Instruction: Generate impression based on findings.

Input: Female 77 years old Reason: Evaluation of biliary system; evidence of pancreatic mass? GI CONCERNED FOR ASCENDING CHOLANGITIS History: Jaundice, fever ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. There is moderate intrahepatic biliary ductal dilatation. There is mild hyperenhancement of the bile duct walls.Gallbladder contains gallstones. There is mild perihepatic and pericholecystic fluid. There is dilatation of the common bile duct measuring up to 11 mm and contains several stones. The largest stone is impacted in the distal common bile duct near the ampulla.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: Bilateral pleural effusions, right greater than left with basilar atelectasis and consolidation

Output: 1.Cholelithiasis with choledocholithiasis causing biliary obstruction. Mild hyperenhancement of the ducts suggests cholangitis.Findings discussed with clinical service at the time of dictation.


Instruction: Generate impression based on findings.

Input: 84-year-old female with altered mental status x 1 week and visual hallucinations. Chronic headache. Question of ischemic stroke. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of periventricular and subcortical white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Well-defined focal hypodensity adjacent to the left basal ganglia consistent with old hemorrhagic stroke. No acute cortical stroke.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: Prior strokes and small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: New dx nasopharyngeal ca, needs baseline neck imaging. There is an infiltrative somewhat lobulated enhancing nasopharyngeal soft tissue mass eccentric to the left corresponding to the region of hypermetabolic activity seen on recent PET/CT. The lesion is difficult to measure, however the right and central cranial aspect of the lesion measures approximately 1.9 x 1.4 cm whereas eccentric left aspect more inferiorly measures 1.3 x 2.2 cm. The mass is inseparable from the underlying adenoids.Multiple significantly enlarged bilateral neck lymph nodes are demonstrated corresponding to areas of increased PET activity. There is a large conglomerate of lymph nodes in the right level 2 nodal region measuring 5.5 x 5.4 x 5.7 cm (AP by transverse by CC). The right internal jugular vein is not visualized adjacent to this nodal mass and may be compressed or completely encased. A left level IIA partially necrotic node measures 3.7 x 1.8 x 3.8 cm. There is a left node of Rouviere measuring 2.1 cm. There is also an enlarged left level III/IV node. A few small supraclavicular lymph nodes are seen bilaterally.There is fluid present in the mastoid air cells. The visualized submandibular glands and thyroid gland appear grossly unremarkable. Developmental narrowing of the spinal canal with mild superimposed degenerative changes is seen.

Output: 1. Large infiltrative nasopharyngeal mass with right much greater than left cervical lymphadenopathy. 2. The right internal jugular vein is not identified amongst the level 2 nodal conglomerate.


Instruction: Generate impression based on findings.

Input: Abnormality of gait. Clinical question: disc disease. Signs and Symptoms: falls The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation presentAt 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 central disc extrusion present at this level with disc material extending behind the C3 vertebral body with mild effacement of spinal fluid ventricle but not posterior to the spinal cord. Overall there is mild spinal stenosis at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this levelAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.The thyroid gland is not readily identified.Imaging is degraded by artifact related to patient motion.

Output: 1.There is a central disc extrusion present at C3-4 associated with only mild spinal stenosis.2.The examination was compromised due to patient's ability to cooperate with the exam which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 41-year-old female BRCA 1 positive. Family history of breast cancer diagnosed in maternal cousin, ovarian cancer diagnosed in mother, and cervical cancer in maternal grandmother. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: History of ovarian cancer and brain metastases status post resection. MR for radiation treatment planning. Interval resection of prior right occipital region mass. No residual enhancing tumor is identified. Adjacent vasogenic edema has decreased. Postoperative changes from right occipital craniotomy. There is expected postoperative dural enhancement along the craniotomy bed. No significant extra-axial fluid collection. No new suspicious enhancing lesions. The ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present. Persistent right maxillary sinus opacification and mucosal enhancement compatible with sinusitis. The orbits are unremarkable.

Output: 1. Interval surgical resection of previously noted right occipital metastasis. No residual enhancing tumor is identified.2. Persistent right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is a small amount of subacromial subdeltoid fluid. Otherwise no significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Small amount of subacromial subdeltoid fluid which may reflect a component of minimal bursitis. Otherwise evaluation of the left shoulder is unremarkable.


Instruction: Generate impression based on findings.

Input: Cognitive impairment, please evaluate. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered areas of high T2 signal in the cerebral white matter bilaterally. There is also a small lacunar infarct in the right thalamus with associated susceptibility effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small right temporomandibular joint synovial cyst. There is a partly imaged well-defined subcentimeter left parotid tail T2 hyperintense lesion.

Output: 1. Scattered areas of high T2 signal in the cerebral white matter bilaterally may represent chronic small vessel ischemic disease and a chronic hemorrhagic right thalamus lacunar infarct. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A partly imaged well-defined subcentimeter left parotid tail T2 hyperintense lesion may represent a cyst, but is nonspecific.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. There is again a pointed configuration of the cerebellar tonsils although which descend 5-6 mm below the level of the foramen magnum, with associated mild crowding. There is a relative shallow clival angle with positioning on the current exam. CSF flow imaging demonstrates biphasic CSF flow at the foramen magnum ventrally and dorsally with the visualization of flow through the cerebral aqueduct and fourth ventricle.There is stable appearance of focal central T2 hyperintensity within cord extending to a subtle fashion up to the C6 level down to the tip of the conus at the L1-L2 level. This has slightly increased in size with maximal dimensions now 6 x 6 mm at the mid to lower T7 level on 1301/39, previously measuring 5 x 5 mm at this level.The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The marrow signal is unremarkable. There is no significant spinal canal stenosis. The conus terminates at L1-L2.There is significant prominence of the soft tissue along the posterior nasopharynx in the region of the adenoids and lingual tonsils likely representing reactive lymphoid tissue in a patient of this age. There is severe bilateral mastoid air cell fluid opacification which is partially visualized. There is also opacification of visualized paranasal sinuses.

Output: 1. Stable appearance of Chiari 1 malformation with presence of biphasic flow both ventrally and dorsally along the foramen magnum.2. Slight increased degree of syringohydromyelia extending from the level of C6 to the conus, now measuring up to 6 mm in diameter.


Instruction: Generate impression based on findings.

Input: H/o cervical cancer. The lumbar lordosis is present. The lumbar spine alignment appears within normal limits. Abnormal hyperdensity is seen in the L2, L4, L5 and S1 vertebral bodies, in which there are 30% loss of height in the L2 vertebral body and depression of the right superior endplate of the L5 vertebral body. T12/L1: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L1/L2: disc bulge, vacuum phenomena and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L2/L3: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L3/L4: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L4/L5: disc bulge, vacuum phenomena and bilateral facet hypertrophy; left neuroforaminal compromise; no spinal canal stenosis. L5/S1: disc bulge, vacuum phenomena with small amount of air in the epidural space and bilateral facet hypertrophy; bilateral neuroforaminal compromise; no spinal canal stenosis. These findings have been stable since prior MRI.

Output: 1. Metastases likely involving the L2, L4, L5 and S1 vertebral bodies with the L2 and L5 compression or pathologic fractures. 2. Degenerative disease of the lumbar spine as detailed above.


Instruction: Generate impression based on findings.

Input: Diagnosis: AphasiaClinical question: brain ischemiaSigns and Symptoms: aphasia, arm weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 25 x 17 mm axial dimension focus of diffusion restriction present along the lateral aspect of the right precentral gyrus. There is minimal or no associated signal hyperintensity on the associated FLAIR MRI.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with hyperacute infarction involving the lateral aspect of the right precentral gyrus. Findings were reported to Dr. Brorson at the time of exam.


Instruction: Generate impression based on findings.

Input: Recurrent shoulder dislocation ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. There is flattening and marrow edema of the superolateral aspect of the humeral head representing a Hill-Sachs deformity from prior anterior dislocation. Additional marrow edema is identified within the inferior glenoid anteriorly although there is no evidence of a discrete fracture fragment.There is deficiency of the anterior inferior labrum best appreciated on series 1201 image 14. There is no evidence of a displaced labral fragment or discrete labral tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Findings representative of prior anterior dislocation including Hill-Sachs deformity of the humeral head and marrow edema of the inferior glenoid. There is no evidence of a glenoid fracture.2. Deficiency of the anterior inferior labrum which may be the sequela of prior dislocation given its location and the patient's history, however there is no evidence of a displaced labral fragment or discrete labral tear.


Instruction: Generate impression based on findings.

Input: Intracranial mass follow up. There is an extra-axial, lobulated, heterogeneously enhancing right suprasellar mass with extension into the right prepontine cistern that measures up to 23 mm. There is mild mass-effect upon the surrounding neurovascular structures, including the pons and optic apparatus. The tumor surrounds the right internal carotid artery and abuts the basilar artery, but there is no significant narrowing of the flow voids. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchymal signal and pituitary gland appear unremarkable. The ventricles are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A right suprasellar mass with extension into the right prepontine cistern is unchanged.


Instruction: Generate impression based on findings.

Input: 57-year-old woman with family history of breast cancer in mother and sister. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Redemonstrated is a oval well-circumscribed mass in the left breast upper inner quadrant near the 11:00 position, anterior depth with benign MR features. This is mammographically stable dating back to 2004. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Other: There are a few nonenhancing T2 bright lesions in hepatic dome likely cysts or hemangiomas, that are stable (series 301, image 27).

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


Instruction: Generate impression based on findings.

Input: There is a 9 mm AP x 12 mm transverse x 9 mm craniocaudal CSF intensity lesion in the expected location of the pineal gland without associated nodular enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are low lying, normal in morphology, felt to represent ectopia and not Chiari malformation. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size bilaterally without signal abnormalities, masses, or abnormal enhancement identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: 1.MRI findings consistent with a simple pineal cyst.2.Other wise negative contrast-enhanced MRI without MRI evident abnormality to explain the patient's seizures.


Instruction: Generate impression based on findings.

Input: Acute pancreatitis, denies history chronic pancreatitis, dilated pancreatic duct, cholelithiasis/?cystitis, evaluate for stones, lesions. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense foci compatible with simple cysts. Liver is otherwise unremarkable. Gallbladder is filled with tiny stones. There is gallbladder wall edema and mild pericholecystic fluid. Slight dilation of the common duct. Choledocholithiasis is identified (series 401, image 24; series 601, image 16).SPLEEN: No significant abnormality noted.PANCREAS: Mild pancreatic ductal dilatation is noted. No pancreatic lesion is present.ADRENAL GLANDS: No significant adrenal nodularity or thickening.KIDNEYS, URETERS: No focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small bilateral pleural effusions are noted.

Output: 1.Choledocholithiasis with slight common bile duct dilatation and mild pancreatic duct dilatation. Pancreatic ductal dilatation may be due to choledocholithiasis.2.No obstructing mass lesion is identified.3.Gallbladder wall edema and pericholecystic fluid; right upper quadrant ultrasound may be considered if there is clinical concern for cholecystitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate recurrent GBM. Compared to prior OSH imaging. Signs and symptoms: GBM. Pre- and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrates a large focus of vasogenic edema in the left posterior temporal and with minimal extension into the left occipital lobe. Within this region there is a large enhancing mass measuring 29 x 25 x 23 mm in size. There is a internal focus of near CSF signal intensity suggestive of a small focus of surgical resection measuring approximately 16 x 7 mm in size (coronal T2 weighted series). The mass extends from the cortex across the left posterior temporal lobe and reaches the trigone of left lateral ventricle which is also mildly compressed secondary to the tumor. There is no detectable enhancement of the ependymal lining of the ventricle. Finding is consistent with patient's known glioblastoma.Constellation of findings results in subtle mass effect on the trigone of left lateral ventricle and without evidence of midline shift.Compared to prior examination there is significant interval increased size of tumor and surrounding vasogenic edema. On prior study the focus of enhancement measured approximately 14 x 12 mm in transaxial dimensions.The morphology as well as the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences and without detectable additional foci of parenchymal enhancement.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Interval increased size of a left posterior temporal GBM and its surrounding vasogenic edema since prior study.2.The enhancing tumor measures at 29 x 25 mm on current exam compared to prior study measurement of 16 x 7.3.The tumor extends from the cortex across the left temporal lobe and reaches the trigone of left lateral ventricle without detectable enhancement of the ependymal lining.4.There is evidence of regional mass effect and without deviation of the midline.


Instruction: Generate impression based on findings.

Input: Female 26 years old Reason: eval ligaments History: knee dislocation s/p reduction MENISCI: Complex tear of the posterior horn of the lateral meniscus with a torn fragment near the intercondylar notch. Also, there is undersurface tearing of the peripheral aspect of the posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: Impaction fracture of the posterior aspect of the lateral tibial plateau involving the articular surface with mild displacement and posterior angulation. The fragment measures approximately 7 x 10 mm (series 601, image 11). Bone contusions are present along the anterior lateral femoral condyle and underlying the posterior lateral tibial condyle fracture. There is also a bone contusion of the posterior medial tibial condyle underlying the meniscal tear (series 701, image 22).LIGAMENTS: Complete disruption of the ACL, likely in the mid substance fibers. A portion of the torn ACL, which appears to be attached to the femur is situated posterior to the PCL. The PCL is indistinct at its attachment to the tibial plateau, likely indicating a high-grade partial tear (series 601, image 18). A full thickness tear at its tibial attachment is possible. There is complete disruption of the MCL. Edema surrounds the components of the LCL complex, however the LCL complex appears intact. There is also edema in the posterior lateral corner. The popliteus appears intact. However, the posterior capsule is disrupted at its tibial attachment (series 701, image 19).EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complete disruption of the ACL and MCL with high-grade partial tearing at the insertion of the PCL. A full thickness tear at its tibial attachment is possible. 2.Impaction fracture in the posterior lateral tibial plateau and other osseous contusions as detailed above.3.Tear of the posterior horns of the medial and lateral menisci. The lateral meniscus posterior horn and body are torn with areas of maceration.4.Disruption of the posterior capsule of the joint.


Instruction: Generate impression based on findings.

Input: 81 year old female patient with right-sided visual field deficit, visual hallucinations. Question of stroke. BRAIN: There is extensive encephalomalacia involving the right frontal, parietal, and temporal lobes as well as the right basal ganglia with associated ex-vacuo dilatation of the right lateral ventricle. Surrounding susceptibility artifact within this area likely represents chronic blood products. There is Wallerian degeneration of the right pons and right cerebral peduncle. There is a focus of diffusion restriction within the region of the motor cortex within the right precentral gyrus without definite evidence of ADC restriction; this could be artifactual or represent a small ischemic lesion. Otherwise, there is no diffusion-weighted abnormalities to suggest acute ischemia. There is extensive subcortical and periventricular abnormal T2 signal within the right cerebral hemisphere and mild T2 signal abnormality within the left cerebral hemisphere consistent with chronic small vessel ischemic disease. There is no midline shift or herniation. There is attenuation of the M1 segment of the right middle cerebral artery flow void. There is fluid in the left mastoid air cells. ORBITS: The bilateral globes and ocular adnexa are unremarkable, other than bilateral lens implants. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. Extensive right cerebral hemispheric encephalomalacia in the distribution of the right middle cerebral artery.2. A focus of diffusion restriction within the right precentral gyrus without definite evidence of ADC restriction; this could be artifactual or represent a small ischemic lesion.3. Chronic small vessel ischemic disease. 4. Unremarkable examination of the bilateral orbits.


Instruction: Generate impression based on findings.

Input: There is a right-sided pituitary mass which measures 16 mm transverse by 10 mm craniocaudal by 11 mm AP dimension. It enters the adjacent cavernous sinus, abutting the cavernous carotid, however without arterial encircling or narrowing. There is no significant deviation of the pituitary stalk, and the mass does not approach the optic apparatus.A small T2 hyperintense multiloculated lesion is noted within the right paramedian clivus (best seen series 901 image 12/44) with a pedunculated portion which extends into the adjacent subarachnoid space abutting the basilar artery, however without arterial deformation or displacement. There is minimal, questionable enhancement along its lateral aspect. It demonstrates a narrow zone of transition with what appears to be intact cortical borders.There are scattered foci of T2 hyperintensity in periventricular and subcortical white matter (primarily subcortical) not associated restricted diffusion, mass effect, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Right sided pituitary macroadenoma which does not approach the optic apparatus.2.Clival-based lesion with an MRI appearance most consistent with ecchordosis physaliphora. Given the lack of significant enhancement, clival chordoma is felt to be less likely.3.Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Confusion - newly diagnosed lymphoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific scattered cerebral white mater T2 hyperintensity, which may represent chronic small vessel ischemic disease. 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 appears to be a defect in the left orbital floor, with protrusion of orbital fat, which may be related to prior trauma. There is right maxillary and left ethmoid sinus mucosal thickening.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. However, evaluation for CNS lymph is limited without intravenous contrast.


Instruction: Generate impression based on findings.

Input: 70 year old man with multiple myeloma, referred for evaluation of cardiac amyloid. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 254 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 96 ml (normal range 47+/-19). There is mild concentric LVH (IVSd 12mm). There are no regional wall motion abnormalities present. There is late gadolinium enhancement in the lateral walls that is atypical for infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. It appears similar to LGE on prior cardiac MRI on 10/16/15. There is a small area of delayed enhancement in the inferoseptum suggestive of "RV insertion" point enhancement. The basal IVS native myocardial T1 time is 1006ms and the basal inferolateral T1 time is 1080ms (decreased from prior MRI).Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVEDV is 200 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 98 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 62%.2. There is late gadolinium enhancement in the lateral walls that is atypical for infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. It appears similar to LGE on prior cardiac MRI on 10/16/15. The basal IVS native myocardial T1 time is 1006ms and the basal inferolateral T1 time is 1080ms (decreased from prior MRI).3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%. 4. Compared to prior MRI on 10/16/15, the LGE pattern visually appears similar, however the native T1 times have decreased.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of SRS for single brain metastasis No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. Periventricular and subcortical white matter T2/FLAIR hyperintense foci is likely secondary to moderate small vessel ischemic disease and/or posttreatment changes. No mass lesion or abnormal areas of enhancement are present. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature.Mild mucosal thickening is seen in the maxillary sinuses. The imaged portions of the orbits are intact.

Output: 1.No evidence of intracranial metastases.2.No change in moderate chronic small vessel ischemic disease and/or post treatment changes.


Instruction: Generate impression based on findings.

Input: There are post treatment findings related to prior left parietal craniotomy for resection of a subjacent lesion as well as radiation related changes. There is unchanged confluent T2 hyperintensity surrounding the resection cavity and adjacent to the left lateral ventricular body as well as within the bilateral periventricular white matter and corpus callosum where there is mild mass effect upon the lateral ventricle. There are additional unchanged nonspecific patchy foci of T2 hypertensity throughout the supratentorial white matter that may represent treatment related changes and/or chronic small vessel ischemic disease. There is no abnormal enhancement. The perfusion images are nondiagnostic due to poor bolus additional contrast dose.There is no evidence of acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Posttreatment findings without evidence for disease progression.


Instruction: Generate impression based on findings.

Input: Autonomic dysfunction likely from dementia with Lewy bodies: syncope. There is mild disproportionate volume loss involving the bilateral posterior cerebral hemispheres. There is no evidence of intracranial hemorrhage or acute infarct. There is mild nonspecific diffuse periventricular white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There are bilateral choroid plexus xanthogranulomas. 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. There are bilateral lens implants.

Output: Findings compatible with dementia with Lewy bodies.


Instruction: Generate impression based on findings.

Input: A 29 year old female with a diagnosis of sarcoidosis (skin rash, arthralgias, lung). Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 143 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 46 g/m2 (normal range 67+/-11), and the LV mass is 85 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No iron overload.No intracavitary thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 FindingsInfiltration in both lungs and mild mediastinal lymphadenopathy, with no change compared to chest CT (6/10/2015). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 61% without evidence of underlying myocardial fibrosis, inflammation, or infiltration. No cardiac MRI evidence of cardiac sarcoidosis.2. The right ventricle is normal in size and systolic function, the RVEF is 56%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 17 years old, Female, Reason: Evaluate for anterior talofibular ligament injury History: ankle sprain 2 months ago and still with pain, swelling, limp ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS and Tendons: The Achilles, tibialis posterior, flexor digitorum longus, and flexor hallucis longus appear intact without evidence of tear or strain. The tibialis anterior, extensor hallucis longus, extensor digitorum longus are intact without evidence of strain or tear. Increased signal intensity within the ATFL ligament indicates sprain without evidence of tear.ADDITIONAL

Output: ATFL sprain without evidence of tear.


Instruction: Generate impression based on findings.

Input: 69 years, Male, status post craniotomy for GBM resection. Weakness. Evaluate for new infarct or another new lesion. Again seen are postsurgical changes of left parietal craniotomy for tumor resection. Again seen is nodular enhancement involving the anterior medial and anterior inferior aspects of the resection cavity including the left parietal and posterior frontal lobes which appears more prominent than on prior. There is restricted diffusion surrounding the postoperative resection cavity compatible with cytotoxic edema/infarct which shows mild evolution. There is no new infarct elsewhere in the brain. There is also interval increase in FLAIR hyperintensity surrounding the resection cavity which has increased since postoperative study from 9/29/2015. Small extra-axial collection beneath the left parietal craniotomy is again seen with evolution in signal intensity of the blood products. There is no midline shift or herniation. No hydrocephalus.

Output: Compared to postoperative MRI from 9/29/2015, there has been evolution of postoperative changes including of the small areas of cytotoxic edema/infarct surrounding the left parietal resection cavity. There is interval increase in nodular enhancement surrounding the resection cavity, particularly in its anterior medial and anterior inferior aspects, as well as increase in FLAIR hyperintensity surrounding the resection cavity. These changes may represent evolution of postsurgical changes and mildly worsened edema but early tumor progression cannot be excluded. Suggest close follow-up evaluation.


Instruction: Generate impression based on findings.

Input: Reason: osteomyelitis History: radiographs questionable bony involvement of obvious soft tissue infection Abnormal bone marrow signal and enhancement of the 2nd and 3rd toes and metatarsals representing osteomyelitis. Amputation of great toe at MTP joint, otherwise great toe appears normal. Small subchondral cyst at head of the 4th metatarsal. Diffuse soft tissue swelling and subcutaneous fat standing representing cellulitis. No drainable fluid collection.

Output: Osteomyelitis of 2nd and 3rd toes and metatarsals.


Instruction: Generate impression based on findings.

Input: The examination is limited by motion artifact. There is a large area of ischemia involving the left PICA territory, specifically the left lateral medulla and left cerebellar hemisphere. Small areas of ischemia are also present in the right cerebellum. There is ischemia involving the red nucleus of the right midbrain as well as a punctate area of ischemia in the left pons. Symmetric appearing areas of ischemia are demonstrated in the bilateral occipital lobes. Punctate foci of ischemia are demonstrated in the right frontal lobe and left parietal lobe. There is global volume loss with scattered lacunar infarcts present in the bilateral basal ganglia and periventricular white matter. There is no evidence for hydrocephalus. Scattered punctate areas of susceptibility are demonstrated however there is no evidence for hemorrhagic transformation in the areas of infarction. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. There is scattered paranasal sinus disease with ethmoid mucosal thickening and air-fluid levels present in the left maxillary sinus and right sphenoid sinus.MRA HEAD

Output: Limited examination secondary to motion artifact.1. Multifocal areas of ischemia involving the anterior and posterior circulation with largest area involving the left PICA territory. Additional smaller areas of ischemia are demonstrated in the right cerebellum, bilateral brainstem, bilateral occipital lobes, posterior right frontal lobe, and left parietal lobe.2. There is high-grade stenosis or occlusion of the distal left vertebral artery with nonvisualization of the left PICA.3. Mild to moderate multifocal areas of atherosclerotic disease involving the intracranial vasculature, most prominent involving the bilateral cavernous internal carotid arteries.4. Global volume loss and scattered white matter and basal ganglia lacunar infarcts likely related to chronic microvascular ischemic disease.5. There is scattered paranasal sinus disease with ethmoid mucosal thickening and air-fluid levels present in the left maxillary sinus and right sphenoid sinus.


Instruction: Generate impression based on findings.

Input: 61 year old woman with new aortic dilation and aortic regurgitation seen on echo, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 122 ml/m2 (normal range: 65+/-11), the LVEDV is 220 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 98 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 24 ml/m2 (normal range 22+/-8), and the RVESV is 43 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and is tri-leaflet. There is moderate aortic regurgitation (regurgitant fraction 36%) that is eccentrically directed towards the anterior mitral valve leaflet. The AR regurgitant jet appears to be centrally located.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. No thoracic aortic dissection is noted. The thoracic aorta has minimal tortuosity. No aortic coarctation is noted. Aortic dimensions are as below:Sinus of Valsalva: 40mm x 41mm x 42mmSinotubular Junction: 42mm x 40mmAscending Aorta (4cm from annulus): 43mm x 44mmProximal Aortic Arch (proximal to innominate artery): 43mm x 40mmMid Aortic Arch: 31mm x 30mmDescending Aorta: 27mm x 27mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderate dilation of the ascending aorta (dimensions described above). SOV measurement z-score is 3.62. The aortic valve opens widely and is tri-leaflet. There is moderate aortic regurgitation (regurgitant fraction 36%) that is centrally located.3. The left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 56%.4. The right ventricle is normal in size with normal systolic function.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute cord compression. As noted on the prior examination, while counting from above, there are 6 lumbar vertebral bodies.There is redemonstration of extensive abnormal T2 hyperintensity within the cord extending from T6-7 down to T12 level, slightly progressed superiorly from T8-9 level on the prior exam. There's no significant cord expansion.There is a stable small rounded nodular focus along the dorsal aspect of the thecal sac measuring 6 mm on series 1001 image 12 at the recent laminectomy level.Postsurgical hardware can be better visualized with CT if clinically indicated. There has been evolution of immediate postoperative findings related to T11 laminectomy, and posterior surgical fusion of L3 and L4 with bilateral pedicle screws and interbody spacer as well as anterior fusion of L6 through S2 with probable S1 corpectomy (as numbered previously). There are laminectomy defects at L4 and L5. Old screw tracts are present through L5 and L6. There are interbody spacers at L4-5 and L5-6. There is no significant osseous marrow edema.

Output: 1.This is a limited exam specific for the exclusion of acute cord compression only. No acute cord compression is identified.2.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. However, there appears to be mildly severe extension of abnormal T2 hyperintense signal within the cord extending from T6-7 down to T12 on exam, previously extending from T8-9 level to T12. There is no expansion of the cord.3.Interval evolution of immediate postsurgical changes on the prior examination.4.No epidural collection is appreciated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Knee pain and swelling MENISCI: Minimal fraying of the inner edge of the lateral meniscus without additional discrete intrasubstance or changes observed in the meniscal body. Medial meniscus is unremarkable. Both menisci are properly anchored posteriorly.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Specifically no cartilaginous focal abnormality and/or marrow signal abnormalityLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No internal derangement or focal acute or subacute abnormality, see detail provided. Mild varicose veins


Instruction: Generate impression based on findings.

Input: Jaw pain, juvenile arthritis Left TMJ: There is a normal rounded appearance of the mandibular condyle without evidence of discrete bony erosion. There is synovial thickening, increased fluid signal, and enhancement surrounding the left temporomandibular joint. The articular disc is normally positioned between the mandibular condyle and the temporal bone in both open and closed positions. There is normal anterior translation of the mandibular condyle with jaw opening.Right TMJ: There is a normal rounded appearance of the mandibular condyle without evidence of discrete bony erosion. There is mild synovial thickening without significant inflammatory change. The articular disc is normally positioned between the mandibular condyle and the temporal bone in both open and closed positions. There is normal anterior translation of the mandibular condyle with jaw opening.

Output: 1. Mild synovitis of the left TMJ. There is no significant enhancement or inflammatory changes of the right TMJ to suggest acute synovitis although the synovium appears slightly thickened.2. Normal articular disc positioning and motion of both the left and right TMJ.


Instruction: Generate impression based on findings.

Input: 74 year old man with a history of IBS, GERD, OSA on CPAP, DM 2, coronary artery disease s/p PCI most recent ~2014, cardiomyopathy (EF by self report 50%), heart failure, and permanent atrial fibrillation with last cardioversion 15 years ago. MRI evaluation of cardiac function to plan further course of treatment for atrial fibrillation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%. The LVEDV is 143 ml (normal range 142+/-34), the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVESV is 77 ml (normal range 47+/-19) and the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is a small area of subendocardial late gadolinium enhancement in the mid-basal lateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is typical for myocardial infarction. There is no LV thrombus. Left AtriumThe left atrium is severely dilated.RUPV 19x21RLPV 13x16LUPV 17x18LLPV 13x22Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%. The RVEDV is 166 ml (normal range 142+/-31), RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVESV is 94 ml (normal range 54+/-17), and the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is trace significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Normal left ventricular size and mildly reduced systolic function with no significant hypertrophy (LVEF 46%).2.Normal right ventricular size and mildly reduced systolic function with no significant hypertrophy (RVEF 44%).3.Left atrial dilation.4.There is a small area of subendocardial late gadolinium enhancement in the mid-basal lateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is typical for myocardial infarction.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, 76 years old, with low back pain and leg pain, history of fusion from T11 to L3, assess for stenosis below the fusion. Susceptibility artifact induced by posterior spinal fusion instruments results in signal loss and obscuration of the vertebral bodies and spinal canal from T11 through L2. Within this limitation, the following observations are made.A grade 1 retrolisthesis of L2 relative to L3 appears to have progressed from the prior MRI, though it is stable dating back to a CT from 9/16/2014. A grade 1 anterolisthesis of L4 relative to L5 is new from prior exams.The known L1 vertebral body compression fracture is not well assessed due to artifact. The visualized vertebral bodies demonstrate preservation of height. The visualized marrow space shows no evidence of concerning marrow replacement or pathologic enhancement.As on the prior MRI, the spinal canal and its contents are not assessed from T11 through L2. Additional level specific findings are as follows:L3-4: Evidence of prior laminectomy. The facet joints are hypertrophic and the ligamentum flavum is thickened, similar to prior. Very mild progressive loss of disc height with bulging disc, slightly asymmetric to the right. Moderate spinal canal stenosis with slight crowding of the cauda equina, unchanged. The neural foramina are not adequately assessed due to artifact from pedicle screws. L4-5: Facet hypertrophy. Ligamentum flavum thickening. Slight progression of loss of disc height and bulging disc which is asymmetric to the right foraminal zone. Moderate generalized spinal canal stenosis which may be mildly progressed at the level of the right lateral recess. Severe right and moderate left foraminal narrowing, both very slightly progressed. L5-S1: Facet hypertrophy, marked on the right, but unchanged. Ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Severe right and mild to moderate left foraminal narrowing without significant interval change. Bilateral renal cystic lesions are again seen without interval change.

Output: 1.As on the prior MRI examination, the spinal canal and vertebral bodies are not adequately assessed from T11 through L2 secondary to artifact induced by the orthopedic instrumentation.2.Below the level of the fusion, mild progressive degenerative disease is seen. In particular, there is new spondylolisthesis at L2-3 and L4-5. Also noted is progressive mild loss of disc height at L3-4 and L4-5. A slight progressive narrowing of the right lateral recess at L4-5, as well as progressive narrowing of the L4-5 foramina, are suspected.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of digestive system [D49.0] / Malignant neoplasm of unspecified kidney, except renal pelvis [C64.9], Reason for Study: ^Reason: 52 y/o with history of renal cell ca and IPMN s/p resection now with 6 months of low back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis. L2-L3: Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis. L3-L4: Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis. L4-L5: There is minimal (grade 1) anterolisthesis of L4 on L5 with disc desiccation. No neuroforaminal narrowing or spinal stenosis. L5-S1: Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Grade 1 anterolisthesis of L4 on L5.2. Multilevel desiccation indicating degenerative changes.3. No evidence of metastatic lesion.


Instruction: Generate impression based on findings.

Input: There are no diffusion-weighted abnormalities to suggest acute ischemia. There is minimal susceptibility weighted abnormality corresponding to the region of prior infarct in the left post central gyrus which was visible on the MRI of the brain from 12/9/2015. There is minimal volume loss in this region when compared to the prior images. There is no gross evidence of recurrent cortical vein thrombus based on the SWI sequence. The ventricles and sulci are normal in size. There is no mass, mass effect, midline shift or extraaxial fluid collection. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Subtle sequela of prior likely venous infarct involving the left postcentral gyrus, well seen on outside MRI from 12/9/2015. No new infarct or hemorrhage.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of uncertain behavior of central nervous system, unspecifiedClinical question: CT guided biopsy of right infiltrative cavernous sinus lesion-Dr. ChristoforidisSigns and Symptoms: Cavernous Sinus lesion. Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the skull base lesion at the foramen ovale. Following needle removal images obtained demonstrate no complications.

Output: Skull base lesion aspiration under CT guidance.


Instruction: Generate impression based on findings.

Input: History of intracranial tumor resection. Cerebral cysts. This is a limited examination performed for surgical planning. Sequelae of prior right parietal vertex craniotomy are seen. The right paracentral region near the vertex shows encephalomalacia from previous tumor resection. Contrast enhancement along the surface of the brain correlates with marked T2-hyperintensity and may reflect posttreatment change. The enhancement is mildly improved compared to the previous examination. Deep to the contrast enhancement, there is a subcortical, well-circumscribed T1-hypointense, T2-hyperintense area, which measures in the axial plane 4.6 cm x 2.2 cm. This probably represents cystic change with thin internal septations. It causes no significant mass-effect and has not changed compared to the previous examination. Ill-defined bilateral periventricular cerebral white-matter T2-hyperintensity is not significantly changed. Dural thickening underlying the craniotomy flap and along the fixed edge of the cerebral falx is redemonstrated. Patency of the adjacent superior sagittal sinus is difficult to ascertain. The right frontal developmental venous anomaly is unchanged.

Output: 1.Limited examination, performed for surgical planning.2.Subcortical cystic lesion in the right paracentral region causes no mass-effect and is not definitely changed compared to the previous examination from November 2015. 3.Additional findings as above compatible with prior tumor resection and treatment.


Instruction: Generate impression based on findings.

Input: 77 yo male with metastatic prostate cancer, low back pain, right lower extremity pain and weakness For the purposes of numbering, there are 5 lumbar type vertebral bodies. Again seen are postsurgical changes of posterior instrumentation at the L4-L5 level with paraspinous rods and pedicle screws better assessed on recent CT. There is extensive marrow infiltrating tumor involving the L4 and L5 vertebrae. No recent MRI is available, however there is clear progression of tumor when compared to prior MRI dated 7/17/2012 with increased marrow infiltration involving the L4 and L5 vertebral bodies extending into the posterior elements and epidural space. There also multiple additional small enhancing lesions including the T10 vertebral body as well as the sacrum which are new since prior study from 2012.There is minimal loss of height involving the L4 and L5 vertebral bodies; vertebral body heights are otherwise grossly preserved. Alignment is within normal limits. There is moderate stenosis involving the spinal canal at the upper L4 level which becomes severe at the mid L5 level related to combination of epidural tumor tumor, posterior convexity of the L5 vertebral body and degenerative changes. Thecal sac becomes patent more inferiorly at the L5-S1 disc level. There is a prior laminectomy at the L4-L5 level; however the CSF spaces at this level remain effaced.There is moderate to severe stenosis involving the right L4-L5 neural foramen and moderate stenosis involving the right L5-S1 neural foramen. There is mild left L4-L5 and mild to moderate left L5-S1 neural foraminal narrowing. Expansile bone remodeling related to infiltrating tumor is better appreciated on recent CT. There is no significant spinal canal or neural foraminal stenosis at the L1-L2, L2-L3, and L3-L4 levels. Epidural enhancement dorsal to the L3 vertebral body is nonspecific and not definitively indicative of tumor. Small fluid collection in the posterior paraspinous soft tissues at the L5 level is noted but smaller than 2012.

Output: 1. No recent MRI is available for comparison however compared to 7/17/2012, there is evidence of progressive infiltration of the L4 and L5 vertebral bodies extending into the posterior elements as well as increased epidural tissue. There is moderate spinal canal stenosis at the upper L4 level. Spinal canal stenosis becomes worse more inferiorly and is severe at the mid L5 level. Thecal sac becomes patent again further inferiorly at the L5-S1 disc level.2. There is also worsening neural foraminal stenosis related to epidural tumor and expansile bony remodeling related to the infiltrating tumor, particularly on the right, where there may be impingement of the exiting right L4 and L5 nerve roots.3. Please see additional details above, including multiple new foci of osseous metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with right hard palate lesion. An enhancing mass is evident centered within the maxillary alveolus at the location of the right lateral incisor. This lesion measures 12 x 11 mm in the sagittal plane and 11 x 11 mm in the coronal plane. The lesion involves the alveolus and the underlying hard palate mucosa. There is a mild invasion into the overlying hard palate, but no invasion through the hard palate or involvement of the nasal cavity is seen.As noted on the prior CT, there is also evidence of erosion along the posterior right maxillary alveolus (see image 23 series 13). The erosive defect is filled with nonspecific soft tissue which demonstrates ill-defined enhancement and mildly hyperintense T2 signal.A cluster of small lymph nodes is evident just lateral to the submandibular glands bilaterally, but more so on the right. Although individually these lymph nodes do not meet imaging criteria for pathologic enlargement, they are somewhat concerning due to their increased number. Lymph nodes are also evident bilaterally at level 2, but again none of these meets imaging criteria for pathologic enlargement.The salivary glands and thyroid are unremarkable. No additional soft tissue neck lesions are seen. Bone marrow characteristics are unremarkable. Limited intracranial views demonstrate patchy asymmetric periventricular T2 hyperintensity which may reflect microvascular ischemic disease. The paranasal sinuses and nasal cavity are otherwise unremarkable allowing for a small mucous retention cyst in the right maxillary sinus.

Output: 1.An erosive lesion is evident along the right maxillary alveolus at the level of the lateral incisor. This lesion involves the alveolus and underlying mucosa with minimal encroachment upon the hard palate. No evidence of extension through the hard palate into nasal cavity is seen.2.A second area of bone erosion is seen more posteriorly along the right maxillary alveolar ridge. This region demonstrates mildly elevated T2 signal and mild ill-defined enhancement. Findings are nonspecific and may very well reflect a benign etiology, but direct inspection of this region is highly recommended.3.No definite pathologic adenopathy is detected in the neck by size criteria. Lymph node clustering along the submandibular glands, right side more than left, is somewhat concerning due to the unusual increased number of these nodes. Additional lymph nodes at level 2 bilaterally are nonspecific as they do not meet imaging criteria for pathologic enlargement.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell cancer There is a destructive lesion within the scapular neck measuring approximately 3 x 2 cm in the transverse dimensions and approximately 3 cm in the craniocaudal dimension. There is irregularity of the adjacent cortex anteriorly representing tumor penetration. Edema type signal is noted within the adjacent rotator cuff musculature, particularly within the subscapularis, but there is no definite adjacent soft tissue mass. The scapular lesion does not appear to extend into the suprascapular notch.ROTATOR CUFF: There is a small focus of increased signal intensity within the distal supraspinatus tendons anteriorly representing a partial-thickness, likely concealed interstitial tear with a small cyst in the underlying greater tuberosity. The infraspinatus and teres minor tendons appear intact. Evaluation of the subscapularis is limited by rotation of the humeral head however there is linear fluid signal intensity traversing the tendon distally suggesting focal full-thickness tearing which is of uncertain clinical significance.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. A trace amount of fluid is noted within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild osteoarthritis of the glenohumeral joint. A small amount of fluid is present within the subscapular recess and glenohumeral joint but there is no sizable joint effusion. The anterior labrum appears slightly attenuated which may reflect chronic attritional tearing.BICEPS TENDON: There is mild increased signal intensity of the tendon of the long head of the biceps suggesting mild tendinosis.

Output: 1. Lesion of the glenoid of the scapula representing metastatic disease.2. Focal full-thickness tearing of the subscapularis tendon and partial thickness insertional tearing of the supraspinatus tendon.3. Edema within the rotator cuff musculature, particularly of the subscapularis, which may in part be secondary to radiation therapy given the patient's history.4. Osteoarthritis of the glenohumeral and acromioclavicular joints with other findings described above.


Instruction: Generate impression based on findings.

Input: 44-year-old female with worsening headache with morning nausea and blurry vision. Assess for intracranial pathology. Redemonstrated are two punctate foci of Flair hyperintensity in the left centrum semiovale and right frontal subcortical white matter, without new lesions. These remain nonspecific.There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Minimal nonspecific white matter signal abnormality unchanged from the exam of 11/9/2011 and without new lesions.


Instruction: Generate impression based on findings.

Input: 56-year-old female with history of fifth PIP joint subluxation status post ORIF. Assess volar plate. There is post traumatic deformity of the fifth middle phalanx as seen on recent radiographs. The majority of the middle phalanx is subluxed/dislocated volarly with respect to the proximal phalanx. A bandlike structure extending from the head of the proximal phalanx to the volar aspect of the base of the middle phalanx likely represents the volar plate and appears grossly intact. Mild deformity of and edema within the middle phalanx are compatible with healing fracture. Edema is also noted within the head, neck, and diaphysis of the proximal phalanx and may also be post-traumatic in etiology. A small bony fragment situated posterior to the base of the middle phalanx and distal to the head of the proximal phalanx is consistent with an ununited fracture fragment as seen on recent radiographs. The central slip of the extensor tendon appears to extend to this bony fragment. The lateral slips of the extensor tendon extend to the base of the fifth distal phalanx as expected. The flexor tendon apparatus appears intact, with a small amount of fluid in the flexor tendon sheath volar to the 5th metacarpal. The A2 pulley appears intact on transverse images; however, we cannot comment on the integrity of the C1 and A3 pulleys. Evaluation of the collateral ligaments is limited secondary to post-traumatic deformity of the joint and adjacent edema.

Output: Fracture and subluxation/dislocation of the fifth PIP joint as described above, with what appears to be an intact volar plate.


Instruction: Generate impression based on findings.

Input: Male, 5 months old, seizures. A 10 x 8 mm cystic structure is evident along the temporal horn of the right lateral ventricle approximately at the level of the choroidal fissure. The structure exerts mild mass effect upon the right hippocampal formation but no definite hippocampal signal abnormality is seen.No other discrete intracranial lesions are detected. The mesial temporal lobe structures are otherwise unremarkable. No evidence for restricted diffusion or parenchymal edema is detected. No intracranial hemorrhage or any other abnormal extra-axial collections are seen.The pituitary gland as visualized is normal for age. The brain stem and cerebellar vermis are unremarkable. The cerebellar hemispheres are fully formed and normal. The cerebellar tonsils terminate above the level of the foramen magnum. The corpus callosum is intact. The pattern of white matter myelination is appropriate for age.

Output: A cystic structure is present along the right temporal horn with imaging features and location most suggestive of a choroidal fissure cyst. A cystic neoplasm is felt to be much less likely, though follow-up imaging with contrast should be considered to exclude this possibility.This lesion exerts mild mass-effect on the right hippocampal formation. However, the true significance of this finding relative to the patient's seizures is uncertain.


Instruction: Generate impression based on findings.

Input: 45-year-old female with a previous abnormal mammogram and lobular breast cancer. No abnormal osseous foci are identified to indicate metastatic disease. There are degenerative changes seen in bilateral knees and bilateral feet.

Output: No evidence of osseous metastases.


Instruction: Generate impression based on findings.

Input: Male 24 years old Reason: Crohn's disease with phlegmon evaluate for response to therapy History: Abdominal pain 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: Stable mild focal prominence of the upper collecting system of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Persistent mural thickening and hyper enhancement of the terminal ileum (segment measuring 4.8 cm on series 4, image 4) and ascending colon (segment measuring 4.5 cm on series 5, image 18) immediately distal to the ileocecal valve and to the level of the hepatic flexure. The appearance is suggestive of acute on chronic inflammation with interval improvement in the active inflammation compared to prior MRI study, as evidenced by decreased abnormal diffusion. These areas demonstrate luminal narrowing suggestive of stricturing with associated prestenotic dilatation of the cecum and distal ileum. There is a small residual focus of phlegmon measuring 1.6 x 1.2 cm (series 11, image 4), reduced from recent CT abdomen and pelvis where it measured 2.8 x 2.2 cm. There is no high-grade bowel obstruction. There are residual inflammatory changes within the surrounding mesentery. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Acute on chronic inflammation of the terminal ileum and ascending colon, reduced compared to prior study with associated stricturing. 2.Interval decrease in the adjacent previously described phlegmon.


Instruction: Generate impression based on findings.

Input: Reason: brain metastasis, status post whole brain radiotherapy. There are several supratentorial and infratentorial lesions, which have decreased in size. For example, a lesion located along the right prefrontal gyrus measures approximately up to 9 mm, previously 14 mm, a left anterior temporal lobe lesion measures 6 mm, previously 12 mm, a right midline temporal gyrus lesions measures 7 mm, previously 10 mm, and a medial right cerebellar hemisphere lesion measures2 mm , previously 6 mm. Additional subcentimeter foci of abnormal enhancement are present along the inferior right temporal lobe, anterior left temporal lobe, posterior left parietal lobe, and bilateral cerebellar hemispheres. There are scattered areas of abnormal high T2 signal within the cerebral and pontine white matter, which likely represent chronic small vessel ischemic disease, but no evidence of acute infarction. There is also patchy high T2 signal within the pons, greater on the right. There are nonspecific punctate foci of susceptibility effect along the left sylvian fissure. There is mild cerebral parenchymal volume loss. There appears to be a small right sigmoid sinus diverticulum. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: Multiple intracranial enhancing lesions have decreased in size.


Instruction: Generate impression based on findings.

Input: Reason: Meningioma yearly surveilalnce History: Meningioma. Postoperative findings related to bifrontal craniotomy and endoscopic sinus surgery for meningioma resection appears similar to the prior exam. There is persistent linear enhancement overlying the dural flap which is unchanged without a discrete enhancing mass to suggest recurrence. Multifocal mucosal thickening with mucous retention cysts in the left maxillary sinus and right ethmoid sinus is unchanged. There is extensive bifrontal encephalomalacia and gliosis which is unchanged. Ventricles are unchanged in size and configuration. A partial empty sella is again noted the orbits and mastoid air cells are unremarkable.

Output: Postoperative findings from meningioma resection without definite evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Evaluate for ACL versus meniscal tear. MCL sprain months ago with instability and intermittent swelling. MENISCI: Signal characteristics and morphology is normal in both the medial and lateral menisci without evidence of discrete tear.ARTICULAR CARTILAGE AND BONE: Articular cartilage in the medial, lateral, and patellofemoral compartments is intact. Bone marrow signal characteristics are within normal limits.LIGAMENTS: There is increased fluid signal within the ACL with some fibers intact, suggestive of partial tearing.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Partial ACL tear, as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Acute hemorrhage. Signs and symptoms: Altered mental status x 24 hours. Nonenhanced head CT:No detectable acute intracranial process. CT however it is insensitive for early detection of acute nonhemorrhagic ischemic stroke. The clinical concern persist recommend follow-up with an MRI examination.Mild degree of small vessel ischemic strokes of indeterminate age are evident by subtle periventricular and subcortical low attenuation white matter.The cortical sulci, ventricular system and the CSF cisterns are within normal for patient stated age.Mild large vessel intracranial vascular calcification of the cavernous carotid and bilateral routine post is present.Calvarium, visualized paranasal sinuses and orbits and mastoid air cells are unremarkable.

Output: Mild small vessel ischemic strokes of indeterminate age. CT however it is insensitive for early detection of acute nonhemorrhagic ischemic stroke.


Instruction: Generate impression based on findings.

Input: Episodes of confusion since 2014. Epilepsy protocol. The bilateral hippocampal regions are symmetric. There is no evidence of gray matter heterotopia or cortical dysplasia. There is no evidence of intracranial hemorrhage, mass effect, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The sella appears to be partially empty, but this probably just represents a relatively U-shaped pituitary gland. The skull and extracranial soft tissues are unremarkable.

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


Instruction: Generate impression based on findings.

Input: 16 year-old female with systemic lupus and nephritis. History of elevated cardiac enzymes and chest pain.Referred for CMR to rule out myocardits Left VentricleThe left ventricle is mild-moderately dilated with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 108 ml/m2 (normal range: 65+/-11), the LVEDV is 202 ml (normal range 109+/-23), the LV end systolic volume index is 45 ml/m2 (normal range 18+/-5), the LVESV is 84 ml (normal range 31+/-10), the LV mass index is 67 g/m2 (normal range 67+/-11), and the LV mass is 126 g (normal range 114+/-24). There are no regional wall motion abnormalities present. T2 Stir images show evidence of edema/inflammation in the region of e lateral/antero-lateral wall which is suggestive of an acute inflammatory process such as myocarditis There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Myocardial T1 time ~1150 ms which is abnormal and could be consistent with diffuse fibrosis.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 107 ml/m2 (normal range 69+/-14), the RVEDV is 200 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 89 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-moderate 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. PericardiumSmall pericardial effusion. Bright pericardium noted on T2-stir images suggestive of pericarditis.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mild-moderately dilated with normal systolic function. The overall LV ejection fraction is 59%. There are no regional wall motion abnormalities present. T2 Stir images show evidence of edema/inflammation in the region of e lateral/antero-lateral wall which is suggestive of an acute inflammatory process such as myocarditis There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Myocardial T1 time ~1150 ms which is abnormal and could be consistent with diffuse fibrosis.2. The right ventricle is mildly dilated. The overall RV ejection fraction is 56%3. Small pericardial effusion. Hyperenhancement on T2-stir images suggestive of pericardits4. At least mild aortic regurgitation and mid-moderate tricuspid regurgitation. 5. This constellation of findings is consistent with myo-pericarditis.


Instruction: Generate impression based on findings.

Input: Left posterior oral tongue cancer T4a treated with CRT and 2nd primary T1 excised in 2014. Now with thickening and pain. There are post-treatment findings in the left oral cavity region. There is decreased conspicuity of a patchy areas of T2 hyperintensity in the left oral tongue. Otherwise, there is no evidence of measurable oropharyngeal mass lesions or cervical lymphadenopathy. There is an unchanged well-defined T2 hyperintense lesion in the left shoulder region, without convincing enhancement. The thyroid gland and remaining salivary glands are unremarkable. There is minimal fluid within the left mastoid air cells. The orbits and imaged intracranial structures are unremarkable.

Output: 1. Post-treatment findings in the left oral cavity region with decreased conspicuity of a nonspecific patchy areas of T2 hyperintensity in the left oral tongue. Otherwise, no evidence of measurable oropharyngeal mass lesions or cervical lymphadenopathy. 2. Unchanged well-defined cystic lesion in the left shoulder region.


Instruction: Generate impression based on findings.

Input: Male 83 years old Reason: 83 yo with abnl LFT, septated mass in liver History: none ABDOMEN:LIVER, BILIARY TRACT: There is a 6.2 x 8.1 cm T2 hyperintense lesion within the left hepatic lobe with mild central complexity consisting of thin nonenhancing internal septations.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintense lesions are consistent with simple cysts. A mildly complex left upper pole cyst contains a thin nonenhancing internal septation. Subcentimeter T2 hypointensities in the lower pole of the left kidney measuring up to 1.0 cm (series 4, image 27), demonstrate intrinsic T1 hyperintense signal and are suggestive of hemorrhagic/proteinaceous cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cystic lesion within the liver with thin nonenhancing central septations. This is suggestive of a mildly complex hepatic cyst/biliary hamartoma.2.Mildly complex left upper pole renal cyst.


Instruction: Generate impression based on findings.

Input: Left knee pain, check for meniscal tear MENISCI: A discrete oblique tear within the posterior horn of the medial meniscus extends to the inferior articular surface extending towards the body. The remainder of the meniscus otherwise is significant for blunting of the anterior horn representing degeneration along the free anterior edge. The lateral meniscus is otherwise intactARTICULAR CARTILAGE AND BONE: Focal cleft is observed in the lateral femoral condylar cartilage laterally (image 11 series 901) with mild thinning. More pronounced cartilaginous loss deep to bone with underlying degenerative changes and small cysts is otherwise observed in the medial compartment, covering an area of at least 2 cm. Tibial plateau cartilage is grossly intact as well as the patellar cartilage and compartment. Scattered moderate degenerative changes more pronounced laterally, specifically an unusual bulky osteophyte is otherwise observed anterior and lateral to the femoral condyle. No additional osseous or marrow signal changesLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate to extensive cartilaginous defects in both the medial and lateral compartments along with an oblique tear in the posterior horn of the medial meniscus


Instruction: Generate impression based on findings.

Input: 37 years Male (DOB:9/16/1979)Reason: stroke protocol History: as abovePROVIDER/ATTENDING NAME: TERESITA M HOGAN TERESITA M HOGAN There is a large volume of diffusion restriction involving the all the right basal ganglia, the entire right insular cortex, almost all the right frontal lobe and small portions of the right parietal and temporal lobe.

Output: 1.Large acute ischemic cerebral infarction involving ACA and MCA territories as described above. Endovascular intervention is not indicated here.2.Findings were discussed with Dr Ardelt at the time the exam was obtained.


Instruction: Generate impression based on findings.

Input: History of indeterminate colitis. History of PSC. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: There is intrahepatic and extrahepatic irregular narrowing and dilatation of the biliary tree compatible with known history of primary sclerosing cholangitis. Again the narrowing is most severe at Klatskin's point and the distal common bile duct, not significantly changed from the prior study. No new dominant stricture. No focal mass lesion is evident.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: Findings of primary sclerosing otitis without a new dominant or worsening stricture. No focal mass lesion to suggest cholangiocarcinoma.


Instruction: Generate impression based on findings.

Input: 65 year old female with history of right knee pain. MENISCI: There is intrasubstance degeneration of the medial meniscus, but we see no discrete meniscal tear. There is poorly defined signal intensity particularly within the anterior horn of the lateral meniscus compatible with intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritis particularly at the patellofemoral articulation with near complete loss of all articular cartilage as well as subchondral cysts and bone marrow edema. There is relatively mild degenerative change affecting the tibiofemoral compartment. There are tricompartmental osteophytes. There are cyst-like lesions within the tibial plateau and posterior distal femur likely degenerative in etiology.The femoral trochlea is shallow and even convex superiorly which may reflect an underlying dysplasia. There is slight lateral translation of the patella.LIGAMENTS: There is increased signal intensity and thickening of the ACL compatible with mucoid degeneration. The PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Severe osteoarthritis predominantly affecting the patellofemoral joint with a loose body as well as degeneration of the menisci and ACL.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with headaches, increasing in frequency, with syncope. The diffusion and susceptibility weighted sequences are degraded by artifact presumably arising from orthodontic hardware. The other sequences are of good quality.Brain parenchymal morphology is within normal limits. No focal signal abnormality, edema or mass effect is detected. No pathologic parenchymal enhancement is seen. Note is made of prominent vascularity between the cerebellar tonsils and at the level of the foramen of Magendie. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.No acute intracranial abnormality and no definite findings to account for the patient's symptoms.2.Note is made of prominent vascularity between the cerebellar tonsils which is of uncertain significance. This could represent normal anatomic variation although a shunting lesion such as a dural AV fistula could present similarly. Dedicated vascular imaging can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: Left weakness. CT of brain without infusion: Findings consistent with small vessel disease of indeterminate age are again identified. The strokes are again bilateral subcortical, periventricular and basal ganglia. No definitive evidence of cortical stroke is detected. There is no evidence of hemorrhage. This findings remains similar to what was noted on prior examination of the same date. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Hard or follow-up with an MRI examination is recommended.CTA of intracranial circulation:Right internal carotid:There is heavy calcification of cavernous carotid however on sagittal MIP images no stenosis is detected. The supraclinoid right internal carotid artery is unremarkable. A normal and patent right posterior communicating artery is identified. The right anterior and middle cerebral arteries are visualized and patent. Very minimal irregularity of the vessel walls on 3-D reformatted images may indicate atherosclerotic disease. There is however no evidence of any area of significant stenosis.There is filling of both anterior cerebral arteries from the right side which is secondary to hypoplastic left A1. Right ophthalmic artery on 2-D reformatted images is identified.Left internal carotid:Heavy vascular calcification of the left cavernous carotid on sagittal MIP images are noted. No hemodynamically significant stenosis is detected. Supraclinoid internal carotid artery demonstrate minimal vascular calcification and is otherwise unremarkable. Eight patent prominent left posterior communicating artery is identified. Ophthalmic artery on coronal MIP images is identified.There is hypoplastic left A1 and with no visualization of the A1 segment.The left middle cerebral artery and all of its branches are well visualized and with no evidence of definitive pathology. Very minimal irregularity on 3-D images of these branches may represent atherosclerotic disease however possibility of reformatted artifact cannot be entirely.Vertebral -- basilar system:A very small right vertebral artery note the process well please and within the subarachnoid space at the level of foramen magnum. On 2-D reformatted images a small right pica is identified. Distal portion of small right vertebral artery appears to continue and communicates with the basilar artery.A dominant left vertebral artery is noted to traverse the foramina magnum and give rise to a patent left pica branch. Basilar artery is uniformly narrow along its entire course and is smaller than is expected. I believe this is secondary to prominent patent bilateral posterior communicating arteries that supply the posterior cerebral arteries. Very minimal irregularity of the lumen of basilar artery on 3-D reformatted images may represent minimal atherosclerotic disease. No significant foci of stenosis however is identified.Superior cerebellar arteries are visualized and unremarkable.Hypoplastic bilateral P1 segments of posterior cerebral arteries are noted.MRA of neck:Right carotid.Right brachial cephalic artery and including its origin remains normal. The origin of right common carotid artery and its entire course remains patent. Heavy vascular calcification at the level of carotid bifurcation with extension into proximal internal carotid artery is present. There is however no hemodynamically significant stenosis. The cervical portion of right internal carotid artery is unremarkable.The external carotid arteries unremarkable.Left carotid.Small calcification at the origin of the left common carotid artery is noted. No stenosis at this location is identified. Shallow plaques within the mid cervical portion of the left common carotid artery some with minimal calcification are present. There is minimal compromise of the lumen however no hemodynamically significant stenosis. Minimally calcified plaques at the origin of the left internal carotid artery are noted. No hemodynamically significant stenosis of the left internal carotid artery at any level is detected. External carotid artery is unremarkable.Vertebral -- basilar system:Left vertebral.Dominant left vertebral artery is patent throughout its course. The overall caliber of this dominant vessel is however smaller than usual which is believed to be secondary to patent large bilateral posterior communicating arteries. A small calcific plaque at the origin of left vertebral artery is noted. No focal area of the stenosis of the left vertebral.Right vertebral.The intracranial component of very small size right vertebral artery is identified on 2-D reformatted images and can be traced retrogradely to the level of foramina magnum. This artery cannot be identified from the level from the magnum inferiorly to approximately C2 level. This is small vertebral artery is reidentified at C2 level and can be traced retrogradely to C3 -- C4 intervertebral disk level. There is no visualization of vertebral artery from this level inferiorly to the level of the origin of right vertebral artery. The right subclavian is tortuous and demonstrates minimal after sclerotic disease with calcification however no significant stenosis is detected.

Output: 1.Minimal small vessel disease and a known definitive at pressure or interval change since prior study of the same date.2.No evidence of any hemodynamically significant stenosis of the intracranial vasculature. Minimal atherosclerotic disease is suspected.3.Heavy vascular calcification of bilateral cavernous carotids with no detectable significant stenosis.4.Uniformly smaller than expected basilar artery lumen which is believed to be secondary to a large patent bilateral posterior communicating arteries. No significant focal area of stenosis.5.No significant stenosis of carotid arteries in the neck. Please see above comments.6.Vascular calcification of carotid bifurcations.7.Complete occlusion of the right vertebral artery at its origin up up to approximately C3 -- C4 level. Fragmented visualization of small right vertebral artery superiorly to the level of foramina magnum. Patent right vertebral artery intracranially and with visualization of right pica.8.Patent small dominant left vertebral artery as detailed.9.Visualized origins of major vessels arising from the arch appear unremarkable.


Instruction: Generate impression based on findings.

Input: 58-year-old female with liver lesion seen on CT ABDOMEN:LIVER, BILIARY TRACT: Mildly cirrhotic liver morphology. Metallic clip in the dependent posterior hepatic. Redemonstrated is a 9 x 9 mm lesion in the caudate lobe that demonstrates mild progressive discontinuous peripheral enhancement. No additional liver lesions are identified.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: Prominent periportal lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Prominent subcarinal lymph node, partially imaged, appears similar to prior CT dated 11/18/2011.

Output: 1.Cirrhotic liver morphology. 2.9 x 9 mm caudate lobe lesion with mild progressive discontinuous peripheral enhancement favored to represent a small hemangioma. The lesion does not have typical imaging characteristics of HCC. Follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: 55-year-old female with colon cancer, on chemotherapy. Signs and symptoms: Complains of cervical and thoracic pain.? Bone metastases. Pre-and post-enhanced cervical MRI:Examination demonstrate no evidence of osseous metastatic lesion of the cervical spine.The signal intensity of the vertebral column is unremarkable. There is normal anatomical alignment of cervical spine. Unremarkable images at the level of foramen magnum and no evidence of central spinal stenosis at any level. No convincing evidence of neural foraminal compromise at any level. Minimal degenerative disease at C2-- C4 is noted.There is normal signal intensity and caliber of cervical cord without abnormal enhancement.Pre-and post-enhanced thoracic MRI:Examination demonstrates a large loculated primarily T2/T2 stir hyperintense mass in the dorsal aspect of the spinal canal extending from approximately T2 -- T3 disk level inferiorly to mid T9 level. There is faint patchy and linear enhancement of the cystic lesion which is highly suspected for a cystic metastatic lesion. There is mass effect and anterior displacement of the cord along the length of this tumor however without detectable edema or abnormal enhancement of the cord. This finding however results in central spinal stenosis throughout this region. The lesion demonstrates partial fixation and resultant expansion of the right neural foramina at T4 -- T5, bilateral neural foramina at T5 -- T6, bilateral neural foramina at T6 -- T7 and right neural foraminal T7 -- T8 levels.The signal intensity and alignment the vertebral column remains within normal and without detectable abnormal enhancement to suggest metastatic disease.

Output: 1.Pre-and post-enhanced MRI of the cervical spine demonstrate no evidence of osseous, leptomeningeal or cord metastatic disease. Minimal degenerative changes without central spinal stenosis or neural foramina compromise.2.Pre-and post-enhanced MRI of thoracic spine demonstrate an intracanalicular extramedullary cystic loculated rim enhancing mass posteriorly extending from T2 to T9 levels highly suggestive of a cystic metastatic lesion as detailed above. There is mass effect and forward displacement of the cord and central spinal stenosis at these levels. Unremarkable pre-and post enhanced thoracic MRI otherwise. Please see detailed report above.