Instruction: Generate impression based on findings.

Input: Female, 58 years old, with sarcoid, outside PET/CT showing a lesion in the brain. No enhancing lesions are identified intracranially. However, fairly extensive patchy T2 hyperintensity is seen in the periventricular and subcortical white matter bilaterally. No evidence of edema or mass effect is observed. The ventricles are normal in size. The sulci are slightly prominent suggesting a degree of parenchymal volume loss.

Output: No specific focal lesions are identified on this examination. However, extensive patchy white matter T2 hyperintensity is demonstrated which could represent the sequelae of lupus, microvascular ischemia or demyelinating disease among other possibilities. Please note that the examination as ordered is a limited surgical planning study. If a complete evaluation is warranted, MRI brain with and without contrast can be ordered. In addition, if the outside PET/CT can be made available and uploaded to PACS, comparison would be helpful to the interpretation.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 01:21

Output: Successful right hip arthrogram for MRI study.


Instruction: Generate impression based on findings.

Input: Seizure activity. There is extensive volume loss related to cystic encephalomalacia predominantly involving the left parietal lobe. There are adjacent areas of gyriform high T1 signal as well as high T1 signal in the left basal ganglia. There is ex vacuo dilatation of the left lateral ventricle. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are areas of nodular low T1 signal in the midline and right occipital scalp.

Output: 1. Findings compatible with chronic left middle cerebral artery territory infarction predominantly involving the left basal ganglia and parietal lobe. 2. Incompletely characterized areas of nodular low T1 signal in the occipital scalp are nonspecific.


Instruction: Generate impression based on findings.

Input: 27 years Female (DOB:5/8/1989)Reason: prior lesion in right occipital lobes (restricted diffusion, high T2 signal, mild enhancement), evaluate for evolution History: headachePROVIDER/ATTENDING NAME: HELENE G. RUBEIZ SERVICES ANCILLARY There is a 19 x 37 mm axial dimension cystic lesion anterior to the left temporal lobe which is associated with some mild expansion of the adjacent bony structures. This most likely represents an arachnoid cyst. It follows spinal fluid on all pulse sequences.Previously noted punctate lesion in the right occipital lobe is no longer visualized.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.There is an arachnoid cyst present in the left middle cranial fossa. It is stable.2.Previously noted punctate lesion in the right occipital lobe most likely representing a microinfarct is no longer visualized.


Instruction: Generate impression based on findings.

Input: Left arm radiculopathyDiagnosis: Pain in joint, upper arm. Other malignant lymphomas, unspecified site, extranodal and solid organ sitesClinical question: left arm neuropathic pain. Hx cutaneous lymphoma R/O massSigns and Symptoms: as above 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. There is multilevel disk dessication 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 minor central disk protrusion at this level.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. There is a minor right lateral disk protrusion associated with minimal osteophyte formation.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

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


Instruction: Generate impression based on findings.

Input: PEA arrest, CPR, and left renal mass invading the IVC. There are areas of cortical T2 hyperintensity and restricted diffusion involving the posterior occipital and frontoparietal cortices bilaterally. There is also a punctate focus of restricted diffusion in the left cerebellar hemisphere. There are scattered foci of T2 hyperintensity in the cerebral white matter without restricted diffusion. There is perhaps trace extra-axial fluid hemorrhage along the right aspect of the posterior falx cerebri. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is fluid signal in the bilateral mastoid air cells, which may be related to intubation.

Output: 1. Scattered areas of restricted diffusion primarily involving the posterior occipital and frontoparietal cortices bilaterally may represent acute infarcts related to hypoxia or less likely microemboli versus perhaps a form of posterior reversible encephalopathy syndrome.2. Scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic effects of small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 75-year-old male with HCV. CT abdomen in August with hepatic lesions with enhancement without washout. Follow-up imaging to evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology related to widening of the fissures. The portal and hepatic veins are patent. No intra or extrahepatic biliary ductal dilatation.Subcentimeter T2 hyperintense focus in hepatic segment 2 (series 9 image 14) with arterial and venous phase enhancement and no washout (series 13 images 65, 170, 273) is unchanged compared to the 11/3/2009 CT exam. Scattered punctate arterially enhancing foci without washout are again seen and compatible with perfusional variants. No suspicious lesions with washout are identified. SPLEEN: No significant abnormality noted. Small splenule.PANCREAS: Mild loss of the normal bright T1 precontrast signal intensity is noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter enhancing focus of hepatic segment 2 is unchanged in appearance compared to the 11/3/2009 CT exam, consider flash filling hemangioma.2.No suspicious hepatic lesions with washout are identified. Scattered punctate arterially enhancing foci without washout are most compatible with perfusional anomalies.3.Mild cirrhotic morphology.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Small right air fluid level in the right maxillary sinus and scattered ethmoid air cell opacity. MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. There are scattered atherosclerotic calcifications involving the MCA, ACA and PCA arteries. The middle and anterior cerebral arteries are also patent. Left PCA is fetal origin with small left PCA P1 segment. The vertebral arteries, basilar artery, are without significant stenosis. There is a focal stenosis near the origin of the left PICA. No evidence of aneurysms or vascular malformations.MRA Neck: There is origin of the left common carotid artery from the brachiocephalic artery. The common carotid arteries and cervical internal carotid arteries are without significant stenosis. There is no evidence of stenosis or occlusion. The right vertebral artery is hypoplastic and the origin of the right vertebral artery cannot be adequately evaluated.

Output: 1.No evidence of acute intracranial hemorrhage, mass or acute infarct.2.Mild chronic small vessel ischemic disease.3.The origin of the right vertebral artery cannot be assessed. Otherwise scattered atherosclerotic disease without significant flow-limiting stenosis in the neck or intracranial arteries. No intracranial aneurysm, No intracranial arterial stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left facial and neck shooting pain, dizziness, evaluate for progression of known glomus tumor in left upper carotid sheath and jugular fossa. MRI Brain and Neck: There are post-surgical changes of a partial left mastoidectomy with fluid signal in the residual air cells. There is redemonstration of mildly T2 hyperintense mass with flow voids and metal clips in the left jugular foramen with infiltration into the left middle ear cavity. Overall, the tumor measures up to approximately 22 mm. There is no evidence of intracranial hemorrhage or acute infarct. There are scattered areas of periventricular and subcortical white matter hyperintensity, suggestive of chronic small vessel ischemic disease. The brain parenchyma and pituitary gland otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. There is scattered mild paranasal sinus mucosal thickening. There appears to be a subcentimeter Thornwaldt cyst.MRA Brain and Neck: The exam is mildly motion degraded. There is no evidence of cerebral aneurysm or flow-limiting stenosis, occlusive thrombus, or dissection in the head and neck arteries.

Output: 1. Post-surgical changes related to partial left mastoidectomy with evidence of a residual jugulotympanicum paraganglioma measuring up to approximately 22 mm. Fluid in the remaining left mastoid air cells may represent acute mastoiditis.2. No evidence of aneurysm, flow-limiting stenosis, occlusive thrombus, or dissection in the head and neck arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68 year old man with history of multiple myeloma, referred for evaluation of possible underlying cardiac amyloid. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 44% the LV end diastolic volume index is 114 ml/m2 (normal range: 74+/-15), the LVEDV is 273 ml (normal range 142+/-34), the LV end systolic volume index is 64 ml/m2 (normal range 25+/-9), the LVESV is 154 ml (normal range 47+/-19), the LV mass index is 79 g/m2 (normal range 85+/-15), and the LV mass is 188 g (normal range 164+/-36). There is moderate concentric LVH (13mm wall thickness). There is abnormal septal motion due to left bundle branch block. The IVS myocardial T1 time is 917ms (normal range) and the ECV fraction is 21% (normal range). There is a small epicardial patch of late gadolinium enhancement in the basal anterolateral wall. The pattern is atypical for infarction and may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Given the normal native myocardial T1 times, the normal ECV fraction, and the small epicardial pattern of late gadolinium enhancement, the diagnosis of cardiac amyloidosis is less likely. Left AtriumThe left atrium is mildly dilatedRight VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in sizeAortic 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 FindingsThere is atelectasis or infiltration in the left lower lung. 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. Moderate concentric left ventricular hypertrophy with mild LV dilation and mildly reduced systolic function (LVEF 44%). There is a small amount of epicardial late gadolinium enhancement involving the basal anterolateral wall. The finding is atypical for prior myocardial infarction. Additionally, given the normal native myocardial T1 time and normal extra-cellular volume fraction, the finding would also be atypical for cardiac amyloidosis. The finding represents a small amount of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 52%).3. Mild left atrial dilation. 4. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 66-year-old male with known prostate cancer. Planning for MRI fusion biopsy. PELVIS:PROSTATE:Prostate Size: The prostate measures 6 cm in transverse, 4.2 cm in AP, and 5.3 cm in cranial caudal diameter.Peripheral Zone: There is a small (2 to 3 mm) focus of early contrast enhancement in the right apex (axial series 1401 image 971) without a discrete targetable lesion on the T2 or ADC sequences.Central Gland: Heterogenous appearance.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Small (2 to 3 mm) focus of early contrast enhancement in the right apex without a discrete targetable lesion on the T2 or ADC sequences.


Instruction: Generate impression based on findings.

Input: 28-year-old male with a history of malrotated left kidney presents with abdominal pain and hematuria. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of an anteriorly located left renal hilum and laterally displaced left proximal ureter consistent with the stated history of malrotation. There are two left renal arteries. There is an obstructing left renal calculus at the level of the left UPJ which measures approximately 4 mm in diameter. There is mild left hydronephrosis to the level of the aforementioned stone. The right kidney is normal in size and appearance with single right renal artery. There are no focal mass lesions identified in either kidney. The distal ureters are not well assessed on this non dedicated study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Left sided renal calculi, including a 4-mm calculus at the level of the UPJ, resulting in mild left sided hydronephrosis. 2. Malrotated left kidney with two left renal arteries, as detailed above.


Instruction: Generate impression based on findings.

Input: Enlarged orbital muscles: proptosis. Orbits: There is interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle. There is mild protosis bilaterally, right more than left, which appears to be attributable to diffuse prominence of the orbital fat. Otherwise, the bilateral globes, lacrimal glands, and optic nerves bilaterally are intact. There is no evidence of orbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific punctate foci of T2 hyperintensity in the right parietal lobe white matter. The brain, brainstem, and cerebellum otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle, which may be related to evolution of an inflammatory process. Otherwise, mild protosis bilaterally, right more than left, appears to be attributable to diffuse prominence of the orbital fat.2. No evidence of intracranial hemorrhage, mass, or acute infarct. Punctate foci of T2 hyperintensity in the right parietal lobe white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example.


Instruction: Generate impression based on findings.

Input: 56-year-old female presents with left shoulder pain. ROTATOR CUFF: There is a full-thickness anterior edge tear of the superior supraspinatus, approximately 11 mm in axial dimension, in a background of moderate tendinosis. The infraspinatus has a small intrasubstance tear. There is a split tear of the subscapularis and partial dislocation of the intra-articular biceps tendon with superimposed tendinosis of the biceps tendon. The teres minor tendon is unremarkable. The rotator cuff musculature remains normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. The glenohumeral joint alignment is normal. There is a SLAP tear involving the biceps anchor.BICEPS TENDON: There is fluid around the biceps tendon with partial dislocation of the intra-articular biceps tendon as well as superimposed tendinosis.ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus as well as intrasubstance tears of the infraspinatus and subscapularis.2. Partial dislocation of the intra-articular biceps tendon with superimposed tendinosis.3. SLAP tear of the glenoid labrum.


Instruction: Generate impression based on findings.

Input: Diarrhea in the setting of very mild ileitis seen on colonoscopy. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal-appearing bowel loops without dilation, bowel wall thickening, or abnormal enhancement. The ileocecal valve is within normal limits. No mesenteric fibrofatty changes. No intra-abdominal fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Simple appearing adnexal cysts. Intrauterine device noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal-appearing bowel loops without dilation, bowel wall thickening, or abnormal enhancement. The ileocecal valve is within normal limits. No mesenteric fibrofatty changes. No intra-abdominal fluid collections.BONES, SOFT TISSUES: Bilateral breast implants, partially imaged. No significant abnormality noted.

Output: No MR evidence of Crohn's disease or findings otherwise to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: New posterior shoulder mass, history of myeloma. Left posterior shoulder pain. Markers placed along the superior and lateral aspect of the shoulder presumably denote the margins of a palpable mass. Between and deep to the markers, there is a subcutaneous mass which predominantly follows fat signal intensity on all sequences with thin septations consistent with a lipoma. There is no enhancement of this mass. The mass measures approximately 5.5 x 1.5 x 4.0 cm, although accurate measurements are difficult due to lack of inherent contrast with the surrounding tissues.Multiple foci of signal abnormality within the visualized proximal humerus and scapula, many of which enhance, are compatible with stated history of multiple myeloma.The rotator cuff muscles and tendons appear normal for age. Mild osteoarthritis affects the acromioclavicular joint. There is trace fluid within the subacromial bursa, which is probably of no clinical significance. There is a small amount of fluid in the glenohumeral joint but no frank effusion. Please note this study was not detailed for evaluation of the labrum, but we see no gross abnormality. The long head of the biceps tendon appears normal.

Output: 1. Lipoma.2. Findings compatible with multiple myeloma.3. Degenerative changes as above.


Instruction: Generate impression based on findings.

Input: Left arm pain and paresthesia. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are right thyroid nodules.

Output: 1. No evidence of demyelinating lesions in the cervical spinal cord. 2. Nonspecific right thyroid nodules. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 48-year-old female with cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. No arterially enhancing lesions with washout are identified. Transient hepatic intensity differences are noted on the arterial phase only. Cholelithiasis without evidence for acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Cirrhotic morphology.2. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for? Progression of paraspinal muscle atrophy. Signs and symptoms: Pain, tenderness to palpation. Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column.The signal intensity of vertebral column is unremarkable.Unremarkable no most visualized thoracic spine and thoracic cord.T12 -- L1 and L1 -- L2 levels are unremarkable.L2 -- L3 demonstrate mild disk desiccation. A tiny centrally located annular fissure is present. No spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate minimal disk desiccation and unremarkable otherwise.L4 -- L5 demonstrate mild disk desiccation and minimal bilateral ligamentum flavum hypertrophy. There is a linear increased T2/T2 stir signal within the annulus of the disk in the midline and consistent with an annular fissure. No spinal stenosis or neural foraminal compromise.L5 -- S1 demonstrate minimal degenerative changes and unremarkable otherwise.There is no detectable. Spinal soft tissue abnormalities and in particular no evidence of atrophy of paraspinal musculature are detected.

Output: 1.Tiny midline annular fissure at L2 -- L3 and a slightly larger midline annular fissure at L4 -- L5 levels are noted.2.Unremarkable exam otherwise and without spinal canal or neuroforaminal compromise at any level.3.No detectable paraspinal soft tissue abnormalities.


Instruction: Generate impression based on findings.

Input: 61 year old male with history of heart failure secondary to presumed non-ischemic cardiomyopathy, atrial fibrillation, who presents for cardiac MRI to evaluate for etiology and fibrosis. Left VentricleThe left ventricle is severely dilated with mildly reduced function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 149 ml/m2 (normal range: 74+/-15), the LVEDV is 297 ml (normal range 142+/-34), the LV end systolic volume index is 72 ml/m2 (normal range 25+/-9), the LVESV is 142 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. . There is a mild mid-wall stripe of late gadolinium enhancement in the mid to basal septum, which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is non-specific and often seen in dilated cardiomyopathy.Left AtriumThe left atrium is severely dilated. 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 156 ml/m2 (normal range 82+/-16), the RVEDV is 309 ml (normal range 142+/-31), the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9), and the RVESV is 142 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is probably severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. IVC severely dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge right pleural effusion and small left pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with mildly reduced systolic function [LVEF 52%]2. The right ventricle is severely dilated with normal systolic function [RVEF 54%]3. There is a mild mid-wall stripe of late gadolinium enhancement in the mid to basal septum, which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is non-specific and often seen in dilated cardiomyopathy.4. Severe tricuspid regurgitation4. Severe biatrial dilationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB:9/27/1963)Reason: to assess for polyradiculopathy, hypertrophic neuro[pathy History: H/O stem cell transplant, presents with progressive LE weakness and neuropathyPROVIDER/ATTENDING NAME: KOUROSH REZANIA KOUROSH REZANIA Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. The nerve roots within the cauda equina appear to vaguely enhance and to be mildly thickened. There is some borderline finding.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and Schmorl's node at this level associated with endplate reactive changes and some contrast enhancement along the Schmorl's node. There is mild facet hypertrophy at this level. Signal change along the inferior endplate of L5 is high signal on T1 and low signal on T2 STIR.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation and a minor disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a cystic lesion which is not entirely included located at the inferior pole of the left kidney measures approximately 22 mm in diameter. Most likely represents a simple cyst.

Output: 1.Findings raise the question of some thickening and enhancement along the cauda equina which can be explained by inflammation but is nonspecific. Please note that this is a borderline finding and can be considered upper limits of normal in enhancement.2.No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Neck pain with radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Tiny central protrusion. No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex. No significant compromise to the spinal canal or neural foramina.C5-6: Small disc osteophyte complex including disc bulge eccentric to the left with partial effacement of the ventral thecal sac. There is minimal narrowing of the spinal canal. Right neural foramen is patent. There is mild to moderate narrowing of the left neural foramen related to uncovertebral hypertrophy and disc material where there may be impingement of the left C6 nerve root.C6-7: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine, relatively worse at the C5-C6 level. There is mild to moderate stenosis involving the left C5-C6 neural foramen where there may be impingement of the left C6 nerve root. Additional details as above.


Instruction: Generate impression based on findings.

Input: 68-year-old male with history of right renal cell carcinoma, chromophobe type. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Previously noted small nodule in the right nephrectomy bed is indeterminant but may represent a small adrenal nodule appearing similar to the prior CT. Unchanged nonenhancing left simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unchanged right nephrectomy bed nodule is indeterminant, but may represent an adrenal nodule. Close followup recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Loss of balance. Signs and symptoms: Loss of balance. Pre-and post-enhanced cervical spine MRI:Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate advanced disk disease with significant loss of disk height, minimal grade 1 retrolisthesis, mild bilateral facet and ligamentum flavum hypertrophy. There is slight flattening and posterior displacement of the cord, mild central spinal stenosis, significant right and moderate left neural foraminal compromise.C4 -- C5 demonstrate mild disk disease and loss of disk height, mild bulging disk, mild ( L > R) facet and ligamentum flavum hypertrophy. Findings results in mild central spinal stenosis and severe left and moderate right neural foraminal compromise.C5 -- C6 demonstrate mild degenerative disk disease and mild bilateral facet and ligamentum flavum hypertrophy which is slightly more pronounced on the left. No central spinal stenosis however significant bilateral ( L>R) neural foramina compromise is detected.C6 -- C7 demonstrate moderate disk disease with loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy bilaterally. There is no central spinal stenosis. Significant left and mild right neural foraminal compromise is present.C7 -- T1 demonstrate mild degenerative changes without neural foraminal or central spinal canal compromise.The signal intensity of the cord remains within normal.Post-enhanced images demonstrate no detectable abnormal enhancement of the cord or leptomeninges. There is however expected mild enhancement of hypertrophic changes of the spine.Pre-and post-enhanced thoracic MRI:There is normal anatomical alignment vertebral column. There is however significant exaggeration of thoracic lordosis in the upper thoracic spine centered approximately at T3 level. There is mild compression deformity of T3 without associated marrow signal changes or malalignment and consistent with a chronic process. There is no evidence of spinal canal compromise or stenosis at any level.The signal intensity of vertebral column is unremarkable.There is no significant neural foraminal compromise at any level. There is no detectable abnormal enhancement the vertebral column, thoracic cord or the leptomeninges. Perispinal soft tissues are unremarkable and without abnormal enhancement.

Output: 1.Pre-and post-enhanced MRI cervical spine demonstrate degenerative changes of cervical spine (most severe at C3 -- C4) with resultant moderate central spinal stenosis at C3 -- C4 and mild central spinal stenosis at C4 -- C5. There are also multilevel bilateral neural foraminal compromise (several significantly) as detailed per level above. Normal signal intensity of the cervical cord without abnormal enhancement. Mild expected enhancement of the degenerative changes of cervical spine however is noted.2.Pre-and post-enhanced thoracic spine demonstrate no abnormal enhancement. There is mild chronic compression deformity of T3 vertebrae without enhancement. There is exaggerated kyphosis of upper thoracic spine at T3 level disproportionate to mild chronic compression deformity of T3 as described above. There is no evidence of spinal canal or appreciable neural foramina compromise at any level. The signal intensity and the caliber of the thoracic cord is within normal.


Instruction: Generate impression based on findings.

Input: Check for meniscal tear, pain MENISCI: The medial meniscus is intact with only minimal fraying along the inner edge. The lateral meniscus however demonstrates pronounced globular signal throughout the body extending into the posterior horn. There is a somewhat horizontal linear component extending towards the inferior articular surface as it extends posteriorly.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritic changes with findings similar to previous plain film imaging. A lateral compartment contusion involving both the condyles and tibial plateau. Associated marked thinning of the underlying cartilage with relative sparing of the medial compartment, again most pronounced in the lateral and patellofemoral compartments. Mild patella alta deformityLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Lateral meniscal tear and retinacular abnormality, please correlate to physical exam findings and history.


Instruction: Generate impression based on findings.

Input: 72-year-old male with hypertensive urgency, CHF, diabetes, chronic kidney disease with mental status changes. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. Atherosclerotic calcification of the cavernous carotid and vertebral arteries are noted. If there is concern for an acute stroke, an MRI may be considered for further evaluation.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: Small vessel ischemic disease, age indeterminate. If there is concern for an acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 63-year-old female status post lung transplant with elevated alkaline phosphatase and GGT. ABDOMEN: Suboptimal examination of the postcontrast sequences due to severe respiratory motion.LIVER, BILIARY TRACT: No suspicious liver lesions. No intrahepatic or extra hepatic biliary ductal dilatation. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts. Nonspecific fullness of the right renal collecting system and proximal ureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fibrotic native right lung and transplanted left lung noted. Minimal peripherally enhancing pleural fluid in the left lung is likely related to transplant.

Output: 1. No specific evidence to account for the patient's elevated alkaline phosphatase and GGT.2. Nonspecific fullness of the partially imaged right renal collecting system and proximal ureter.3. Minimal peripherally enhancing pleural fluid in the left lung is likely related to transplant.


Instruction: Generate impression based on findings.

Input: Severe L4 pain radiating left sciatic, T12 lipoma. Patient has history of allergic reaction and premedicated. Five lumbar type vertebral bodies are presumed to be present. There is significant dextroscoliosis of the lumbar spine with apex at the L2-L3 level. Vertebral body heights are within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is significant loss of disc height involving the left aspect of the L2-L3 level with prominent left-sided lateral osteophytes. There are associated edematous endplate marrow signal changes at the L2-L3 level. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Severe loss of disc space involving the left aspect of the disc, edematous endplate marrow signal changes, minimal bulge, and advanced left-sided facet arthropathy. There is moderate left-sided neural foraminal stenosis with possible impingement of the left L2 nerve root. There is partial effacement of the left lateral aspect of the thecal sac related to the facet arthropathy, otherwise no significant central canal stenosis at this level. No significant right neural foraminal stenosis.L3-L4: Small central disc protrusion. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.L5-S1: Loss of intervertebral disc space and mild bulge. Bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.There is enhancement related to the L2-L3 degenerative changes. No suspicious enhancement or masses in the spine or paraspinous soft tissues are appreciated.

Output: Advanced degenerative changes at the left L2-L3 level related to dextroscoliosis. There is moderate left-sided neural foraminal stenosis and possible impingement of the exiting left L2 nerve root. No significant spinal canal or neural foraminal stenosis elsewhere in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with GBM, currently on CCNU. There has been no significant change in size or morphology of the resection cavity incorporating the right anterior temporal lobe, a portion of the right insula, and the right inferior frontal lobe. T2 FLAIR abnormality surrounding the resection cavity is also unchanged.Thin enhancement along the medial edge of the resection cavity is unchanged. Likewise, thin ependymal enhancement along the right frontal horn, the left frontal horn, and minimally at the right atrium, shows no significant or convincing interval change. No new enhancing or T2 hyperintense lesions are seen. Mild periventricular T2 hyperintensity along the left lateral ventricle is unchanged and probably related to treatment. Ventricular size and morphology are stable.

Output: Stable examination with no convincing disease progression around the resection cavity, and no significant change in mild ependymal disease.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, with left arm and leg weakness. Suspected mild dating disease. Small foci of spinal cord T2 signal abnormality are demonstrated along the left dorsal cord at C2 and again at C3 (see image 11 and image 16 of series 8). No definite additional spinal cord lesions are seen. The spinal cord is otherwise unremarkable with the conus tip terminating at the L1-2 level. The nerve roots of the cauda equina are unremarkable.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No marrow replacement or marrow edema is observed.A few scattered Schmorl's nodes are seen in the lower thoracic spine. No significant disc bulging or disc herniation is seen. No compromise of the spinal canal or neural foramina is suspected.

Output: Two small foci of signal abnormality are evident within the cervical cord at the C2 and C3 levels. These would be compatible with demyelinating disease.No additional spinal cord lesions are seen, and the evaluation of the spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question: 21-year-old female with AIDS. Right frontal headaches and vomiting. Nonenhanced head CT: New since prior examination is a focus of vasogenic edema in height comment CT right paramedian frontal lobe. This finding measures approximately 16 x 33 mm in transaxial dimensions. There is minimal high density material within this area of edema along its medial aspect. Recommend further follow-up with an MRI examination. Finding is concerning for an infection, neoplasm considering provided clinical history of AIDS.This examination is otherwise unremarkable and within normal limits for patient's stated age.

Output: Focus of vasogenic edema in high convexity right frontal lobe measuring 16 times 33-mm in size. Recommend follow-up with an enhanced MRI examination.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:8/2/1941)Reason: Compare to prior MRI. Oddoma finding in skull last time Right temporal bone History: NonePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA There is a stable mildly enhancing extra-axial mass which is arising from the right clinoid process measuring 17 x 18 x 14 mm (AP/TR/CC). Finding correlates with patient's known history meningioma. Lesion is not significantly changed when compared to the prior exam in which it measured 18 x 17 x 14 mm. No other areas of abnormal post contrast enhancement identified. The mass abuts the right anterior and middle cerebral arteries as well as the distal right internal carotid artery. This also partially surrounds the right optic nerve and displaces it superiorly and medially.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 prior exam.Incidental note is made of partial empty sella.A small focus of enhancement is redemonstrated in the right parietal bone measuring 22 x 6 mm in axial dimensions. On the prior exam it was smaller and measured 14 x 4 mm axial dimensions.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.Stable meningioma arising adjacent to the right anterior clinoid process. It partially involves the right optic nerve, right internal carotid artery, right anterior cerebral artery and right middle cerebral artery.2.The right parietal bone lesion appears more extensive on the current versus the prior exam. Further evaluation with a CT scan may be of benefit.


Instruction: Generate impression based on findings.

Input: 18 year-old female. Extent of Crohn's disease involvement. Evaluate for evidence of TI stenosis, stricture. Compare to last exam. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Approximately 30-cm long segment of most distal terminal ileum hyperenhancement and circumferential wall thickening consistent with active inflammatory bowel disease, increased in extent from prior exam. No evidence of a stricture, abscess, or a fistula.No bowel obstruction.Associated small amount of mesenteric edema and reactive lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Approximately 30 cm long segment of active inflammatory bowel disease involving the most distal terminal ileum.


Instruction: Generate impression based on findings.

Input: Evaluate lymph nodes in neck prior to scheduling surgery for lesion removal on right ear: mass to right ear in patient with history of angiosarcoma. There an exophytic nodule along the inferior right auricle that measures up to 15 mm. The tumor appears to be confined to the auricle, without evidence of invasion of the underlying temporal bone. There is no evidence of significant cervical lymphadenopathy. The salivary glands, thyroid, and upper aerodigestive tract are unremarkable. There are bilateral retropharyngeal internal carotid arteries. There appears to be a small defect in the inferior right orbit, with herniation of orbital fat. There is a right maxillary sinus retention cyst. There is patchy white matter T2 hyperintensity in the pons and bilateral cerebral hemispheres, which may represent chronic small vessel ischemic disease.

Output: A lesion along the inferior right auricle corresponds to the known angiosarcoma. No evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Memory issues and headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a subcentimeter retention cyst in the left maxillary sinus.

Output: No findings to suggest a specific neurodegenerative condition. No evidence of acute intracranial hemorrhage, mass, or acute cerebral infarction.


Instruction: Generate impression based on findings.

Input: 75 year old with aortic stenosis and previous coronary artery disease with history of myocardial infarction presenting for assessment of function and viability Left VentricleThe left ventricle is is mildly enlarged. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 230 ml (normal range 142+/-34), the LV end systolic volume index is 80 ml/m2 (normal range 25+/-9), the LVESV is 161 ml (normal range 47+/-19). There is an extensive mid-distal anterior, mid-distal septal and apical wall motion abnormality. There is > 50% transmural enhancement in all the hypokinetic segments c/w no-viability. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 89 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThere is significant AS, extensive leaflet calcification prevents determination of leaflet morphology. No AR noted.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 dilated at 33-34mm.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBL pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderate to severe LV systolic dysfunction with EF of 30%.There is an extensive mid-distal anterior, mid-distal septal and apical wall motion abnormality. There is > 50% transmural enhancement in all the hypokinetic segments c/w no-viability. 2. Mild RV dysfunction.3. Aortic stenosis


Instruction: Generate impression based on findings.

Input: Reason: Is there a tumor in the flexor sheath? History: Swollen and painful finger around the PIP joint. Focal signal abnormality and thickening of the flexor tendon is observed underlying the head of the proximal second phalanx. This 1 cm long focal signal abnormality is associated with surrounding soft tissue swelling and minimal fluid, including signal changes consistent with the suspected focal synovial changes and related history of possible synovitis. Ligamentous changes are intrasubstance with discrete intact fibers observed throughout with additional punctate small foci of fluid suggesting internal minimal retraction of some intrasubstance fibers (image 22 series 14). Other than diffuse overall mild swelling of the second digit, the visualized proximal and more distal components are otherwise intact and unremarkable. Osseous structures and marrow signal are normal. No vascular abnormality. Visualized portions of the adjacent digits are also unremarkable

Output: Focal flexor tendon abnormality underlying the head of the proximal second phalanx representing intrasubstance tear and tendinopathy. See details provided I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 31 years old Reason: right calf pain, concerned for peroneal tear, calf pain for a month. There is a feathery pattern of intramuscular edema without discontinuity of the muscle within the tibial side of the soleus muscle at the musculotendinous junction which would be consistent with a low-grade strain. There is no muscle atrophy. There is no fluid collection or hematoma. The Achilles' tendon is intact and appears unremarkable. The remainder of the muscles of the calf are unremarkable. There is normal marrow signal within the visualized osseous structures. Unremarkable appearance of the visualized knee and ankle joint however this was not a dedicated study for evaluation of the joint.

Output: Findings which would be consistent with a low-grade soleus muscle strain.


Instruction: Generate impression based on findings.

Input: Male 63 years old Reason: hcc screening History: hep C cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Nodular contour to the liver with prominence of the hepatic fissures consistent with cirrhotic morphology. Small pericholecystic fluid/wall thickening, may be secondary to chronic liver disease. No significant gallbladder distention. No intraluminal signal void seen to suggest underlying cholelithiasis. No suspicious liver parenchymal lesion. Patent hepatic vasculature.SPLEEN: Splenomegaly measuring 17.8 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintensities are suggestive of renal cysts. T2 hypointense lesion within the left kidney demonstrates intrinsic T1 hyperintensity signal and is suggestive of a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace abdominal ascites. Upper abdominal varices.

Output: 1. Cirrhotic liver morphology with stigmata of portal hypertension. No suspicious liver lesion.2. Small pericholecystic fluid/wall thickening, may be secondary to chronic liver disease. No significant gallbladder distention.


Instruction: Generate impression based on findings.

Input: 53 year old female with AML status post transplant with mental status changes, known subdural hemorrhage. Redemonstration of thin subdural blood products along the posterior falx cerebrum and tentorium appearing similar to the prior exam. No new focus of hemorrhage is identified.Additional subdural collections seen along the convexities on prior MRI of 4/7/2012 are not as well visualized on this exam.There is no evidence of mass effect, midline shift or edema. The gray-white matter differentiation is grossly preserved.Asymmetry of the lateral ventricles with the right lateral ventricle appearing significantly larger than the left, unchanged from the exam on 6/2009. The remaining cortical sulci and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Signal abnormality reported on prior MRI is not as well appreciated on this CT study due to technical limitation of CT.Mucosal thickening of the maxillary, ethmoid and right sphenoid sinuses. The mastoid air cells and middle ear cavities also appear partially opacified, unchanged from the prior exam.

Output: 1. Small subdural hematomas appear grossly unchanged as compared to the prior exam. No new focus of hemorrhage is identified. 2. Stable moderate paranasal sinus, middle ear cavity and mastoid opacification.


Instruction: Generate impression based on findings.

Input: Worsening frontal headaches, tremors. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mildly prominent perivascular spaces in the bilateral peritrigonal white matter. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses.

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


Instruction: Generate impression based on findings.

Input: Radiculopathy, site unspecified [M54.10], eval for mets vs septic emboli vs causes for new R sided sciatica. R sided sciatica, evidence of possible septic emboli to brain. The spinal cord demonstrates normal caliber and signal intensity. There is no evidence of tumors in the cervical spine. The vertebral body heights and intervertebral disc spaces are maintained. There is no vertebral subluxation. The bone marrow appears unremarkable. There are small disc bulges at C2-3, C3-4, and C5-6 without significant spinal or neuroforaminal stenosis. The paraspinal soft tissues are grossly unremarkable. There is a partly imaged lesion in the right middle cerebellar peduncle region.

Output: 1. Within limitations of noncontrast examination, there is no evidence for metastatic disease to the cervical spine.2. No evidence of lesions in the imaged portions of the spinal cord.3. Mild degenerative spondylosis of the cervical spine without significant spinal or neural foraminal stenosis.4. Partly imaged lesion in the right middle cerebellar peduncle region. Please refer to the prior brain MRI report for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Optic disc swelling: pain on left. Brain MRI: There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The cavernous sinuses are not enlarged. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits MRI: There is prominence of the subarachnoid spaces within the optic nerve sheaths bilaterally. There is also bulging of the left optic nerve disc. The lacrimal glands, extraocular muscles, and periorbital soft tissues are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.Brain MRV: There is constriction of the bilateral transverse sinuses. There is otherwise no evidence of cerebral venous sinus thrombosis.

Output: The combination of a partially empty sella, constriction of the bilateral transverse sinuses, and prominence of the subarachnoid spaces within the optic nerve sheaths bilaterally with bulging of the left optic nerve disc is suggestive of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: 25 days, Female, severe acidosis at birth. History of prematurity, 29-30 completed weeks per chart. Sulci are within normal limits for patient's corrected age. There is mild T1 hyperintensity and susceptibility effect along the posterior to the left cerebellar hemisphere and left occipital lobe compatible with minimal subdural blood products. There is also a focus of susceptibility in the right temporal horn which may represent minimal intraventricular hemorrhage. Ventricles are normal in size.There is no evidence of acute infarct, intracranial mass, edema, or mass effect. No midline shift or herniation. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. No clear evidence of ischemic injury in the brain.2. Minimal subdural blood products along the left posterior convexity. There is also focus of susceptibility in the right temporal horn suspected to represent minimal intraventricular blood.


Instruction: Generate impression based on findings.

Input: 63-year-old male with chronic diarrhea and low fecal elastase. No known history of pancreatitis. Evaluate for evidence of chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: No evidence of intra-or extrahepatic biliary ductal dilation. No focal mass lesions are identified. SPLEEN: No significant abnormality noted.PANCREAS: Incidental note is made of pancreatic divisum. There is no dilation of the main pancreatic duct. There is no atrophy of the pancreas. Although assessment for calcifications would be better performed by CT examination, no foci of signal abnormality are identified to suggest calcification within the pancreas. No mass lesions are identified. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: None is made of multiple simple cysts within the kidneys bilaterally. Numerous subcentimeter foci of fluid signal intensity are too small to characterize, but likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings consistent with pancreatic divisum without MRI findings of chronic pancreatitis, as clinically questioned.


Instruction: Generate impression based on findings.

Input: The study is motion degraded. Fast imaging sequence acquisition was utilized in an attempt to complete a diagnostic study. Given this caveat:There is a left focal cortical abnormality involving the underlying subcortical white matter at the left temporo-occipital junction. It demonstrates T2 hyperintensity (series 1001 image 13, series 1301 image 13, series 1201 image 24). Within the center of the lesion is a linear T1 precontrast focus (series 601 image 13) which appears to correlate with a vessel as demonstrated on susceptibility technique (series 1401 image 60). There is a suggestion of a subtle blush of enhancement along the lateral aspect of the linear T1 precontrast hyperintense focus (series 1601 image 13).There is a solitary punctate focus of T2 hyperintensity along the subcortical white matter of the medial left parietal lobe (series 1301 image 17) without associated mass effect, restricted diffusion, enhancement, or susceptibility abnormality. Given its solitary nature, this is of uncertain clinical etiology or significance.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and left left mastoid air cells are clear. Fluid is again noted within a few right mastoid air cells.

Output: 1.There is a left focal cortical abnormality involving the underlying subcortical white matter at the left temporo-occipital junction. It demonstrates T2 hyperintensity (series 1001 image 13, series 1301 image 13, series 1201 image 24). Within the center of the lesion is a linear T1 precontrast focus (series 601 image 13) which appears to correlate with a vessel as demonstrated on susceptibility technique (series 1401 image 60). There is a suggestion of a subtle blush of enhancement along the lateral aspect of the linear T1 precontrast hyperintense focus (series 1601 image 13). The differential diagnosis would most likely include a small vascular malformation versus neoplasm.2. Fluid is again noted within a few right mastoid air cells.


Instruction: Generate impression based on findings.

Input: Medically refractory right temporal lobe epilepsy. Preoperative planning for depth electrode insertion. There is perhaps slight asymmetry of the medial temporal lobes, which are otherwise incompletely characterized. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Perhaps slight asymmetry of the medial temporal lobes, which are otherwise incompletely characterized on this preoperative planning MRI. Please refer to prior exams for additional details.


Instruction: Generate impression based on findings.

Input: 79 year-old female with dizziness and nausea for 5 days. Evaluate for stroke. There is no evidence of intracranial hemorrhage, mass or edema. Posterior right occipital hypodensity with extension to the cortex and adjacent ventricular compensation, consistent with previous stroke. No evidence of new cortical stroke. Multiple areas of diffuse periventricular and subcortical white matter hypodensity consistent with small vessel ischemic disease. If there is clinical concern for acute ischemia, an MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Small vessel ischemic disease and previous old stroke without evidence of new cortical stroke.2. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Lesions. Signs and symptoms: Numbness and tingling sensation Pre-and post-enhanced brain MRI:Negative diffusion weighted series. There is normal anatomical morphology and signal intensity of the brain parenchyma on all MRI sequences. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination the brain is within normal. The signal voids of major intracranial arterial branches are identified.Post-enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium, scalp and orbits and without detectable abnormal enhancement.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.Pre-and post enhanced cervical MRI:There is normal signal intensity and caliber of the cervical cord and without detectable abnormal enhancement.The signal intensity of vertebral column demonstrate minimal changes secondary to degenerative disease and unremarkable otherwise. There is no detectable abnormal enhancement the vertebral column.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 is unremarkable.C4 -- C5 demonstrate mild degenerative disk disease with resultant mild to moderate right neural foraminal compromise and unremarkable otherwise.C5 -- C6 demonstrate moderate disk disease and loss of disk height shallow broad based bulging disk and bilateral uncovertebral hypertrophic changes are noted. There is moderate bilateral neural foraminal compromise and mild central spinal stenosis.C6 -- C7 demonstrate moderate disk disease and loss of disk height, prominent left lateral disk -- osteophyte complex results in subtle flattening in posterior displacement of the cord on the left. No spinal stenosis or neural foraminal compromise. The signal intensity of the cord remains within normal.C7 -- T1 is unremarkable.Pre-and post enhanced thoracic MRI:Examination demonstrate normal signal intensity and caliber the thoracic cord and without evidence of abnormal enhancement.The signal intensity and the anatomical alignment of vertebral column is unremarkable and without detectable abnormal enhancement.There is no evidence of spinal canal or neural foraminal compromise at any level.At T2 a mesh and one there is a right lateral small disk protrusion (axial T2 series 28 image 38 and sagittal T2 series 23 image 8) with subtle effacement of the ventral subarachnoid space however without spinal stenosis or neural foramina compromise.Pre-and post enhanced lumbosacral spine:There is normal anatomical alignment and signal intensity which column. There is normal signal intensity and morphology of the conus and the cauda equina. There is no detectable abnormal enhancement the vertebral column, conus or cauda equina.There is no evidence of spinal canal or neural foraminal compromise at any level. Mild facet and ligamentum flavum hypertrophic changes at L5 -- S1 and to a lesser degree at L4 -- L5 levels are noted.

Output: 1.Unremarkable pre-and post enhanced brain MRI.2.Pre-and post enhanced cervical MRI demonstrate normal signal intensity of the cord without abnormal enhancement. Mild-to-moderate degenerative disk disease with resultant mild central spinal stenosis at C5 -- C6 as detailed. Left lateral disk osteophyte complex at C6 the C7 with resultant subtle indentation of the ventral aspect of the cord. Neural foraminal compromise as detailed per level above.3.Pre-and post enhanced MRI of thoracic spine demonstrate normal signal intensity and caliber of the cord and without abnormal enhancement. No spinal stenosis or neural foraminal compromise. Tiny right-sided disk protrusion at T12 with subtle effacement of the ventral subarachnoid space.4.Unremarkable pre-and post enhanced lumbosacral spine MRI.


Instruction: Generate impression based on findings.

Input: Demyelinating disease of central nervous system, unspecified [341.9], Reason for Study: ^Reason: MS? History: tingling sensations. C-SpineThere are multifocal somewhat patchy high signal intensity spinal cord lesions on cervical spine on T2 and STIR images including C23, C45 and C67disc level and fusiform lesion from T1 to T2 vertebral level. The lesion on C23 and C67 level lesion show enhancement and T1-T2 level shows peripheral enhancement..The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. No evidence of spinal canal/neural foraminal narrowing or myelopathy. There is minimal diffuse bulging of disc at the level of C56.Otherwise no evidence of disc disease.Thoracic SpineT3, T56, T89, T10 and T11 level spinal cord show multifocal high signal intensities on T2 weighted images. These lesions do not show any evidence of enhancement.There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. There is no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level.

Output: Multifocal somewhat patchy spinal cord high signal intensity lesions with some of them showed enhancement. These findings suggest possibility of spinal cord involvement of demyelinating disease such as multiple sclerosis.Differential diagnosis include transverse myelitis, infectious origin or tumorous conditions which appear to be lower possibility.


Instruction: Generate impression based on findings.

Input: There was no change in the 7 x 6 mm left front subcortical white matter lesion between the 2/13/14 exam and this exam.

Output: No significant change in the non-specific sub-centimeter left frontal lobe lesion when compared to the MRI at the outside hospital dated 2/13/14 which has since been made available for comparison.


Instruction: Generate impression based on findings.

Input: Tingling in 4 limbs, evaluation for NMO. Confluent T2 signal in distal medulla to C7 and T3-T12 in NW MRI from November 2015. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal residual T2 hyperintensity in the inferior medulla. The brain parenchyma and cerebellum otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There is decrease in the degree of T2 hyperintensity and swelling involving the majority of the cervical and thoracic spinal cord. The cauda equina nerve root sare unremarkable. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Interval decrease in the degree of edema involving the medulla and large portions of the spinal cord.


Instruction: Generate impression based on findings.

Input: 85 year-old male with fall and loss of consciousness. CT of brain without infusion.Large vessel intracondylar vascular calcification is noted.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Patchy areas of periventricular lucencies are concerning for small vessel disease considering patient's age. Small area of cortical encephalomalacia in the high convexity left parietal is believed to represent an old small cortical stroke. No evidence of post traumatic findings. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.CT of the cervical spine.Extensive degenerative changes of the cervical spine with significant loss of intervertebral disk height at multiple levels are noted. The alignment of cervical spine remains within normal limits. The facets are aligned and demonstrate no subluxation. A linear defect bilaterally across the pedicles of C6 is noted. There is however no evidence of any malalignment of these pedicles. Considering the patient's history I cannot entirely rule out nondisplaced bilateral pedicular fracture.These findings are best appreciated on sagittal image 15 for the right pedicle of C6 and sagittal images 24 and 25 for the left. Both of these findings are also appreciated on axial images 41 and 42. Follow-up with a repeat thin cuts CT and or an MRI is recommended.Dr. Watts from the emergency service was notified of the findings at the time of interpretation.

Output: 1.Unremarkable CT of brain without infusion.2.Suspected bilateral C6 pedicular fracture as detailed.3.Extensive degenerative changes of cervical spine.4.No malalignment of the cervical spine.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke History: left sided weakness There is restricted diffusion on the right basal ganglia without evidence of hemorrhagic conversion indicating acute ischemic stroke. There is minimal to mild mass effects of the lesion toward right lateral ventricle.The sulci and cisterns are unremarkable. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: Acute ischemic infarct on the right basal ganglia without hemorrhagic conversion.


Instruction: Generate impression based on findings.

Input: 52-year-old man status post craniotomy for tumor resection. Evaluate postoperative changes. There are postoperative findings related to right frontal and temporal craniotomy with blood products\within the resection cavities and persistent surrounding T2 signal abnormality compatible with vasogenic edema. The edema results in mass effect with sulcal effacement in the right frontal lobe, partial effacement of the right lateral ventricle, and approximately 8 mm of midline shift to the left. The basal cisterns are maintained. There is no residual abnormal enhancement in the frontal lobes. There are unchanged punctate foci of abnormal enhancement in the bilateral cerebellar hemispheres, with associated susceptibility artifact in the right-sided lesion. There are small areas of restricted diffusion surrounding the resection cavities, but no evidence of territorial acute ischemia. The major cerebral flow voids are intact. There is dolichocephaly.

Output: 1.Status post resection of right frontal lobe metastases without evidence of gross residual tumor, but persistent vasogenic edema with associated midline shift of 8 mm.2. Punctate lesions in the bilateral cerebellar hemispheres likely represent metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: History of right vestibular schwannoma status post resection in 2011. Yearly follow-up. Signs and symptoms: Follow-up for tumor. Pre- and post enhanced brain MRI:Dedicated images for evaluation of the IACs demonstrate stable postoperative changes of right-sided suboccipital craniotomy and without evidence of residual or recurrence of tumor. Tiny nodule of enhancement deep in the right internal auditory canal is believed to represent scarring and has remained stable since multiple prior exam.Pre and post enhanced brain MRI demonstrate no diffusion-weighted abnormality.Examination again demonstrates expected postoperative changes of right-sided suboccipital craniectomy evidence of right lateral cerebellar parenchymal volume loss and gliosis without change since multiple prior studies.The anatomical morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.The signal voids of major intracranial arterial branches are identified.Post contrast images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses, bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization and signal pattern.

Output: 1.Stable post operative changes of right suboccipital craniotomy with revisualization of a stable tiny nodule of enhancement in the depth of right IAC since multiple prior exams.2.Pre and postcontrast enhanced brain MRI demonstrate stable right lateral cerebellar encephalomalacia and volume loss and unremarkable otherwise.


Instruction: Generate impression based on findings.

Input: Diagnosis: Ataxia, unspecifiedClinical question: stroke MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck: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.

Output: 1.No evidence for acute ischemic cerebral infarction.2.No evidence for intracranial or extracranial cerebrovascular occlusion or stenosis.3.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma: surveillance. There appears to be an ill-defined subcentimeter area of hypoenhancement in the posterior right adenohypophysis. The infundibulum is deviated slightly to the left. There is no mass effect upon the cavernous sinuses or optic apparatus. The posterior pituitary bright spot is intact.

Output: An apparent small, ill-defined area of hypoenhancement in the posterior right adenohypophysis may represent a microadenoma.


Instruction: Generate impression based on findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9], Reason for Study: ^Reason: evaluate for left thalamic, internal capsule infarct History: right face numbness, weakness, right hand weakness, numbness No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 78 years Male (DOB: 4/26/1937)Reason: eval for brain/spinal mets History: weaknessPROVIDER NAME: CARA A ROSENBAUM CARA A ROSENBAUM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The pituitary infundibulum is mildly tilted, however, no underlying lesion is appreciated.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRI cervical spine: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.There is fusion of the V3 and V4 vertebral bodies at the disk space. There is no significant change since the 9/25/2014 examAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is no significant change since the 9/25/2014 examAt C3-4 there is no significant compromise to the spinal canal. The fusion of the C3-4 disk space. There is encroachment of the left sided exiting nerve roots at this level due to osteophytes. There is no significant change since the 9/25/2014 examAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height, disk dessication and posterior ligamentum flavum hypertrophy present at this level associated with effacement of the spinal fluid surrounding the spinal cord. There are endplate and uncovertebral osteophytes at this level. There is encroachment of the exiting nerve roots within the neural foramina at this level bilaterally. There is moderate spinal stenosis at this level. There is no significant change since the 9/25/2014 examAt C5-6 there is no significant compromise to the spinal canal. There is loss of disk space height, disk dessication and a mild disk bulge at this level. There is encroachment of the left sided exiting nerve roots at this level due to osteophytes and disk material. There is no significant change since the 9/25/2014 examAt C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height, disk dessication and posterior ligamentum flavum hypertrophy present at this level . There are end plate reactive changes present at this level. There is mild spinal stenosis at this level. There is encroachment of the exiting nerve roots bilaterally at this level. There is no significant change since the 9/25/2014 examAt C7-T1 there is no significant compromise to the spinal canal. There is loss of disk space height, disk dessication and a mild disk bulge at this level. There is narrowing of the neural foramina bilaterally due to disk material and osteophytes with encroachment of the left sided exiting nerve roots at this level due to osteophytes and disk material. There is no significant change since the 9/25/2014 examThe vertebral artery flow voids appear to be intact.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. No abnormal enhancing lesions are identified in the thoracic spine. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine. There is no significant change since the 9/25/2014 exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, end plate reactive change, disk bulge and Schmorl's nodes at this level. There is patchy contrast enhancement present adjacent ot the endplates. At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, end plate reactive change, disk bulge and Schmorl's nodes at this level. There is patchy contrast enhancement present adjacent ot the endplates. At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, end plate reactive change, disk bulge and Schmorl's nodes at this level. There is patchy contrast enhancement present adjacent ot the Schmorl's nodes.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There are degenerative changes in the cervical spine which are stable since the prior exam with moderate spinal stenosis at C4-5 and multilevel neural foramen encroachment as detailed above worse bilaterally at C4-5 and C6-7 and on the left side at C3-4, C5-6 and C7-1. There is no significant change since the 9/25/2014 exam.3.There are multilevel degenerative changes in the lumbar spine without significant compromise to the spinal canal or neural foramina but with inflammation due to subacute degenerative end plate reactive change at L2-3, L3-4 and L4-5. 4.No abnormal mass lesions are appreciated in the brain or the cervical, thoracic or lumbar spine.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:6/8/1971)Reason: Eval AA. Pt off all Tx. History: AAPROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is redemonstration of abnormal focus of heterogeneous enhancement located in the left superior parietal lobe but also involving the postcentral gyrus as well as subcortical white matter and white matter adjacent to the left lateral ventricle. It does extend into the subcortical white matter of the precuneus. Dimensions are 41 x 30 mm on FLAIR MRI on the current exam and also on the prior exam. On postcontrast imaging it measures 14 x 22 mm and is unchanged compared to the prior exam. On susceptibility imaging there are punctate foci of susceptibility effect are demonstrated.A burr hole is present along the left parietal bone.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since the previous exam in December there is no substantial change in the size of the patient's left parietal lobe lesion. This is known to be the location of the patient's astrocytoma. It's quite possible that this represents radiation necrosis as well as neoplasm.


Instruction: Generate impression based on findings.

Input: Slit ventricle syndrome: headaches. There is a right transparietal shunt catheter that terminates in the posterior third ventricle. Artifact related to the catheter reservoir obscures surrounding anatomy. There is also a right transfrontal catheter that terminates in the right frontal lobe. The third and lateral ventricles are diminutive, with relative prominence of the bilateral temporal horns, but unchanged in size. The fourth ventricle is unremarkable. There are minimal nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. There is microcephaly. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Unchanged diminutive appearance of the shunted supratentorial ventricular system, with relative prominence of the bilateral temporal horns, which can be a manifestation of slit ventricle syndrome.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: There is an overall decrease in brain volume and white matter, with resultant prominence of extra-axial CSF. The corpus callosum directly interfaces with this overlying cerebrospinal fluid, which also indicates a paucity of gray matter. There is fluid in the nasal cavity with bilateral choanal narrowing, left greater than right. Anteriorly, the falx is dysplastic or partially absent. The internal auditory canals are narrowed. Dysmorphic external ears are suggested but not well delineated. Additional temporal bone abnormalities discussed on the prior study are also poorly delineated on today's MRI.No extra-axial fluid collection, hydrocephalus, or pathologic midline shift. Normal myelination pattern is observed for age. There are no focal lesions or areas of abnormal signal within the brain parenchyma. There is no acute intracranial hemorrhage. No evidence of acute ischemia on diffusion-weighted imaging. The corpus callosum and other midline structures are present. There is no cerebellar tonsillar herniation. Flow voids indicate patency of the major intracranial vessels.

Output: 1.No acute intracranial abnormality or focal lesion to account for the patient's symptoms. Global parenchymal volume loss including decreased white matter volume.2.Bilateral choanal atresia with dysmorphic ears and other abnormalities as described above. While not fully characterized on today's study, this constellation of findings is compatible with the patient's underlying history of Treacher-Collins syndrome.


Instruction: Generate impression based on findings.

Input: 47 years, Male, questionable focus of increased activity in the right thalamus on PET. Newly diagnosed tonsil cancer. Multiple sequences are motion degraded. There is however no evidence of intracranial metastatic disease or signal abnormality in the thalamus. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal is within normal limits. Right tonsillar mass and right cervical lymphadenopathy is partially imaged.

Output: Brain parenchyma appears within normal limits for age. Specifically, no evidence of intracranial metastatic disease or signal abnormality in the right thalamus.


Instruction: Generate impression based on findings.

Input: 59 year old female with a bacteremia and metastatic breast lesions to the spine. Evaluate for discitis/osteomyelitis. There is transitional lumbosacral anatomy with 6 lumbar appearing vertebrae. For the purposes of this exam, the last fully formed disc is at L6-S1. The last rib-bearing vertebra is designated as T12. Please note that this differs from the previous counting convention from the CT lumbar spine 7/1/2015.There are diffuse osseous metastases involving the visualized vertebrae with similar pattern to previous. Again seen is a mild overall compression deformity of L3 due to associated metastatic disease with a focal concavity along the inferior endplate. A focal concave metastatic lesion along the inferior plate of L4 also appears similar to prior exam.The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord. There is slight reversal of the cervical lordosis with associated degenerative changes most prominently involving the C5-6 and C6-7 levels. There is retropulsion of fracture fragments at L3-L4 along with minimal disc disease without high-grade central spinal canal stenosis. There is prominent pre-vertebral fluid signal, measuring up to 12 mm in greatest thickness at the lower C4 level with loss of the fat plane involving the posterior pharyngeal region. Again demonstrated is a partially visualized presumed enlarged fibroid uterus. Correlate with the recent CT abdomen and pelvis.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.No evidence of discitis/osteomyelitis.3.Prominent prevertebral fluid signal along the cervical spine with loss of the intervening fat plane with the pharynx, which can be evaluated further with a neck CT if there is clinical concern for infection in this region.4.Transitional lumbosacral anatomy as detailed above, which differs from previous counting convention. If surgery is being contemplated, recommend correlation with imaging of the entire spine.5.Diffuse osseous metastases involving the spine and evidence of persistent concavity of the inferior endplates of L3 and L4 relating to metastatic lesions/compression deformity.6.Partially visualized presumed enlarged fibroid uterus. Correlate with the recent CT abdomen and pelvis.Findings were discussed with Dr. Kiraly (Pager 3655) at approximately 12:30 pm on 7/2/2016 by Dr. Veronesi of the Radiology service.


Instruction: Generate impression based on findings.

Input: 59-year-old male with stage IV melanoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal scattered punctate T2 hyperintensity in the subcortical and periventricular white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and orbits are unremarkable. There are postoperative findings in the left temporal scalp related to prior excision without evidence of recurrent or residual mass.

Output: 1. No evidence of intracranial metastases.2. Postoperative changes of the left temporal scalp without discernible mass lesions.