of chronic pancreatitis. No pseudocyst or mass lesion is seen.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with lethargy, weakness, failure to thrive. CT with possible evidence of PRES. No evidence of restricted diffusion is seen. However, there is extensive confluent periventricular T2 hyperintensity, particularly in the periatrial regions, with patchy hyperintensity in the subcortical white matter and in the pons. No edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collections. The ventricles and sulci are slightly prominent compatible with underlying volume loss.

Output: Fairly extensive periventricular and subcortical hyperintensity is seen without evidence of restricted diffusion, edema or mass effect. The pattern of these lesions is not particularly suggestive of PRES or any other specific underlying etiology. Statistically, chronic small vessel ischemic disease would be most likely.


Instruction: Generate impression based on findings.

Input: Post craniotomy with aneurysm clipping. New symptoms and worsening headaches Non-infused head CT:Minimal area of low attenuation in the inferior aspect of right frontal lobe near the surgical site of clipped aneurysm may represent edema or encephalomalacia. This finding remains stable since prior exam. Expected postoperative changes of right-sided frontal craniotomy with interval improvement since prior study. Patchy nonspecific foci of subcortical low attenuation could represent small was ischemic disease. This appears a slightly more pronounced on the current exam than prior study. Recommend follow-up with an MRI. There is no evidence of cortical low attenuation to suggest ischemic cortical stroke.Widened subarachnoid space along the inner table of the skull in the right posterior frontal and parietal is highly suspected only small subdural collection. This is also a new finding since prior exam. There is very subtle effacement of cortical sulci secondary to finding.

Output: 1.Findings I do suspect that of small vessel disease of indeterminate age with interval worsening since prior study. Recommend follow-up with an MRI to exclude new subcortical ischemic strokes.2.A small CSF density subdural in the right posterior frontal -- parietal with minimal effacement of adjacent cortical sulci is a new finding since prior exam3.there is no evidence of any acute cortical stroke, hemorrhage, hydrocephalus or midline shift.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:6/30/1951)Reason: Follow up of two 2mm brain lesions suspicious for metastatic disease History: NonePROVIDER/ATTENDING NAME: RENUKA MALIK RENUKA MALIK The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate enhancing nodule in the right precuneus associated with susceptibility effect. Another punctate enhancing nodule is present in the left cerebellar hemisphere medially. It is also associated with a low but susceptibility effectThere are several punctate foci of susceptibility effect in the right periventricular white matter, right parietal lobe, left parietal lobe and right temporal lobe which are not associated with abnormal enhancement.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.There are couple punctate lesions which are suspicious for metastatic disease which are now associated with microhemorrhage. Previously they are not associated with a microhemorrhage2.There are several microhemorrhages in the supratentorial brain which were not readily identified on the prior exam. It is possible these are treatment related


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache(784.0)Clinical question: r/o structural abnormalitySigns and Symptoms: headacheComments: S/p left parotidectomy | The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the 9/7/2012 examNormal 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 left parotid gland is smaller than the right parotid gland - probably related to the reported history of parotidectomyThere is redemonstration of a cystic lesion in the superficial portion of the left parotid gland. It is homogeneously hyperintense in signal on T2-weighted imaging, intermediate signal on FLAIR imaging hyperintense on ADC map, hypointense on exponential ADC map, mildly hyperintense on diffusion imaging and hypointense on T1-weighted imaging. It measures 14 x 12 mm axial dimensions. On the prior exam it measured approximately 8 x 10 mm .There is now a similar lesion in the right parotid gland measuring 11 x 9 mm axial dimensions which was not present on the prior exam. It is adjacent and superficial to the right retromandibular vein. Along the posterior superficial aspect of the right parotid gland there is an incompletely visualized 10 x 6 mm similar lesion which previously measured 7 x 3 mm.

Output: 1.Continued enlargement of a left parotid gland lesion. In general this has a relatively benign appearance.2.New right parotid gland lesion which has similar signal characteristics and morphology to the left-sided parotid lesion but is smaller. It is adjacent and superficial to the right retromandibular vein.3.A smaller right parotid gland cystic type lesion along the posterior superficial portion has also mildly increased in size compared to the previous exam from 2012.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. These are stable compared to the 2012 exam.


Instruction: Generate impression based on findings.

Input: Female 37 years old Reason: 37 year old with history of AML, s/p alloSCT now with increasing ruq post-prandial pain radiating to back. R/o cholecystitis. History: pain after eating LIVER: 15.4 cm in length. Several broad ill-defined areas of increased echogenicity in the posterior segment of the right lobe. I favor focal fat. Given the history neoplasm is unlikely. This could be evaluated further with CT or MRI.Flow in the portal vein is hepatopedal peak velocity 0.2 m/sGALLBLADDER, BILIARY TRACT: Gallbladder is normal with no evidence of stones, wall thickening or pericholecystic fluid. Sonographic Murphy's sign was absent.No intrahepatic or extrahepatic biliary dilatation. Common bile duct 0.4 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Morphologically normal 8.7 cm length.OTHER: Left kidney morphologically normal 9.9 cm in length. Spleen 9.19 in length.No evidence of ascites.

Output: Broad ill-defined areas of mild increased echogenicity in the posterior segment of the right lobe. Differential diagnostic considerations include focal fat or less likely neoplasm. Clinically indicated this could be evaluated further with CT or MRI.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke History: stroke Re-demonstration of right MCA restricted diffusion indicate subacute right MCA ischemic stroke.Susceptibility artifacts are seen on the right basal ganglia more on the putamen than globus pallidus with surrounding edema indicating hemorrhagic conversion.Midline shift toward left side at the level of foramen of Monroe is seen (6.1mm) which compared to prior CT scan, no significant interval change.There is calcified nodular lesion based on the inner table of skull at the right high parietal area which may indicate calcified meningioma or simple exostosis. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Opacification of the right maxillary sinus with round signal void lesion indicate possible chronic sinusitis and possible internal hemorrhage, thick mucus ball or associated fungal sinusitis. Clinical correlation is recommended. The left maxillary sinus shows mucosal thickening.

Output: 1. Evolving right MCA territorial subacute ischemic stroke with hemorrhagic conversion of the right basal ganglia as described above.2. Sinusitis, bilateral maxillary sinuses, right worse than left.


Instruction: Generate impression based on findings.

Input: 76-year-old male with history of cervical spine surgery 4/2013 for schwannoma resection. Postoperative findings related to laminectomies and placement of posterior stabilization rods and pedicular screws are seen at C6 through T1. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord is dorsally tented, likely related to intrathecal adhesions from surgery. The cord otherwise has has normal signal characteristics and overall morphology. Susceptibility artifact limits evaluation; however, no obvious mass is seen in the spinal canal or neural foramina.Moderate degenerative changes affect the cervical spine. Disk-osteophyte complexes projecting from each level from C2-3 to C6-7 as well as ligamentum flavum hypertrophy result in mild spinal canal stenosis at C3-4, C4-5, and to a lesser degree at C5-6. There is also mild to moderate neural foraminal stenosis at these levels bilaterally. The vertebral artery flow voids appear to be intact.

Output: 1.Susceptibility artifact from hardware and absence of prior studies limits evaluation, however, no gross evidence of tumor recurrence.2.Post-operative and degenerative changes, as above.