Instruction: Generate impression based on findings.

Input: 63 year old man with history of heart transplant in 2005, chronic kidney disease and recent endomyocardial biopsy positive for mild rejection referred for cardiac MRI to further evaluate. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 128 g (normal range 164+/-36). There is mild left ventricular hypertrophy (12mm in the mid septum). The apex is thinned and aneurysmal with evidence of increased T2-signal suggesting that the process may have occurred within the past 4-6 weeks.The native T1 myocardial relaxation time is 1120ms, which is elevated and suggests the presence of diffuse underlying fibrosis or infiltration. The T2-STIR myocardial:skeletal muscle ratio is upper normal. There is no myocardial iron overload.No obvious left ventricular thrombus noted; however, contrast was not used in this study.Left AtriumThe left atrium is enlarged, consistent with previous transplant surgery. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 157 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is extensive epicardial fat. There is no pericardial edema or effusion.Extracardiac FindingsSternotomy wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (EF 63%). The apex is thinned and aneurysmal with increased myocardial T2-signal suggesting that the patient may have had an infarction within the last 4-6 weeks.2. The native T1 myocardial relaxation time is mildly elevated, which may signify mild underlying diffuse infiltration or fibrosis. 3. The right ventricle is normal in size with normal systolic function (EF 65%).


Instruction: Generate impression based on findings.

Input: 57-year-old female, rule out osteomyelitis Evaluation is slightly limited due to motion artifact.There is ulceration of the soft tissues dorsal to the second through fourth metatarsals as seen on recent radiographs. Patchy foci of high signal intensity within the first through fourth metatarsals is nonspecific and could reflect reactive osteitis or simply sequelae of demineralization as we see no focal cortical defects or confluent abnormal signal on T1 weighted sequences to confirm osteomyelitis. There are similar patchy foci of abnormal signal intensity in the visualized bones of the midfoot and scattered phalangeal bones. Mild osteoarthritis affects the first MTP joint. Abnormal signal intensity with the head of the proximal phalanx of the first toe probably represents an old healed fracture.Increased signal intensity within the plantar musculature of the foot and adjacent subcutaneous fat likely represents a combination of atrophy and edema. Fluid signal within the dorsal lateral aspect of the second toe likely represents a blister. A small focus of enhancement along the medial aspect of the soft tissues of the second toe may represent inflammation. There is no additional abnormal enhancement.

Output: Soft tissue ulcer and other findings as described above without specific features of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Endoscopic 3rd ventriculostomy for hydrocephalus/aqueduct stenosis due to tectal glioma: yearly follow up. There has been apparent slight interval increase in size and degree of enhancement of the exophytic nodular portion of the tumor within the posterior third ventricle, which now measures 16 x 12 mm, previously 14 x 10 mm. Otherwise, there is no significant change in the ill-defined portion of the tumor within the left thalamus that contains associated susceptibility effect and intrinsic T1 hyperintensity likely related to prior hemorrhage, which measures approximately 20 x 15 mm. The third ventriculostomy appears to be patent, as evidenced by the presence of a robust jet of cerebrospinal fluid into the third ventricle. There is no significant interval change in the degree of bilateral lateral and anterior third ventricular dilatation with a right transfrontal shunt catheter in position. Likewise, effacement of the superior aspect of the cerebral aqueduct persists and the fourth ventricle appears unchanged in size. There is no evidence of acute infarction. The major cerebrovascular flow voids appears to be grossly intact. The skull, paranasal sinuses, mastoid air cells, scalp, and orbits appear unchanged.

Output: 1. Apparent slight interval increase in size and enhancement of the exophytic nodular component of the glioma within the third ventricle, but no significant change of the left thalamic portion of the tumor.2. Patent third ventriculostomy, but persistent dilatation of the shunted bilateral lateral and anterior third ventricles.


Instruction: Generate impression based on findings.

Input: The last well-formed disk space is referred to as L5-S1. There is an 18 x 16 x 20 mm sclerotic lesion in the central, posterior and superior aspect of L5 vertebral body which does not enhance; it has been stable from 3/2014 and on prior nuclear medicine bone scan shows no significant uptake. There are no other discrete osseous lesions or suspicious enhancement in the lumbar spine.There is normal alignment with preserved vertebral body heights and osseous marrow signal intensity elsewhere. There is disk dessication and loss of disk height at multiple levels. There is increased intrinsic T1 signal intensity in the L3-4 through L5-S1 disks without enhancement, more conspicuous caudally; on the prior CT, there was noted to be vacuum disk phenomenon at these levels. This is a nonspecific finding and could be due to degenerative disks, metabolic or other etiologies. The conus terminates at L1-2.T12-L1: No disk herniation or spinal stenosis.L1-2: Mild disk bulge and moderate facet arthropathy and prominent posterior epidural fat with no significant spinal canal stenosis, and mild left neural foraminal stenosis.L2-3: Moderate disk bulge and facet arthropathy with prominent posterior epidural fat and ligamentous thickening. Mild spinal canal stenosis. Mild right and moderate left neural foraminal stenosis.L3-4: Diffuse disk bulge and moderate facet arthropathy, prominent posterior epidural fat and ligamenta flava thickening causing moderate spinal canal and bilateral neural foraminal stenosis.L4-5: Diffuse disk bulge asymmetric to the right, advanced facet arthropathy, ligamenta flava thickening and prominent posterior epidural fat. No spinal canal stenosis. Moderate to severe bilateral neural foraminal stenosis.L5-S1: Diffuse disk bulge and moderate facet arthropathy with no spinal canal stenosis and moderate bilateral neural foraminal stenosis with impingement of the right exiting L5 nerve root from disk material.

Output: 1.Stable L5 superior/posterior endplate sclerotic nonenhancing lesion likely representing enostosis. Possibility of sclerotic metastasis is felt to be unlikely, especially given stability, absence of enhancement and lack of uptake on prior nuclear medicine bone scan from last year.2.Multilevel lumbar spondylosis worst at L3-4 where there is moderate spinal canal stenosis. Variable neural foraminal stenoses as described above, worst at L4-5 and L5-S1 with impingement of the right exiting L5 nerve root from disk material. Please see details above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecified Hb-SS disease with crisis, unspecifiedClinical question: s/p stroke. Hgb SS. Evaluate for strokeSigns and Symptoms: worsening left arm and leg weakness. MRI of the brainNo diffusion weighted abnormalities suggestive of acute infarction are appreciated.There is redemonstration of encephalomalacia involving the watershed zone of the right anterior and middle cerebral artery territories with additional involvement of the right middle frontal gyrus and extension to the centrum semiovale. There is a smaller focus of encephalomalacia involving a small portion of the posterior aspect of the right temporal lobe. There is associated ex vacuo effect along the right lateral ventricle. There is redemonstration of small foci of susceptibility effect within the encephalomalacic brain.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening along the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A small 6mm cyst is present in the pharyngeal mucosal space to the right of midline in the nasopharynx which is likely benign.Cervical spine:There is redemonstration and no change in os odontoideum.The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. There is diffuse marrow replacement.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Attenuation of right MCA vasculature is likely related to encephalomalacia.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left vertebral artery is a little larger than the right vertebral artery.There is extracranial origin of the left PICA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is redemonstration of encephalomalacia involving the right hemisphere at or adjacent to watershed territories of the right frontal, parietal and temporal lobe.2.There is redemonstration and no change in os odontoideum. Extension/Flexion plain films may help assess for instability.3.There is no evidence for intracranial cerebrovascular occlusive disease.4.There is no evidence for extracranial cerebrovascular occlusive disease.5.There is diffuse marrow replacement present which is likely related to the patient's sickle cell anemia.


Instruction: Generate impression based on findings.

Input: Images are limited by patient motion especially on axial images and lack of contrast. Extensive postoperative changes are again seen from previous T8-T12 fusion and T10 corpectomy. This results in susceptibility artifact which limits evaluation of surrounding structures.Within these limitations, there is extensive T2/STIR hyperintense fluid signal along the superficial aspect of the surgical bed and posterior aspect of the indwelling instrumentation. This fluid collection measures approximately 8.9 cm transverse x 4.0 cm AP by likely 10.5 cm CC, and appears to abut the dura at the level of the corpectomy where there is less obscuration by artifact. The collection extends from the T8 level down to T12, with a small eccentric component extending more superficially into the left paramedian subcutaneous fat. A few foci of internal susceptibility are seen, which may represent air. The more superficial collection is only partially visualized but measures at least 11.7 cm CC, x 3.0 cm transverse x 3.2 cm AP, identified T7 level down to the T12 level. The paravertebral mass centered at the T9-T10 levels has increased in size. It now measures 8.6 cm transverse by 7.2 cm AP by approximately 5.8 cm CC. Previous MRI suggested measurements of 3.3 cm AP x 4.0 cm CC, while the more recent CT of the abdomen demonstrated a 7.2 cm transverse x 5.6 cm AP mass.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. Scattered multilevel disc narrowing and desiccation is noted. Diffuse low T1 marrow signal and STIR hyperintensity is again seen involving the T5 vertebral body consistent with metastatic disease with interval further mild compression deformity. There has also been interval progression of a smaller metastatic lesion along the right lateral aspect of the T1 vertebral body. There is a stable focal T2 and T1 hyperintense lesion in the T6 vertebral body which is consistent with an area of focal fat. Cord signal cannot be adequately assessed secondary to extensive motion artifact on axial images and probable susceptibility artifact on the sagittal images, although there is questioned mild STIR hyperintensity within the cord spanning the T7 level.There is a small right-sided pleural effusion. An oval area of STIR hyperintensity is noted additionally along the manubrium, representing additional metastatic disease.

Output: 1. Extensive persistent nonspecific fluid collection identified spanning the levels of surgery with asymmetric involvement more superficially to the left of midline. This appears to at least abut the dura at the level of previous corpectomy at T10 where there is less obscuration by metallic susceptibility artifact. This may represent a persistent seroma, although the possibility of superinfection is not excluded. Please correlate clinically.2. Mild interval further pathologic compression deformity of the T5 vertebral body, with additional metastatic lesion in the T1 vertebral body which appears mildly progressed as well.3. Significant progression of perivertebral soft tissue component of metastatic disease spanning the T9 and T10 levels. Cord signal and degree of spinal canal stenosis at these levels is difficult to assess secondary to the extensive artifact.4. Partially evaluated manubrial metastasis.


Instruction: Generate impression based on findings.

Input: Ms. Tomaszewski is a 42 year old female with a personal history of Hodgkin's lymphoma treated with chest radiation. She presents for MRI screening. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Small amount of fluid is seen in a right retroareolar duct. There is no abnormal enhancement seen in either breast. However, there are numerous punctate enhancing lesions identified in the skin (particularly concentrated in the periareolar region) without discrete associated mass. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) No MRI evidence for malignancy in the breasts. (2) Numerous enhancing skin lesions identified, particularly in the periareolar region. Clinical correlation is recommended for further evaluation and management. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Please evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 3.5 x 1.4 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.3 x 1.5 x 1.0 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal-appearing thyroid ultrasound exam. No definite evidence of parathyroid adenoma; consider correlation with nuclear medicine study.


Instruction: Generate impression based on findings.

Input: Reason: Pathology to explain low back pain with radicular symptoms down R leg History: Back Pain R thigh pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.Patient is status post pedicle screw placement at L4 and L5 for posterior fusion and laminectomies at L4 and L5.At L5-S1 there is no significant compromise to spinal canal. There is loss of disk space height disk desiccation, diffuse disk bulge there is bilateral facet hypertrophy at this level a mild to moderate degree. The exiting nerve roots within the neural foramina are surrounded by fat at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height disk desiccation, diffuse disk bulge there is bilateral facet hypertrophy at this level a mild to moderate degree. There is mild intra-subluxation of L4 on L5.At L3-4 there is loss of disk space height comment this desiccation, diffuse disk bulge and moderate bilateral facet and ligamentum flavum hypertrophy with triangulation of the thecal sac and overall mild to moderate degree of spinal stenosis. There is narrowing of the neural foramina bilaterally with some mild encroachment of the exiting nerve roots within the neural foramina .At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a mild disk bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.The patient is status post posterior fusion and laminectomies at L4 and L5.2.There is redemonstration of degenerative changes in the lumbar spine with mild to moderate spinal stenosis at L3-4 associated with encroachment on exiting nerve roots within the neural foramina. This is stable compared to the previous exam


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago. Retention of urine, unspecifiedClinical question: Evidence of cord compression?Signs and Symptoms: Lumbar back pain and urinary retention Acute cord compression protocol:The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disc space height, diffuse disc bulge and bilateral uncovertebral osteophytes. There is effacement of spinal fluid ventral and posterior to the spinal cord at this level as well as encroachment of the exiting nerve roots within the neural foramina due to osteophytes and disc material more on the right side than the left. Overall there is moderate spinal stenosis present at this level.At C4-5 there is loss of disc space height, disc desiccation and disc bulge associated with bilateral uncovertebral osteophytes and bilateral encroachment of the exiting nerve roots within the neural foramina. There is partial effacement of spinal fluid ventral and posterior to the spinal cord at this level. Overall there is mild to moderate spinal stenosis at this level.At C5-6 there is loss of disc space height, diffuse disc bulge and bilateral uncovertebral osteophytes as well as posterior ligamentous hypertrophy with effacement of spinal fluid ventral and posterior to the spinal cord and bilateral encroachment of exiting nerve roots within the neural foramina. Overall there is a moderate degree of spinal stenosis at this levelAt C6-7 there is loss of disc space height and a central disc protrusion as well as disc material extending into the neural foramina bilaterally. There are uncovertebral osteophytes present on the left in the right side at this level. There is mild effacement of spinal fluid ventral to the spinal cord at this level. There is encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.This is a limited exam specific for the exclusion of acute cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No acute cord compression is identified. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2.The cervical spine exam demonstrates multilevel degenerative changes in the cervical spine with moderate spinal stenosis at C3-4 and C5-C6 and mild to moderate spinal stenosis at C4-5. There is bilateral neural foramen encroachment of exiting nerve roots at C4-5 and C5-6 and left-sided encroachment of exiting nerve roots at C6-7 and right-sided exiting nerve root encroachment at C3-4.


Instruction: Generate impression based on findings.

Input: 18 year old female with right hip pain, clinical concern for pyomyositis or abscess. BONE AND MARROW: No significant bone marrow or cortical abnormality is evident.SYNOVIUM: Unchanged moderate joint effusion. Persistent enhancement of the synovium is again seen, without significant interval change. No debris is seen within the joint space.MUSCULATURE: Edema and enhancement of the obturator internus, externus and gluteal musculature is again seen, without significant change.ADDITIONAL

Output: Myositis and synovitis of the right hip without significant change. No associated drainable fluid collection or underlying osseous changes.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with recent biopsy diagnosis of GBM in the left temporal lobe. Evaluate additional lesions in the right temporal lobe, right parietal lobe and left periventricular region for the possibility of nonenhancing tumor. Short TE single voxel spectroscopy was performed over T2 hyperintense lesions in the left periatrial region, the right parietal lobe, and the right mesial temporal lobe/hippocampus. The spectrum obtained from the left periatrial lesion demonstrates elevation of choline more than twofold relative to contralateral normal white matter, and significant reduction of NAA. The spectrum obtained from the right hippocampus also demonstrates elevation of choline and reduction of NAA. The spectrum obtained from a small right parietal lesion shows a nonspecific pattern of reduced NAA and normal to reduced choline.

Output: Lesions in the left periatrial region and the right mesial temporal lobe demonstrate MR spectra with features typical of tumor. A small lesion in the right parietal region shows a nonspecific spectral pattern is of uncertain significance.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for bone lesion. Signs and symptoms: 71-year-old female with left hip and thigh pain, remote history of breast cancer. Nonenhanced lumbar MRI:There is no convincing evidence of an osseous metastatic lesion on this nonenhanced study.There is normal anatomical alignment of vertebral, and without evidence of fracture.There is no detectable paraspinal or epidural abnormality on this non infused exam.Examination of T10-T11 and T11-T12 is unremarkable.T12-L1 demonstrate a right lateral disc protrusion (sagittal T2 series 1101 image 10, axial T2 series 1001 image 37). Finding results in subtle mass effect on the thecal sac however without spinal stenosis or neural foraminal compromise. The signal intensity of the cord is within normal.L1-L2 is unremarkable.L2-L3 demonstrate mild disc desiccation and loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is a well-demarcated epidural lesion in the left paramedian location posterior to the vertebral body of L3 and extending inferiorly to the level of the left L3-L4 neural foramina. There is mass effect on the thecal sac and at the exiting left neural foraminal at L3-L4 level. This finding is not associated with any marrow signal intensity of adjacent bony structures and is highly suspected of an extruded/migrated disc fragment likely originating from and 2-L3 disc level. Without intravenous contrast remote possibility of a dural based metastases cannot be entirely excluded.L3-L4 demonstrate mild disc desiccation and loss of disc height and mild bilateral ligamentum flavum hypertrophy. There is no spinal stenosis and patent bilateral neural foramina.L4-L5 demonstrate advanced disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy and moderate left, mild right facet hypertrophy changes. No evidence of a spinal stenosis. Moderate left and mild right neural foraminal compromise.L5-S1 demonstrate advanced disc disease and significant loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. No central spinal stenosis. Mild to moderate right neural foraminal compromise.

Output: 1.There is no convincing evidence of a metastatic lesion on this nonenhanced exam.2.A right lateral disc protrusion at T12-L1 with mass effect on the right exiting nerve root without spinal stenosis or neural foraminal compromise.3.Epidural well-demarcated lesion posterior to the body of L3 extending from L2-L3 disc level inferiorly to the left neural foramina at L3-L4 level highly suspected of an inferiorly migrated disc fragment. Without intravenous contrast less likely possibility of a dural based metastatic lesion cannot be entirely excluded. This finding results in mass effect on the left exiting nerve at the L3-L4 level. No associated marrow signal changes of adjacent bony structures.4.Degenerative changes at other levels as detailed and without spinal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Reason: 81 yo F with recent CVA 1 week ago at St. Bernard Hospital p/w mental status changes, evaluate for evolving CVA History: R sided weakness, AMS There is diffusion restriction present which involves the medial aspect of the left parietal lobe, the posterior aspect of the left paracentral lobule and adjacent left cingulate gyrus and corpus callosum.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate lesions are present in the thalami and basal ganglia.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.Subacute infarction involving the territory of the left superior internal parietal artery as detailed above.2.Periventricular and subcortical white matter changes as well as lesion in the basal ganglia and thalami of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.The exam is significantly degraded by patient motion. This would obscure more subtle abnormalities. and precluded acquisition of susceptibility imaging and postcontrast imaging


Instruction: Generate impression based on findings.

Input: Female 43 years old Reason: lateral meniscus injury History: pain MENISCI: The medial meniscus is intact. There is a horizontal tear involving the anterior horn body junction of lateral meniscus. There is a multilobulated cystic structure extending anteriorly between the iliotibial band and patellar tendon. It measures 4.0 x 0.6 cm. It has a neck closely associated with a meniscal tear.ARTICULAR CARTILAGE AND BONE: The cartilage of the medial and lateral compartments are normal.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Linear low signal band along the medial aspect of the patella extending superiorly represents a suprapatellar synovial plica. No underlying cartilage abnormality.ADDITIONAL

Output: Tear of the lateral meniscus at the anterior horn body junction with a multilocular para meniscal cyst that extends adjacent to the iliotibial band extending into the anterior soft tissues lateral to the patellar tendon.


Instruction: Generate impression based on findings.

Input: 73-year-old male with right arm stiffness, concern for cord compression. Limited exam redemonstrates diffuse bone marrow signal abnormality throughout the cervical spine, consistent with extensive osseous metastatic disease. In particular, a lesion in the C6 vertebral body demonstrates retropulsion and mass effect upon the spinal cord and bilateral neural foraminal stenosis. However, there is no definite evidence of spinal cord signal abnormality. There is also foci of ligamentum flavum calcification with associated mild spinal canal stenosis at C7 and T2. The vertebral alignment and vertebral body heights are grossly preserved.

Output: Extremely limited exam redemonstrates diffuse osseous metastatic disease with compression of the spinal cord at C6, which is otherwise incompletely characterized. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 59 M with cirrhosis 6.5cm x 3.8cm x 6cm mass in the liver. Triple phase CT to evaluate for HCC and/or evaluate the etiology History: 59 M with cirrhosis 6.5cm x 3.8cm x 6cm mass in the liver. Triple phase CT to evaluate for HCC and/or evaluate the etiology ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Confluent fibrosis and significant atrophy of the right lobe of the liver. Left lobe hypertrophy. In the left lobe of the liver, there is a 3.9 x 6.2 x 5.1 cm lobulated mass (series 5 image 24, series 3 image 40). This mass demonstrates T2 slightly hyperintense and T1 hypointense signal with peripheral early arterial enhancement that progressively fills in. No definite washout seen on delayed images.Cholelithiasis.SPLEEN: Splenomegaly with the spleen measuring 17.5 cm in the craniocaudal dimension. Perisplenic varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged cardiophrenic lymph nodes.BOWEL, MESENTERY: Esophageal varices. Perigastric varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pleural effusions. No ascites.

Output: 1.Mass in the left lobe of the liver with signal and enhancement characteristics more consistent with cholangiocarcinoma. If clinically indicated, this mass is amenable to percutaneous biopsy.2.Cirrhotic morphology. Significant confluent fibrosis and atrophy of the right lobe of the liver. Findings compatible with portal hypertension.


Instruction: Generate impression based on findings.

Input: 48-year-old female with history of left mastectomy for IDC in December 2015 Status post left mastectomy.There is scattered fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast or in the left mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 47 year old female enrolled in high risk breast cancer research screening protocol. She has a family history of breast cancer in her mother at the age of 60, and sister at the age of 46. History of bilateral mastopexy in April 2008. She has had a benign biopsy of the right breast by MRI guidance in March of 2007 at 12 o'clock with unsuccessful clip placement. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Minimal postsurgical changes are present in both breasts. Scattered foci of enhancement are present throughout both breasts, unchanged from prior examination. An area asymmetric parenchymal tissue within the upper outer right breast is unchanged from multiple prior examinations. 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: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male; 28 years old. Reason: PSC, dominant stricture, eval for change in size History: PSC with dominant stricture ABDOMEN:LIVER, BILIARY TRACT: Multiple intra- and extra-hepatic strictures consistent with primary sclerosing cholangitis, similar to prior study. The dominant CBD stricture spanning 1.1 cm in length demonstrates moderate circumferential luminal narrowing, not significantly changed (series 5/34). Strictures involving the common hepatic and central left hepatic ducts are also not significantly changed (series 5/32).Subcentimeter right hepatic lobe hemangioma, unchanged. No suspicious focal hepatic mass. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable multiple intra-and extrahepatic biliary strictures, consistent with primary sclerosing cholangitis.


Instruction: Generate impression based on findings.

Input: There is levocurvature to the lumbar spine centered at L4 and L5. There is osseous fusion at L4 and L5. Otherwise, the vertebral body heights are preserved. There is multilevel disc desiccation as well as trace fluid in the intervertebral disc spaces, with mild to moderate disc height loss at several levels. There are scattered T1 and T2 hyperintense lesions throughout the spine which may represent fat and/or hemangiomas. The vertebral bone marrow signal is otherwise unremarkable. There are advanced degenerative changes in the lower thoracic and lumbar spine. There is 5 mm of retrolisthesis of T12 over L1, which in combination with facet joint arthropathy results in severe spinal canal stenosis with compression of the spinal cord and bilateral neural foraminal narrowing at this level. There is significant spinal canal stenosis. At L1-L2, there is 10 mm of right lateral listhesis, bilateral facet arthropathy, and a disc bulge that result in effacement of the lateral recess bilaterally right more than left, with encroachment on the right exiting nerve root within the neural foramen and moderate spinal canal stenosis. At L2-3, there is disc bulge, facet arthropathy, and ligamentum flavum thickening with resultant moderate bilateral neural foraminal narrowing and mild-to-moderate spinal canal stenosis. At L3-L4, there is loss of disc height, disc bulge, facet arthropathy, ligamentum flavum thickening, and epidural lipomatosis, with resultant moderate bilateral neural foramina narrowing and mild-to-moderate spinal canal narrowing. At L4-5, there is loss of disc height, with osseous bridging across the left side of the disc space. There is bilateral facet hypertrophy with resultant mild right and mild-to-moderate left neuroforaminal narrowing, and severe spinal canal stenosis with compression of the cauda equina nerve roots. At L5-S1, there is loss of disc height, bilateral facet hypertrophy, with minimal spinal canal and neural foramen stenosis. There is a large gallstone. Otherwise, the paravertebral soft tissues are unremarkable.

Output: 1. Extensive multilevel degenerative changes in the lumbar spine, retrolisthesis of T12 over L1, and prominent posterior epidural lipomatosis at L4 and L5, that result in particularly severe spinal canal stenosis and spinal cord compression at T12-L2 and severe spinal canal stenosis at L4-5 with compression of the nerve roots. Variable degrees of neural foraminal narrowing are present at multiple levels as well.2. Levoscoliosis of the lumbar spine.3. Large gallstone.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with severe right thumb, hand and forearm pain in the C6-7 dermatome. Patient has known cervical radiculopathy there but last MRI was in 2012. Slight straightening of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. The visualized spinal cord is normal in signal intensity and morphology. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis or neuroforaminal narrowing. No interval changes.C5-6: Mild posterior disc-osteophyte complex formation and right uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. No interval changes.C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Cervical spondylosis is redemonstrated at C5-6 and C6-7 without significant interval change. This causes moderate foraminal narrowing on the right at C5-6, but there is no significant spinal canal compromise. No new abnormalities are seen.


Instruction: Generate impression based on findings.

Input: Soft tissue mass in the lumbar region. There are 5 non-rib-bearing lumbar vertebrae in normal alignment. The vertebral bodies and discs are preserved in height. Marrow signal is unremarkable. There is a 2 mm wide midline defect involving the posterior elements of the third or fourth sacral segment with an overlying strand-like extension into the subcutaneous fat, not definitely reaching the skin. The tip of the conus medullaris is at the L2 level. The conus shows normal shape and signal. The cauda equina roots are symmetrically distributed dependently in the thecal sac. There is abundance of epidural fat in the sacral spinal canal, reaching into the lower lumbar canal, posterior to L1 vertebral body. However, there is no fat along the filum terminale.There is no definite abnormality deep to the skin marker which are placed overlying the right posterior superior iliac crest.

Output: 1.2 mm defect in the posterior sacral element without associated dural or spinal cord/nerve root abnormality probably represents incomplete fusion.2.The overlying threadlike structure in the subcutaneous fat does not definitively reach the skin and therefore is of doubtful significance. Dorsal dermal sinus classically extends from the skin. 3.There is no definite abnormality deep to the skin marker which are placed overlying the right posterior superior iliac crest.


Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer. Low back pain with right-sided radiculopathy Five lumbar type vertebral bodies are present. Multiple enhancing lesions are seen throughout the lumbar spine as well as the visualized T11 and T12 vertebral bodies, sacrum, and iliac bones. Relatively largest of the lumbar lesions seen at the L3 level measuring 2.0 x 1.7 x 2.1 cm. There is a larger right sacral lesion at S1 and S2 measuring 3.1 x 3.8 x 3.8 cm in the AP, transverse, and craniocaudal dimensions. There is some neural foramina narrowing with possible impingement of the exiting right S1 nerve root. There is S2 lesion measuring 2.7 x 4.0 x 3.9 cm. There is mild epidural tumor extent greater on the left than the right.Schmorl's node is present involving the superior endplate of T12 with minimal loss of anterior vertebral body height. Otherwise no compression fractures are seen. The conus medullaris is normal in position. No evidence of epidural tumor in the lumbar spine or leptomeningeal disease.Mild multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild disk bulge, ligamentum flavum thickening, and facet arthropathy result in mild spinal canal narrowing. Mild to moderate bilateral neural foramina stenosis.L5-S1: Mild disk bulge and facet arthropathy without significant spinal canal stenosis. There is mild right neural foramina stenosis. No significant left neural foramina narrowing.Right adrenal lesion also noted compatible with metastasis and seen previously.

Output: 1. Diffuse metastatic disease in the lumbar spine as well as visualized lower thoracic spine and pelvis, as seen on prior PET.2. Mild loss of height involving the T12 vertebral body with underlying metastatic lesion and Schmorl's node. Otherwise no other pathologic fractures. No osseous retropulsion or significant spinal canal stenosis. 3. Large sacral lesion demonstrates mild epidural extension at the S2 level without high grade spinal canal stenosis. No epidural tumor in the lumbar spine. 4. Degenerative changes including mild disk bulges in the lower lumbar spine and facet arthropathy which may also be contributing to low back pain. Mild right sided neural foramina narrowing at L4-L5 and L5-S1 related to degenerative disease as well as narrowing of the right S1-S2 neural foramen related to tumor, which may be impinging on the exiting right S1 nerve root. There may also be impingement of the left S2 nerve root related to S2 metastatic lesion.


Instruction: Generate impression based on findings.

Input: A 76 year old female with personal history of atrial fibrillation, s/p ablation, hypertension, hypothyroidism, vertigo now hospitalized with wide complex tachycardia in the setting of a presyncope. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), the LVEDV is 175 ml (normal range 109+/-23), the LV end systolic volume index is 45 ml/m2 (normal range 18+/-5), the LVESV is 87 ml (normal range 31+/-10), the LV mass index is 50 g/m2 (normal range 67+/-11), and the LV mass is 96 g (normal range 114+/-24). There is a very small region of transmural late gadolinium enhancement in the apical inferolateral wall; this segment is thin and hypokinetic. This finding probably represents an small embolic myocardial infarction.There is no intracavitary thrombus.Left AtriumThe left atrium is mildly dilated. The LA volume is 118 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 82 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). No fatty infiltration or focal wall motion abnormality is noted. No findings compatible with ARVD diagnosis.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 a trivial pericardial effusion.Extracardiac FindingsThere is a large pleural effusion on the left and small one on the right. A large hiatal hernia is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with low normal systolic function, the LVEF is 51%. 2. There is a very small region of transmural late gadolinium enhancement in the apical inferolateral wall; this segment is thin and hypokinetic. This finding probably represents an small embolic myocardial infarction.3. The left atrium is mildly dilated.4. The right ventricle is normal in size with normal systolic function, the RVEF is 55%. No findings compatible with ARVD diagnosis.5. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Restaging ovarian germ cell tumor.IMAGES: Submitted for interpretation are FDG PET/CT images from the skull base through the thighs, dated 7/17/2015. (The nonenhanced CT images were obtained solely for purposes of completing the PET scan, are not of diagnostic quality and are thus not interpreted or used to diagnose disease independently of the PET images.) Today's CT portion grossly demonstrates right chest Port-A-Cath with tip in the right atrium. The uterus is not well-visualized and may be surgically absent.Today's PET examination demonstrates no suspicious FDG avid lesion to indicate FDG avid tumor currently in the neck, chest, abdomen or pelvis. Note the known hepatic lesions on recent MRI are not demonstrated to be FDG avid. However, given their small size, they are not large enough to confidently characterize on PET. These could represent non-FDG avid tumor or treated tumor versus benign lesions.

Output: No FDG avid tumor identified currently in the neck, chest, abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: 36-year-old female status post bleach ingestion, aspiration, ARDS, prolonged intubation, sedation, paralysis. Now awake, extubated, alert with right-sided upper and lower extremity weakness. Anticoagulated for PE. Please evaluate for ischemic change. There is no evidence of intracranial hemorrhage, mass or edema. Focus of hypodensity within the left internal capsule and thalamus suspicious for acute ischemia. MRI is recommended for further evaluation, if clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Bilateral maxillary sinuses demonstrate layering fluid which may be due to acute sinus disease. The remainder of the paranasal sinuses are normally pneumatized.

Output: Hypodensity within the right thalamic and internal capsule region suspicious for stroke. MRI is recommended for further evaluation, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache Weakness Malignant neoplasm of brain, unspecifiedClinical question: Evaluate for cerebral infarction or hemorrhageSigns and Symptoms: 13 yo F with supratentorial mass and left sided weakness There is redemonstration of heterogeneous signal intensity predominantly peripherally enhancing mass centered in the right cingulate gyrus with extension to the adjacent right half of the corpus callosum, the right paracentral lobule and right parietal lobe which measures 46 x 33 mm coronal dimensions, 39 x 34 mm sagittal dimensions and 40 x 49 mm axial dimensions which on the August exam measured 42 x 35 mm coronal dimension, 39 x 34 mm sagittal dimensions and 50 x 40 mm axial dimensions. There is some associated susceptibility effect on its periphery. Signal characteristics on FLAIR MRI have changed compared to the prior exam. There is some mild surrounding signal changes in the adjacent white matter.The patient status post parietal craniotomy which crosses the midline and is eccentric towards the left sideNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate some scattered opacities. The visualized portions of the orbits are intact.

Output: The patient's mass centered in the region of the right cingulate gyrus extending to adjacent brain tissue ase detailed above appears to be stable compared to prior exam from August.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with worsening headaches. Evaluate for structural lesions. No evidence of restricted diffusion is seen. No significant focal parenchymal signal abnormality, edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. A focus of susceptibility within the right anterior paramedian pons is unchanged and, considering its appearance on the prior examination's postcontrast images, probably represents a small vascular anomaly such as a telangiectasia. Ventricular size and morphology are within normal limits.

Output: 1.No findings are seen which would account for the patient's worsening headaches.2.Findings are redemonstrated suggestive of a small vascular anomaly within the right paramedian pons, most likely unrelated to the patient's symptoms.


Instruction: Generate impression based on findings.

Input: colon cancer patient with headache No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of metastatic lesion.


Instruction: Generate impression based on findings.

Input: 54-year-old male with prostate cancer, low-grade, underactive surveillance PELVIS:PROSTATE:Prostate Size: 4.9 x 4.0 x 2.9 cmPeripheral Zone: Large lesion in the left mid gland peripheral zone extending towards apex restricted diffusion and minimal arterial enhancement. T2 hypointense lesion in the right mid gland peripheral zone with extension towards apex restricts diffusion. There is an additional small third T2 hypointense lesion in the right apex.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: The left mid gland peripheral zone lesion abuts the capsule with indistinctness of portions of the capsule raising suspicion for extracapsular extension. The right mid gland peripheral zone lesion abuts the capsule without extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Colonic diverticulosis without evidence of diverticulitis.

Output: Findings of multifocal disease as described above centered in the mid gland left peripheral zone, mid gland right peripheral zone and small right apical lesion.


Instruction: Generate impression based on findings.

Input: 58 y/o with newly diagnosed NSCLC please obtain staging brain MRI. The examination is limited by motion artifact. There is a large area of encephalomalacia involving the right temporal, parietal, occipital and posterior frontal lobes. Punctate foci of possible diffusion restriction are seen in the left middle frontal gyrus and post central gyrus (series 4, image 27-29). Numerous patchy and focal areas of T2/FLAIR hyperintensity are demonstrated in the periventricular and subcortical white matter as well as within the brainstem, likely related to chronic small vessel ischemic disease. There is confluent T2 hyperintensity likely representing gliosis surrounding the large area of encephalomalacia in the right cerebral hemisphere. No abnormally enhancing lesion parenchymal lesions are identified. There is no acute intracranial hemorrhage. No midline shift is appreciated.

Output: 1. A few punctate foci of possible subacute small vessel ischemia are demonstrated in the left middle frontal and post central gyrus.2. Large area of encephalomalacia involving the right posterior cerebral and middle cerebral artery territory circulation likely indicating prior large vessel infarction.3. No evidence for parenchymal metastatic disease.


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC. There is interval decrease in size of a lesion along the right postcentral sulcus that measures up to 5 mm, with a small amount of susceptibility effect, which has not significantly changed. Some of the images are degraded by patient motion, but there is no definite evidence of additional brain metastases. There are mild scattered foci of nonspecific high T2 signal in the cerebral white matter without enhancement. There is no evidence of acute infarct. There is no midline shift. The ventricles are unchanged in appearance. There is an persistent nonspecific left parietal scalp lesion that measures up to 12 mm.

Output: 1. No significant change in size of the treated metastasis in the right postcentral sulcus. 2. Persistent nonspecific left parietal scalp lesion.


Instruction: Generate impression based on findings.

Input: 44-year-old male history of left parietal temporal lobe grade normal excised in 2003. Very poor quality exam due to extensive motion artifacts. Large area of encephalomalacia in the left posterior temporal with ex vacuo dilatation of the left lateral ventricle is again demonstrated with no interval change. Focal area of encephalomalacia in the right frontal lobe along its inferior aspect is again identified and with no interval change. Large left parietal craniotomy is again noted. Considering provided clinical history of malignancy an MRI examination of brain is recommended.No evidence of hemorrhage, edema, midline shift, hydrocephalus is detected. Punctate calcification within the thalamus on the left remains a stable.

Output: No definite evidence of new finding since prior study of 2003.


Instruction: Generate impression based on findings.

Input: 50 year-old male with left temporal mass. Evaluate extent of tumor. Rule out lung metastases. CT of the soft tissues of the neck with infusion:Large destructive mass extending from approximate the level of the left submandibular region superiorly with complete involvement of the left infratemporal fossa and right massive involvement of the left orbit with associated extensive bony destruction, significant bony destruction of Petrus bone on the left and with further superior extension into the left anterior and middle cranial fossa and with invagination into the brain parenchyma is again identified. The mass has multiple internal cystic components and demonstrates enhancement. Within the left middle cranial fossa the tumor appears to extend into the left cavernous sinus, left skull base and left sphenoid sinus. Extensive bony destruction of Petrus bone and with post obstructive opacification of mastoid air cells and middle cavity is noted. There is interval increase in the intracranial component of the tumor since prior exam. This in particular appears as multiple expansile cystic in the uppermost visualized portion of the tumor within the intracranial space. Very significant mass effect with resultant significant anterior displacement of the left globe is again identified. The carotid artery is along the dorsal aspect of the tumor and does not appear to be encased however there is significant mass-effect and posterior displacement of the carotid. Extensive postoperative changes of partial mandibulectomy with a metallic prosthesis is again identified. In comparison with the prior examination there is further erosion of the bone specifically at the level of the glenoid cavity which was identified on prior exam to overlap the head of the prosthesis. The no detectable pathologic adenopathy in the neck is seen.CT of brain with infusion:Interval increase in the size of the intracranial component of the tumor in the left anterior and middle cranial fossa and within the left and trigger frontal and left anterior and mid temporal lobe. Extensive bony destruction is again identified involving the left orbit, left Petrus bone, left frontal bone and temporal bone. There is vasogenic edema surrounding the tumor and significant mass-effect and midline shift. This is study is compared with the most recent MRI examination of brain dated 4 -- 15 -- 2009 which demonstrates significant increase in the midline shift and mass-effect. There is also slight interval increase in the size of right lateral ventricle concerning for early onset of hydrocephalus.68 cc of Omnipaque 350 was utilized for the above studies.

Output: Increase in the size of patient's known tumor in particular in its intracranial component and with associated increase in edema, mass effect, mid line shift and right-sided ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hereditary hemorrhagic telangiectasia Other malformations of cerebral vessels. Hereditary hemorrhagic telangiectasia Other malformations of cerebral vesselsClinical question: 3T Scanner, Please screen for brain AVMs, hx of HHTSigns and Symptoms: HHT MRI of the brainThe CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells demonstrate a minor opacity in the left mastoid air cells. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is small. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.There are several periventricular and subcortical white matter signal changes present which are nonspecific. Given the small number there are likely of little clinical significance.. 2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm , intracranial hemorrhage or intracranial arteriovenous malformation.


Instruction: Generate impression based on findings.

Input: Female 57 years old Reason: 57 yo with hepatosplenomegaly of unclear etiology History: none ABDOMEN:LIVER, BILIARY TRACT: Liver is enlarged with a nodular contour most suggestive of chronic liver disease. No suspicious hepatic lesions. The main portal vein is mildly dilated. The left and middle hepatic veins are patent. Abnormal signal surrounding the right hepatic vein which may represent some edema. The right hepatic vein itself is patent.There is central hepatic lacelike signal intensities compatible with hepatic fibrosis.Status post cholecystectomy. No significant intrahepatic biliary ductal dilatation.SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive peripancreatic and periportal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.Findings of chronic liver disease without focal hepatic lesion. Imaging findings suggest at least grade 2-3 fibrosis.2.Extensive upper abdominal or hepatic and peripancreatic lymphadenopathy as can be seen in chronic liver disease.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of pancreas mass ABDOMEN:LIVER, BILIARY TRACT: Bone T2 hyperintense lesions scattered throughout the liver some of which are bigger and at least one which is new in segment 5/6.SPLEEN: Splenomegaly measuring up to 18 cm, increased. PANCREAS: Redemonstrated is a 3.7 x 2.9 cm mass in the tail of the pancreas, previously 3.1 x 2.5 cm which follows signal and contrast enhancement of splenic tissue on all sequences.Redemonstrated is a cystic lesion in the body of the pancreas measuring 9 x 6 mm, previously 11 x 7 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mild periportal, aorta caval and mid mesenteric lymphadenopathy, more prominent when compared to the prior exam.BOWEL, MESENTERY: Moderate to large size hiatal hernia. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight interval increase in pancreatic tail mass as described above compatible with intrapancreatic spleen. 2.Mild periportal, aorta caval and mid mesenteric lymphadenopathy, more prominent when compared to the prior exam. Increased splenomegaly. Findings could represent worsening lymphoma. 3.No significant change in pacreatic body cystic lesion may represent sidebranch IPMN.4.Moderate sized hiatal hernia.


Instruction: Generate impression based on findings.

Input: Pathologic T12 fracture. Back and buttock pain. There is a sigmoid-shaped thoracolumbar curvature that is convex to the right in the lumbar region. There is straightening of the lumbar segment as well. There is minimal anterior subluxation of L2 to relative to L3. This is associated with multilevel L1 through L3 central/anterior vertebral body compression fractures. - The L2 vertebral body compression fracture is predominantly central and anterior and is associated with complete replacement of the marrow even extending into the pedicles. The L2 compression results in about 30% height loss. The fracture is associated with a mild predominantly right sided posterior retropulsion/epidural component but no significant thecal sac compression.- There are even more severe compression fractures at L1 and L3 (about 60% height loss) fatty in signal which may reflect osteoporosis or previous radiation treatment. Focal edema-like signal adjacent to the inferior endplate of L3 is probably from an acute/subacute intravertebral herniation of disc.The conus medullaris tip is at T12-L1 level. The conus medullaris has normal morphology and signal characteristics.T11-T12: There is no neural foraminal or spinal canal stenosis.T12-L1: Small and disc bulge but no spinal canal or neural foraminal narrowing.L1-L2: There is mild disc bulge causing no significant spinal canal or foraminal narrowing. However, the L2 compression fracture and associated retropulsion is associated with mild right paracentral spinal canal narrowing as described above.L2-L3: On a background of short pedicles (congenital spinal canal narrowing), there is degenerative disc disease and uncovering along with severe ligamenta flava buckling. These result in moderate spinal canal narrowing. There is no significant neural foraminal narrowing.L3-L4: There is disc bulge and ligamenta flava buckling resulting in mild spinal canal narrowing. There is also facet arthropathy resulting in moderate-to-severe left and mild-to-moderate right neural foraminal narrowing.L4-L5: There is almost complete loss of disc height at this level associated left subarticular recess mild narrowing. There is also ligamenta flava buckling resulting in mild spinal canal narrowing. There is bilateral moderate neural foraminal narrowing given the disc height loss.L5-S1: There is a minimal disc bulge resulting in mild right-sided subarticular recess narrowing. There is also moderate right and mild left neural foraminal narrowing.

Output: 1.L2 compression fracture (30% height loss) is probably pathologic given the loss of the normal marrow signal. However, an acute insufficiency fracture with severe edema can also look similar. It is associated with mild posterior retropulsion/epidural component resulting in mild spinal canal narrowing. 2.L1 and L3 compression fractures (60% height loss) are probably insufficiency fractures and are associated with no significant spinal canal narrowing.3.Multilevel degenerative lumbar spondylosis is most pronounced at L2-L3 where there is moderate spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: 61-year-old female with history of neuroendocrine tumor (carcinoid) ABDOMEN: Suboptimal examination due to patient motion.LIVER, BILIARY TRACT: Normal liver morphology. Hepatic steatosis. Redemonstrated is a 5 mm arterially enhancing focus in hepatic segment two (series 3, image 11), unchanged. A segment 7/8 arterially enhancing lesion measures 8 x 6 mm, previously 6 x 6 mm (series 11, image 42), not significantly changed. No new liver lesions are identified.The gallbladder is within normal limits. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstrated is pancreatic divisum. Main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination with two arterially enhancing subcentimeter foci. No new hepatic lesions.


Instruction: Generate impression based on findings.

Input: Liver edge was incidentally found to have white color that seems to look like scar tissue during laparoscopy for ovarian cystectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal morphology and parenchymal signal intensity without focal lesions. No biliary ductal dilatation. The gallbladder appears within normal limits.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: Trace fluid fluid in the pelvis.

Output: Normal appearance of the liver without focal lesions.


Instruction: Generate impression based on findings.

Input: 56 year old male with a history of hepatitis B presents with weight loss. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without evidence of intra or extrahepatic biliary ductal dilation. No focal mass lesion identified.SPLEEN: No significant abnormality noted.PANCREAS: Incidental note is made of pancreatic divisum. No evidence of acute or chronic pancreatitis. The main pancreatic duct is otherwise normal in appearance. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific subcentimeter gastrohepatic lymph nodes may be reactive in etiology.BOWEL, MESENTERY: No significant abnormality noted. No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No evidence of focal liver lesion, as clinically questioned.2. Pancreatic divisum without MRI evidence of pancreatitis. 3. Nonspecific subcentimeter gastrohepatic lymph nodes may be reactive in etiology.


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB:11/5/1965)Reason: evaluate for ischemic infarct History: weakness Dysarthria and anarthriaPROVIDER/ATTENDING NAME: DIANE B CHANEY AGNIESZKA A ARDELT MRI of the brainThere is a punctate focus of diffusion restriction in the right half of the pons which is associated with some vague signal hyperintensity on FLAIR MRI.Small foci of volume loss and signal change are present in the left cerebellar hemisphere inferiorly compatible with encephalomalacia.There is patchy T2 signal hyperintensity in the midbrain associated with a punctate focus of T2 signal hyperintensity. Punctate foci of T2 signal hyperintensity are present in the left thalamus and in the midbrain.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Punctate focus of signal loss on susceptibility imaging is present in the right centrum semiovale. Another focus of punctate signal loss on SWI is present along the posterior aspect of the left pons. Initial location these are of unknown clinical significance. The could be related to hypertension. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The exam is mildly degraded due to patient motion.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a high-grade stenosis present along the distal cavernous segment of the right internal carotid artery. The intracranial vasculature appears irregular.There is some mild narrowing of the left internal carotid artery at the clinoid segment.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Findings are compatible with acute lacunar infarct involving the right pons.2.Punctate lesions in the left thalamus and right midbrain are suspected to represent old lacunar infarcts.3.There is a high-grade stenosis present along the distal cavernous segment of the right internal carotid artery. 4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.Microhemorrhages are identified in the left thalamus and right centrum semiovale. There is significance is unknown. They could be related to hypertension


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for ischemia, etiology of altered mental status History: Altered mental status, L sided weakness, A punctate focus of diffusion restriction is present at the genu of the right internal capsule.There are punctate foci of T2 and flair signal hyperintensity in the basal ganglia, right cerebral peduncle, midbrain, and pons. There are multiple foci of punctate signal hypointensity on susceptibility imaging scattered in the cerebellar hemispheres the brainstem, basal ganglia and thalami as well as some of the subcortical white matter.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Many of the images especially postcontrast images are degraded by patient motion.

Output: 1.Acute lacunar infarct is present at the genu of the right internal capsule.2. Findings are compatible with multiple old lacunar infarcts in the basal ganglia and brainstem.3.Multiple old foci of microhemorrhage are present in the posterior fossa and basal ganglia and to a lesser degree subcortical white matter in a distribution which is suggestive of hypertension as an etiology.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Motion artifact may obscure more subtle abnormalities are


Instruction: Generate impression based on findings.

Input: Altered mental status. History of metastatic renal cell carcinoma. Assess for brain metastasis. The study is at least moderately limited by patient motion, which is most pronounced on the postcontrast images. There is no gross contrast enhancing or space-occupying brain lesion. Numerous, patchy T2 FLAIR hyperintense foci in the cerebral white-matter and, to lesser extent, the brainstem and cerebellar white-matter are nonspecific. A focus of susceptibility effect involving the superficial right cerebellar hemisphere is associated with focal encephalomalacia and probably represents a chronic infarct with hemosiderin staining. A tiny focus of cortical T2 FLAIR hyperintensity in the right occipital lobe medially without associated diffusion restriction is probably a tiny chronic infarct. There is suggestion of an incidental right cerebellar developmental venous anomaly on susceptibility weighted imaging. The ventricles and other CSF-containing spaces are mildly expanded reflecting underlying brain volume loss. There is no midline shift or brain herniation. Major intracranial vascular flow voids are grossly preserved, reflecting gross patency.There is no gross orbital abnormality or destructive skull lesion. The mastoid air cells are clear.

Output: 1.At least moderately limited examination, by patient motion.2.There is no gross contrast enhancing or space occupying brain lesion to suggest brain metastasis.3.There is no gross diffusion restriction to indicate acute infarct.4.Moderate burden of nonspecific brain white-matter lesions is most likely from chronic microvascular ischemia. Focal encephalomalacia and punctate hemosiderin staining in the right cerebellar hemisphere probably reflect chronic infarct.


Instruction: Generate impression based on findings.

Input: Female 58 years old Reason: evaluate etiology of medial knee pain. Status post left knee arthroscopy 11/2014, with partial meniscectomy and patellofemoral microfracture. MENISCI: There is truncation of the body of the medial meniscus suggestive of interval partial meniscectomy. There is also intermediate globular signal within the body of the medial meniscus extending to the tibial articular surface. This extends into the posterior horn of the medial meniscus as well. There is slight prominence of meniscal tissue along the periphery of the body of the medial meniscus (image 18, series 11). While these findings may represent postoperative changes, they are concerning for undersurface tear with a displaced meniscus fragment into the medial gutter. A small adjacent loculated collection of fluid signal intensity may represent a cyst or fluid in the medial collateral ligament bursa. No significant abnormality is noted within the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Again seen is full-thickness degeneration of the articular cartilage of the medial facet of the patella as well as of the median eminence of the patella. Relatively mild degeneration of the articular cartilage of the lateral facet of the patella with signal abnormality in the underlying bone which is presumably degenerative. There is a new full-thickness defect in the femoral trochlea centrally (image 13, series 8), with thinning of the articular cartilage along the medial facet that is similar to prior study. There has been progression of cartilage degeneration along the weight-bearing portion of the medial femoral condyle with new subchondral edema type signal. There is also new focal partial thickness defect along the articular cartilage of the medial tibial plateau. The articular cartilage of the lateral compartment is relatively intact. Note is made of tricompartmental osteophytes.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Postoperative changes as described above including findings compatible with partial meniscectomy, however there is signal abnormality and deformity of the body of the medial meniscus suggestive of a undersurface flap tear.2. Progression of cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: 47 year old female with altered mental status. Evaluate for bleed versus other abnormality. Examination appears within normal limits. There is no evidence of intracranial hemorrhage, mass, or 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Multifocal low-grade gliomas. The patient was initially diagnosed with a right frontal grade 2 oligodendroglioma which was treated with RT and then subsequently developed a cerebellar/brainstem oligoastrocytoma, which was also treated with RT in 2009. There are postoperative findings related to a right frontal craniotomy with unchanged confluent signal abnormality involving the right anterior frontal lobe, corpus callosum, insula, and right cingulate gyrus. There is cortical thickening and T2 hyperintensity extending posteriorly along the right cingulate gyrus, which is unchanged. A very small area of gyral thickening and signal abnormality within the right precentral gyrus has slowly been progressing since 2013 but is only minimally changed from a prior 2014 study (image 26, series 6). There are unchanged foci of high T2 signal within the left cerebellar hemisphere. A punctate focus of apparent enhancement along the posterior resection cavity correlates with a vessel, which is better seen on a prior study. There is no pathologic enhancement. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with ex-vacuo dilatation of the right lateral ventricle. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: 1. Overall, no significant changes in signal abnormality surrounding the right frontal lobe resection cavity or the left cerebellar hemisphere.2. Small area of cortical thickening and signal abnormality in the right precentral gyrus has been slowly developing over the last two years, but in the near term, only minimal progression is seen.


Instruction: Generate impression based on findings.

Input: Right calcaneous wound, boggy, increase drainage, hx of osteomyelitis. Evaluate for osteomyelitis. Markers were placed along the medial aspect of the heel, presumably denoting the site of the patient's wound. There is diffuse skin thickening and subcutaneous edema, compatible with known history of lymphedema. Mild enhancement in the soft tissues is seen along the posterior inferior aspect of the calcaneus indicating inflammation, though there is no discrete rim-enhancing fluid collection to suggest abscess. Mild osteoarthritis affects the midfoot and hindfoot. Patchy foci of intermediate signal intensity are seen in the bones of the midfoot and hindfoot that may represent red marrow changes, but we see no evidence of osteomyelitis. A fifth metatarsal fracture seen on recent radiographs is incompletely imaged on this study. The visualized tendons are intact.

Output: 1.Soft tissue edema and inflammation without evidence of osteomyelitis or abscess.2.Known fifth metatarsal fracture, incompletely imaged on this study.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with mantle cell lymphoma, now presenting with vision changes. Scattered small foci of nonspecific T2 hyperintensity are evident within the subcortical white matter of the bilateral cerebral hemispheres. No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. On postcontrast imaging, there is no pathologic parenchymal or extra-axial enhancement. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricular system is normal in size and morphology. The globes are round and symmetric. A lens replacement has been performed on the right. Although not a dedicated orbital study, no gross abnormalities of the optic apparatus are seen.

Output: 1.Scattered nonspecific white matter lesions are seen which may reflect chronic microvascular ischemic disease.2.No specific findings are evident to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Evaluate left breast cancer response to neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast 12:00 position, the known cancer appears rim-enhancing, measuring 1.9 x 1.7 x 1.8 cm (AP x LR x CC: previously 2.3 x 2.2 x 2.2 cm). A few foci lateral to known cancer are also noted, but less prominent than previous. The lymph node in the left axilla become normal appearing. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: Interval decrease in size of left breast malignancy. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 65-year-old male. Metastatic renal cancer on chemotherapy presenting for staging CT found to have interloop abscess status post IR drainage. MRI abdomen/pelvis to evaluate for any renal cell cancer deposits. Evaluate for intraperitoneal renal cell carcinoma deposits. ABDOMEN:LUNG BASES: Small bilateral pleural effusions. Left sixth rib soft tissue metastasis (series 1001, image 284).LIVER, BILIARY TRACT: No suspicious hepatic mass. No biliary ductal dilatation.SPLEEN: Diffusely decreased T2 signal of the spleen with signal loss on in phase images consistent with iron deposition.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A large heterogeneously enhancing mass in the right upper pole of the horseshoe kidney measures 9.2 x 8.7 cm (series 1001, image 361), consistent with known renal cell carcinoma. A few cysts in the left pole.RETROPERITONEUM, LYMPH NODES: Moderately enlarged mesenteric lymph nodes.BOWEL, MESENTERY: Diffuse wall thickening of right lower quadrant terminal ileum bowel loops with associated mesenteric stranding and enteroenteric fistulas. Rim enhancing pocket of fluid immediately lateral to the small bowel is 3.8 x 3.5 cm, consistent with an abscess. Small bowel loop tethered to the cecum likely represents a enterocolic fistula (series 1401, image 4). Right lower quadrant drain is seen entering the abdomen; intraabdominal portion is not well-visualized due to technique. No discrete small bowel mass or serosal deposits are evident, though evaluation is limited due to underdistention.Colonic diverticulosis. BONES, SOFT TISSUES: L4 vertebral level metastasis.OTHER: No significant abnormality noted.

Output: 1.Terminal ileal loops with wall thickening and multiple enteroenteric fistulas and likely an enterocolic fistula. Rim enhancing pocket of fluid lateral to these abnormal loops consistent with an abscess. 2.No discrete small bowel mass or serosal deposits are evident.3.Right upper pole renal mass consistent with known renal cell carcinoma with metastatic disease, as described above.


Instruction: Generate impression based on findings.

Input: 40 year old woman with history of post-operatively noted PVC with burden of 16% by Holter monitor, referred to evaluate for underlying cardiomyopathies including ARVC. Left VentricleThe left ventricle is moderately dilated with low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 183 ml (normal range 109+/-23), the LV end systolic volume index is 50 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10), the LV mass index is 38 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). Wall motion is normal. Wall thickness is normal (mid septum ~8mm thickness). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1100-1150ms in the basal to mid septum, which is elevated. These values are mildly elevated, suggestive of underlying diffuse fibrosis or infiltration. There is no obvious evidence for non-compacted LV morphology. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 142 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). There are no regional wall motion abnormalities.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 a trivial pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderately dilated left ventricle with low normal systolic function (EF 53%). There is no late gadolinium enhancement to suggest a focal infiltrative, inflammatory or fibrotic process. However, the native T1 myocardial relaxation time is mildly elevated, which could suggest a diffuse underlying fibrotic process. 2. Normal size right ventricle with normal systolic function (EF 52%) and no regional wall motion abnormalities. 3. Mild left atrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with neck pain. The cervical lordosis is mildly reversed. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No worrisome marrow replacement is seen. Mild endplate edema at C6-7 is noted.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed by level as follows. No epidural abnormalities are suspected.C2-3: Facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Minimal facet hypertrophy. Mild posterior disc-osteophyte complex formation which slightly flattens the ventral cord. No significant spinal canal stenosis. Mild left foraminal narrowing.C4-5: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C5-6: Mild facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left foraminal region. Slight flattening of the ventral cord but no significant spinal canal stenosis. Severe left and mild right foraminal narrowing. C6-7: Minimal facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe bilateral foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing with perineural root sleeve cysts bilaterally.

Output: Multilevel disc degeneration and posterior element hypertrophy result in scattered variable foraminal narrowing, most severely affecting C5-6 on the left and C6-7 bilaterally. No significant spinal canal stenosis is seen.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:10/9/1960)Reason: disc herniation History: sudden onset low back pain while liftingPROVIDER/ATTENDING NAME: MICHAEL A WARD BRIAN C. CALLENDER Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and some endplate reactive change at this level. The endplate reactive changes high signal on T1 and suppresses on fat suppressed imaging. There are some ligamentum flavum hypertrophy present predominantly in the left side at this level. There is some facet hypertrophy present on the left side predominantly at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is some facet hypertrophy of a mild to moderate degree at this level associated with some ligamentum flavum hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina. There are some endplate reactive changes present of a chronic stage located on the left side at this level. There is a left far lateral disc protrusion present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There are some T1 hyperintense foci in the left half of the vertebral body at this level. On the associated with the endplates. These suppress on the fat suppressed images and most likely are degenerative in nature.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a fatty filum terminale present.

Output: 1.There are degenerative changes present in the lumbar spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Brain MRI:Restricted diffusion with matching ADC hypointensity is evident throughout the right hemispheric white matter, sparing portions of the right frontal lobe and anterior temporal lobe, however not involving gray matter of the basal ganglia or cortices. Hemispheric mass effect is associated with this including sulcal effacement, partial effacement of right lateral ventricle, and persistent (2 mm) right to left midline shift. Basilar cisterns remain patent. There is also diffuse right hemispheric leptomeningeal enhancement as well as dural thickening with what appears to be asymmetrically enlarged cortical vessels on the right suggesting an increase of flow. Myelination in the involved areas appears to be mildly disrupted with T1 technique, which is not evident on the T2 technique. The left hemisphere and posterior fossa structures are not involved.Redemonstrated are subdural hemorrhages overlying the right hemisphere as well as involving the falx and tentorium. As before, the right hemispheric subdural hematoma measures up to 6 mm in maximal depth.The cerebellar tonsils are in normal position. There are no masses. 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. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:There is no evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified. Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses.

Output: Restricted diffusion with matching ADC hypointensity is evident throughout the right hemispheric white matter, sparing portions of the right frontal lobe and anterior temporal lobe, however not involving gray matter of the basal ganglia or cortices. Hemispheric mass effect is associated with this including sulcal effacement, partial effacement of right lateral ventricle, and persistent (2 mm) right to left midline shift. There is also diffuse right hemispheric leptomeningeal enhancement as well as dural thickening with what appears to be asymmetrically enlarged cortical vessels on the right suggesting an increase of flow. Myelination in the involved areas appears to be mildly disrupted with T1 technique. The left hemisphere and posterior fossa structures are not involved. This constellation of features, in the setting of normal MR angiograms of the head and neck, are most suggestive of an encephalitic process, which includes consideration of Rasmussen encephalitis. An arterial or venous occlusive etiology for the ischemia is felt to be unlikely.