Instruction: Generate impression based on findings.

Input: History of IPMN status post distal pancreatectomy and splenectomy. Evaluate for recurrence. 11/25/2009 Pathology demonstrated side-branch IPMN and chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: Lobular dilatation of the common bile duct is not significantly changed in caliber or morphology. No filling defect, stricture or mass lesion is evident. Mild central intrahepatic biliary ductal dilatation.Normally distended gallbladder without gallstones.The liver is normal in morphology, size and signal intensity without a focal suspicious lesion.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. The main pancreatic duct is irregularly dilated up to 6 mm, increased from the prior study. No focal lesion or filling defect is evident. This may be related to chronic pancreatitis and chronic stricturing (series 7, image 127).There are several punctate cystic foci in the pancreatic head the largest of which measures 4 mm, compared to 6 mm previously.There is intrinsic low T1-weighted signal intensity of the hepatic parenchyma with relatively mild postcontrast enhancement, compatible with stated history of chronic pancreatitis. There is no peripancreatic fat stranding, fluid collection or vascular stigmata of pancreatitis. ADRENAL GLANDS: Stable small left lipid rich adrenal adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Interval increase in residual pancreatic ductal dilatation, now measuring up to 6 mm without a focal lesion evident. This may be related to chronic pancreatitis and worsening stricturing although a main duct IPMN cannot be entirely excluded. 2. Stable to decreased size of punctate cystic pancreatic parenchymal foci.


Instruction: Generate impression based on findings.

Input: History of tethered cord. Status post redo untethering, history of lipomyelomeningocele. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There are immediate postsurgical changes related to recent cord untethering as well as evidence of prior lipomyelomeningocele repair. There are defects involving the posterior elements below the L4 level reflecting combination of laminectomies and dysplasia related to dysraphism. Spinal cord is low lying appearing to terminate near the S1 level where there is a residual lipoma which measures up to 2.6 cm in the craniocaudal dimension and 15 mm in the AP dimension. There is now CSF surrounding the distal cord and lipoma including posteriorly, significantly improved since outside study and indicating untethering. Prone images demonstrate some ventral motion at the level of the lipoma with CSF space dorsal to the lipoma measuring 3.4 mm in the supine position and 4.4 mm in the prone position (measured at the approximately mid S1 level). The spinal cord at the L4-L5 level remains dorsally positioned in both the supine and prone sequences although there is some CSF space separating it from the dura; this is also improved since outside study. There is a small syrinx involving the distal cord, which for example measures approximately 3 mm at the L5 level, with mild prominence of the central canal extending more superiorly to approximately the L3 level. There is mild interval increase in more ill-defined T2 signal surrounding the small syrinx at the L5 level compared to preoperative study.

Output: Immediate postsurgical changes of spinal cord untethering in the setting of a lipomyelomeningocele. Low-lying conus, residual terminal lipoma, and small distal syrinx as above. Distal cord and lipoma appear more anteriorly positioned compared to the preoperative study consistent with untethering. There is slight increase in ill-defined T2 signal surrounding the distal syrinx at the L5 level compared to preoperative study.


Instruction: Generate impression based on findings.

Input: History of 3+4 adenocarcinoma the prostate. (Right lateral base). PELVIS:PROSTATE:Prostate Size: 3.1 x 5.9 x 4.7 cmPeripheral Zone: There is intrinsic T1 weighted signal intensity extending from the right apex medially to the right base laterally, likely related to postbiopsy hemorrhage, limiting evaluation. In the right medial apex there is a 1.3 x 0.9 x 1.0 cm lesion demonstrating T2 weighted hypointensity (series 701/15) and restricted diffusion (series 804/244). Enhancement is difficult to assess given the underlying T1 weighted signal. This may represent tumor or be related to hemorrhage.In the right base there is a 1.1 x 0.8 cm focus of T2-weighted hypointensity (series 701/19) with associated restricted diffusion (series 804/324) and early enhancement with washout (series 1801/1771) suspicious for adenocarcinoma.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Large bilateral inguinal hernia with the left containing loops of colon.OTHER: No significant abnormality noted.

Output: 1.Post-biopsy hemorrhage resulting in T1-weighted hyperintensity limits evaluation of the peripheral zone.2.1.1 cm suspicious focus in the right peripheral zone base likely represents the patient's site of adenocarcinoma. No evidence of seminal vesicle invasion or extraprostatic extension.3.Additional rounded focus in the right apex measuring 1.3 cm may represent an additional tumor focus or be related to hemorrhage.


Instruction: Generate impression based on findings.

Input: Reason: Is there any sign of calcific tendinitis? History: right shoulder pain, severe Normal appearing right shoulder without findings to account for the patient's pain. Specifically, we see no radiographic findings to suggest calcific tendinopathy.

Output: Normal appearing right shoulder without radiographic findings to suggest calcific tendinopathy or other findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: eval for meniscal tear History: knee pain 2-3 months ago with rugby injury and still with pain, joint pain, pain with walking and lateral side MENISCI: There is abnormal signal intensity and deformity of the anterior horn and body of the lateral meniscus representing a tear, with low signal intensity adjacent to the peripheral fibers of the body of the meniscus likely representing a displaced meniscal flap fragment. The posterior horn of the lateral meniscus appears intact. The medial meniscus appears intact. ARTICULAR CARTILAGE AND BONE: There is edema within the lateral tibial plateau posteriorly, representing a contusion, adjacent to subchondral low signal intensity that may represent a nondisplaced subchondral fracture. There is relatively mild edema within the lateral femoral condyle, also likely representing contusion. There appears to be superficial loss of articular cartilage along the lateral tibial plateau and lateral femoral condyle adjacent to the free edge of the posterior horn of the meniscus. The remaining articular cartilage appears normal.LIGAMENTS: The collateral and cruciate ligaments of the knee are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal.ADDITIONAL

Output: 1.Lateral meniscal tear as described above. 2.Lateral tibial plateau bone contusion and possible nondisplaced subchondral fracture as above. 3.Other findings as above.


Instruction: Generate impression based on findings.

Input: Dementia, unspecified, without behavioral disturbance. Other speech disturbance MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a cystic lesion present crossing the left foramen ovale which is unchanged since the prior exam. It has not changed since the prior examNo intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 left eyeball lens is thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are mildly asymmetric - left larger than right.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.A cystic lesion coursing through the left foramen ovale is unchanged compared to the prior exam. It is contiguous with the left temporal lobe and most likely represents an encephalocele.4.No evidence for acute ischemic cerebral infarction.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: T4N3 nasopharyngeal cancer, s/p induction chemotherapy followed by chemoradiation, now with locally advanced recurrence with involvement of the brain (right temporal lobe), cavernous sinus, and Meckel's cave, currently receiving induction chemotherapy with carboplatin/taxol. There is marked interval decrease in size of the mass within the right cavernous sinus and the adjacent right middle cranial fossa, measuring up to 25 mm in length and 20 mm in thickness. There is mild intrinsic T1 hyperintensity and T2 hypointensity in the tumor related to treatment effects. There is no appreciable edema in the adjacent right temporal lobe. There is no discernible tumor in the right lateral nasopharyngeal recess. There is no evidence of acute cerebral infarction. The ventricular system is not enlarged. There is mild scattered paranasal sinus mucosal thickening. The orbits are unremarkable.

Output: Marked interval decrease in size of the recurrent tumor involving the right cavernous sinus and adjacent middle cranial fossa with superimposed treatment effects.


Instruction: Generate impression based on findings.

Input: Back pain, more left side, was told had lumbar fracture Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits without evidence of compression fracture. There is grade 1 retrolisthesis of L5 on S1. Alignment of the lumbar spine is otherwise preserved. Bone marrow signal is benign. The conus medullaris is normal in position. There is developmental narrowing of the lumbar spinal canal with superimposed degenerative changes including multilevel disc desiccation and moderate loss of disc height at the L5-S1 level. Individual levels as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: There is a right paracentral disc extrusion, ligamentum flavum thickening, and mild facet arthropathy. There is effacement of the right lateral recess. There is mild central canal stenosis. No significant neural foraminal stenosis.L3-L4: There is a central/left paracentral disc protrusion, ligamentum flavum thickening, and bilateral facet arthropathy. There is moderate to severe spinal canal stenosis at this level. There is mild bilateral neural foraminal narrowing. L4-L5: There is disc bulge with minimal central protrusion. There is bilateral facet arthropathy and ligamentum flavum thickening. There is moderate spinal canal stenosis at this level. There is also mild to moderate bilateral neural foraminal stenosis.L5-S1: Mild retrolisthesis with mild disc bulge. There is no significant central canal stenosis. There is moderate bilateral neural foraminal stenosis. Bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. No appreciable fracture is evident by MRI, as questioned. If clinically indicated CT may be considered to better assess for potential small fractures.2. There is developmental narrowing of the lumbar spinal canal with superimposed degenerative changes throughout the lumbar spine. There is moderate to severe spinal canal stenosis at L3-L4 and moderate spinal canal stenosis at L4-L5. There is also moderate bilateral neural foraminal stenosis at L5-S1 which may be impinging on the exiting L5 nerve roots. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Female, 87 years old, with breast cancer metastatic to the brain, SRS planning scan. A cortically based lesion within the left precentral gyrus is again demonstrated. Without contrast, assessment for interval change in lesional size is not reliable although the lesion does appear somewhat flatter. However, the associated parenchymal edema has increased slightly when careful comparison is made. Similarly, the size of a small cortically based tumor within the right postcentral gyrus is not accurately assessed, but associated edema has very slightly increased. A third known metastatic lesion within the right basal ganglia is not well visualized.

Output: Although the sizes of cortically based metastases in the left precentral and right postcentral gyri are difficult to assess without contrast, associated parenchymal edema has mildly increased in both cases. A third known metastasis in the right basal ganglia is not well visualized.


Instruction: Generate impression based on findings.

Input: Reason: rule out meniscal injury History: pain MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: The femoral trochlea is shallow superiorly suggesting femoral trochlear dysplasia. There is a full-thickness articular cartilage defect along the lateral facet of the patella centrally with delamination. There is associated subchondral signal abnormality in the underlying areaLIGAMENTS: The cruciate and collateral ligaments appear intact. There is a subcentimeter focus of fluid signal intensity along the posterior aspect of the distal fibers of the PCL which may represent mucoid degeneration versus ganglion formation.EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall Salvati ratio is between 1.3 and 1.4 indicating patella alta.ADDITIONAL

Output: 1. Focal full thickness articular cartilage defect along the lateral facet of the patella with delamination.2. Borderline tibial tubercle to trochlear groove distance, patella alta, femoral trochlear dysplasia, and edema within the superolateral aspect of Hoffa's fat pad. These findings can be seen in patellofemoral instability.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:3/19/1963)Reason: eval for acute stroke History: left facial droop, dysarthria, ?productive aphasiaPROVIDER/ATTENDING NAME: DAVID G BEISER CATHERINE A BONHAM MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia involving the left superior parietal lobule extending towards the left inferior parietal lobule.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is somewhat degraded due to motion artifact on many of the pulse sequences.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 fetal origin of the posterior cerebral arteries bilaterally with a hypoplastic left P1 segment and a small right P1 segment.Basal artery appears narrowed proximally. The distal vertebral arteries also appear narrowed.There is focal narrowing of the right middle cerebral artery with approximately 50% stenosis.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is encephalomalacia present along the left parietal lobe.2.Findings raise the question of the basilar artery stenosis as well as distal vertebral artery stenosis.3.50% stenosis at the proximal right middle cerebral artery is suspected.4.This could be an appearance produced by local artifacts. If clinically appropriate CT angiogram may help further assess this.5.Examination is somewhat degraded due to patient motion during the exam which would obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 63-year-old man with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 52 x 42 mm.Peripheral Zone: In the anterior right paramedian peripheral zone (series 1001, image 15) there is a 15 x 7 mm masslike area of low signal on T2 and ADC map in addition to mild enhancement. Additional, smaller geographic areas are seen in the right paramedian posterior apex (series 701, image 37) measuring 7 x 7 mm and in the posterior midline peripheral zone of the mid prostate (series 701, image 62) measuring 4 x 7 mm.Central Gland: There is nodular and cystic hyperplasia.Seminal Vesicles: The seminal vesicles appear uninvolved.Extracapsular Extension: None evident.BLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple suspicious foci as described above, the largest of which is in the right paramedian anterior peripheral zone.2.No evidence of extracapsular extension or regional lymphadenopathy.


Instruction: Generate impression based on findings.

Input: MRI: There is a linear focus of restricted diffusion implant hyperintensity in the left hemipons medially consistent with acute infarct. There is other mild nonspecific periventricular and subcortical T2 signal abnormality. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, and in the right frontal operculum. These may represent foci of chronic microhemorrhage.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is fluid in the nasal cavity with mild frontal, moderate ethmoid and right sphenoid sinus mucosal thickening. Sagittal T1 weighted images are not available.MRA: Mild motion artifact degrades axial image quality. Within this limitation, no focal high-grade stenosis is identified in the intracranial circulation. There is a 4 x 4 mm saccular aneurysm arising at the branch point of the right M1 segment directed laterally, which may actually originate from the proximal right M2 segment. The neck of the aneurysm is not well visualized. The right vertebral artery is slightly larger compared to the left, with development to diminutive left V4 segment post-PICA. There is moderate narrowing of the distal left V4 segment. Both vertebral arteries join to form the basilar artery.

Output: 1.Acute medial left hemipontine nonhemorrhagic infarct. Other nonspecific foci of white matter FLAIR hyperintensity likely which likely represents chronic small vessel ischemic changes.2.No flow limiting intracranial stenosis, with moderate narrowing of the distal left V4 segment.3.4 x 4 mm saccular aneurysm arising from the right M1 segment branching point, likely originating from the proximal inferior M2 segment. CTA of the head recommended for further evaluation, as the neck is not well visualized on this MR exam.Findings were communicated with the emergency department by the radiology resident on call at the time of preliminary interpretation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pain question: Headache, tingling, blurred vision, concern for MS. Signs and symptoms: As above. Nonenhanced brain MRI:Examination is performed utilizing multiple sclerosis protocol.Negative diffusion weighted series.Anatomical morphology as well as the signal intensity of brain parenchyma immediately normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces and brain myelination.Normal visualization of signal void of major intracranial arterial branches.There is normal signal intensity of intracranial venous sinuses.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Negative nonenhanced brain MRI as detailed.


Instruction: Generate impression based on findings.

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

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings of metastatic disease.


Instruction: Generate impression based on findings.

Input: Ventriculomegaly possible hydrocephalus. There is a redemonstration of a large ventricles with extensive loss of cortical mantle. The left lateral ventricle is massively enlarged relative to the right lateral ventricle which is also enlarged. There is a septation within the left lateral ventricle and this could also represent porencephaly. The general appearance is is similar to prior exams. A ventriculostomy tube courses through the left frontal bone into the left lateral ventricle. At the level of the top of the right lateral ventricle the diameter of a left-sided ventricle measures and 67 mm in diameter and on the prior MRI exam measured 42 mm in diameter, however, the head is significantly larger currently than on the prior exam and probably related to interval growth of the infant . At the level of the foramina of Monroe the right lateral ventricle measures 29 mm in diameter on the current exam and it measured 20 mm in diameter on the previous MRI exam the left lateral ventricle at this level measures 50 mm on the current exam and 35 mm on the prior exam the third ventricle is also enlarged and measures 22 mm in diameter; on the prior MR it measured 17 mm in diameter. The fourth ventricle is not dilated.In general the left calvarium appears larger than the right calvarium. On the current exam and the angled dimensions of the skull at the level of the top of the thalami are 172 x 132 mm and on the exam of 311/08 they were 85 x 120 mm and on the 8/7/08 exam they were 129 by 109 mm.

Output: Marked enlargement of lateral ventricles and third ventricle left lateral ventricle more than right. Since the previous examination the lateral ventricles and third ventricle have enlarged however so has the head.


Instruction: Generate impression based on findings.

Input: History of bilateral optic gliomas s/p chemotherapy and changes on 9/2014 MRI. There are post-treatment findings for an optic glioma. There is no significant change in size of the optic glioma and associated punctate focus of enhancement within the left optic pathway. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is fluid within the left middle ear and mastoid air cells.

Output: 1. No significant interval change in the optic glioma.2. Fluid within the left middle ear and mastoid air cells may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: 3 t scanner with fudicalis for brain stem avm History: ha Scan was performed stealth protocol with multiple fiducial markers attached.There is a non enhancing 25.4 mm(RL) x 22.1mm (AP) x 23.8mm (CC) righty side pontine lesion with evidence of internal hemorrhage and adjacent DVA.The ventricles, sulci and cisterns appear to be unremarkable. The mastoid air cells are clear.Mucosal thickening of the left maxillary sinus, ethmoid sinus and frontal sinus are seen.

Output: Right pontine cavernous malformation associated with DVA.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapseClinical question: LOCSigns and Symptoms: LOC 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. Incidental note is made of partial empty sella.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Reason: CTh with subacute stroke History: 89 year old male with PMH significant for CAD, CHF. HTN, and previous throat cancer who presents with 2-3 day history of lethargy and altered mental status and had a mechanical fall on the day of admission. Due to the patient's inability to cooperate fast sequences were used There is diffusion restriction present involving the right caudate nucleus, the right anterior limb of the internal capsule and the right putamen. This measures 30 x 34 mm axial dimensions. There is associated T2 and flair MRI signal change. Punctate foci of signal loss on susceptibility imaging are present within the right tutamen and along the right anterior limb of the internal capsule.A focus of signal hyperintensity on T2 and flair MRI imaging located along the left thalamus is present. There is associated punctate signal hypointensity on SWI.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 partially opacified along the ethmoid air cells. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.There is a subacute infarction involving right basal ganglia and anterior limb of internal capsule associated with petechial blood products.2.Older left thalamic lacunar infarction.3.Exam was performed using fast imaging techniques. Subtle abnormalities may be less obvious as a result.


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of metastatic breast cancer and low back pain There is signal abnormality throughout the bones of the pelvis, as well as the lumbar spine and proximal femora compatible with diffuse metastatic breast cancer. The largest lesion involves the left ilium with an associated mildly displaced pathologic fracture which extends into the left SI joint as seen on the prior CT as well as a soft tissue component that invades the gluteal musculature which subjectively appears slightly increased in size compared to the prior CT. There are also pathologic fractures of the superior and inferior pubic rami on the right as well as superior subluxation of the body of the left pubic bone relative to the right, also seen on the prior CT.Within the left proximal femur, tumor appears to penetrate the cortex laterally at the level of the lesser trochanter and posteriorly within the subtrochanteric femur. There is also cortical thinning within the right proximal femur.Please refer to dedicated lumbar spine MRI for findings within the lumbar spine. Increased signal intensity and enhancement of the gluteal musculature on the left may represent denervation atrophy. There is also mild fatty atrophy of the right gluteus minimus. Atrophy of the adductor musculature on the left may also reflect denervation.There is a ventral hernia extending left of midline containing fat and fluid, but we see no definite involvement of bowel. Note is made of small rim-enhancing fluid collections within the sacral foramina which likely represent Tarlov cysts. Heterogeneous marrow enhancement reflects diffuse osseous metastases. Tendinosis of the right hamstrings is seen at their origin. A small amount of fluid is present within both hips, but we see no large joint effusion.

Output: 1.Widespread osseous metastatic disease involving the pelvis, proximal femurs and lower lumbar spine, including a pathologic fracture of the left ilium involving the SI joint which was seen on the prior CT as well as chronic obturator ring fractures.2.Tumor within the proximal left femur appears to penetrate the cortex and orthopedic consultation should be considered.


Instruction: Generate impression based on findings.

Input: Shoulder pain The examination is limited secondary to motion artifact.ROTATOR CUFF: There is undersurface fraying and mild tendinosis of the supraspinatus tendon although no fluid-filled discrete tear is identified. There is tendinosis of the infraspinatus tendon at its insertion on the greater tuberosity but again no fluid-filled tear is identified. There is suggestion of focal undersurface tearing of the subscapularis tendon at its insertion which appears new from the prior exam but no full-thickness tear is identified. The teres minor tendon is intact. The corresponding rotator cuff musculature is normal in volume and signal.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint with impression upon the superior fibers of the supraspinatus. A trace amount of fluid is noted in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the labrum is limited secondary to motion and lack of intra-articular contrast however there is suspected age-related degeneration and degenerative tearing of the superior labrum. There is a small glenohumeral joint effusion with extension to the subscapular recess. There is mild osteoarthritis of the glenohumeral joint.BICEPS TENDON: There is fluid again noted within the tendon sheath of the long head of the biceps which may reflect tenosynovitis and/or extension of glenohumeral joint fluid. Overall this is similar to the prior exam. Otherwise evaluation of the intra-articular portion of the biceps tendon is limited secondary to motion and lack of intra-articular contrast. ADDITIONAL

Output: 1. Limited examination secondary to motion artifact.2. Partial-thickness insertional tearing of the subscapularis tendon with additional rotator cuff tendinosis further detailed above. There is no evidence of a full-thickness rotator cuff tear.3. Osteoarthritis of the shoulder.4. Fluid within the biceps tendon sheath which could reflect tenosynovitis.5. Additional findings detailed above.


Instruction: Generate impression based on findings.

Input: History of bilateral upper extremity radiculopathy. History of PSF, L4-S1. Arthritis? DJD? Cervical spine: The cervicothoracic junction is not well visualized on the lateral view due to overlying anatomy. Moderate degenerative disc disease affects C6/7. There is also moderate multilevel facet joint osteoarthritis and neuroforaminal narrowing particularly affecting the lower cervical levels, better delineated on the recent MRI examination.Lumbar spine: There are posterior rods with screws entering L5 and S1. I see no hardware complications. There appears to be interbody bony bridging at between the L5 and S1 vertebrae. Mild degenerative disc disease affects L4/5. Facet joint osteoarthritis affects the lower lumbar spine, with mature bone graft along the lower lumbar levels. Vertebral body heights are preserved. There is a grade 1 anterolisthesis of L4.

Output: 1.Degenerative disc disease, facet joint osteoarthritis and neuroforaminal narrowing of the cervical spine as above.2.Orthopedic fusion of the lower lumbar spine and other findings as above.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of metastatic non-small cell lung cancer to the brain status post whole brain radiation therapy, now reporting new right eye floater, evaluate. There is no evidence of intracranial mass or abnormal enhancement to suggest metastatic disease. No evidence of hemorrhage or infarct. Again noted is diffuse confluent T2 hyperintensity in the subcortical and periventricular cerebral white matter, similar to the prior exam and likely reflecting treatment changes. There is unchanged nonspecific enhancement along the frontal horns, possibly vascular in etiology. There is diffuse mild ventricular and sulci enlargement, suggestive of parenchymal volume loss. No hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. Bilateral orbits are grossly unremarkable. Calvarium and extracranial soft tissues are also grossly unremarkable.

Output: 1.No intracranial mass or abnormal enhancement to suggest metastatic disease.2.Extensive cerebral white matter signal abnormality, similar to prior exam and compatible with posttreatment changes.


Instruction: Generate impression based on findings.

Input: 63 year-old male with left-sided weakness. No evidence of acute intracranial hemorrhage or midline shift. Again seen is extensive bilateral vasogenic edema due to patient's known metastatic disease. Metastatic foci in the right frontal and left frontal lobes have increased attenuation compared to prior CT, likely corresponding to hemorrhage; however, this is likely unchanged from more recent MRI (series 4, image 23 and image 21).The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No evidence of acute intracranial abnormality.2.Metastatic foci bilaterally have increased attenuation, most consistent with hemorrhage; although this appears increased since CT done 1/1/2012, this is likely unchanged from more recent MR done 1/25/2012. Extensive bilateral vasogenic edema associated with metastases not significantly changed.


Instruction: Generate impression based on findings.

Input: a 53 years old female with history of coronary artery disease with a CABG in 2006 (LIMA to CX, RIMA to LAD) and 2008 (SVG to DG, RI and OM1) with multiple PCI presenting with increasing dyspnea, referred to cardiac MR for evaluation of ischemia.MEDICATIONS: Aspirin, prasugrel, Atorvastatin, Metoprolol, Amlodipine, Pletal First Pass PerfusionDuring hyperemia, there is a perfusion defect (ischemia) throughout most of the basal to mid inferior/inferolateral and inferoseptal walls. There is also a perfusion defect noted in the apical septum and possibly lateral wall. The perfusion defect score is 12/32, representing 37% of the myocardium. The perfusion defect is decreased compared to prior stress MRI on 1/13/15.Viability/ Myocardial ScarThere is an area of subendocardial late gadolinium enhancement noted in the basal inferolateral wall. It is non-transmural throughout most of its length, occupies about 50% of the myocardial thickness and is suggestive of a prior myocardial infarction. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is viable. This area is unchanged from prior stress MRI in 1/13/15.Left VentricleThe left ventricle is upper normal in size with normal systolic function. There is akinesis of the inferolateral wall. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 184 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 82 ml (normal range 31+/-10), the LV mass index is 54 g/m2, and the LV mass is 110 g. There is akinesis of the basal to mid inferolateral wall (with associated myocardial thinning). There is basal to mid inferior/inferoseptal hypokinesis. 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 58%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 166 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are 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. During hyperemia, there is a perfusion defect (ischemia) throughout most of the basal to mid inferior/inferolateral and inferoseptal walls. There is also a perfusion defect noted in the apical septum and possibly lateral wall. The perfusion defect score is 12/32, representing 37% of the myocardium. The perfusion defect is decreased compared to prior stress MRI on 1/13/15.2. There is an area of subendocardial late gadolinium enhancement noted in the basal inferolateral wall. It is non-transmural throughout most of its length, occupies about 50% of the myocardial thickness and is suggestive of a prior myocardial infarction. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is viable. This area is unchanged from prior stress MRI in 1/13/15.3. The left ventricle is upper normal in size with normal systolic function. There is akinesis of the inferolateral wall. The overall LV ejection fraction is 55%. There is akinesis of the basal inferoseptum and the mid lateral wall (with associated myocardial thinning)4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%5. Mild to moderate mitral and mild tricuspid regurgitation.6. Extra-cardiac findings as above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: please eval for moyamoyaSigns and Symptoms: Sickle cell trait MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are small foci of T2 and FLAIR signal hyperintensity present in the brainstem in the right thalamus. A focus of T2 and FLAIR signal hyperintensity is present in the right centrum semiovale which measures 9 x 17 mm axial dimensions and is associated with some mild exit vacuo effect on the right lateral ventricle.There are punctate foci of susceptibility present in the right thalamus and left basal ganglia as well as the right pons.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size.. The posterior communicating arteries are identified. The right posterior communicating artery is small. The left posterior communicating artery is a very small. The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery.There is marrow replacement present.

Output: 1.There is no evidence for acute cerebral infarction.2.There are multiple microhemorrhages identified in the basal ganglia, thalami and brainstem which are non-specific but whose pattern suggests they are related to hypertension.3.There is a small focus of encephalomalacia in the right centrum semiovale present which is most likely vascular related.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. They are most likely vascular related. 5.Patchy lesions in the brainstem are most likely vascular related.6.There is no evidence for intracranial cerebrovascular stenosis or moyamoya.7.Diffuse marrow replacement is likely related to patient's known sickle cell.


Instruction: Generate impression based on findings.

Input: 61-year-old female with history of IPMN. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. Stable 8 mm right hepatic lobe hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: Stable-appearing cystic lesion in the pancreatic head measuring 8 x 5 mm (image 22 of series 601). This lesion communicates with the main pancreatic duct. No suspicious enhancement or nodularity.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable presumed side-branch IPMN in the pancreatic head without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: 68-year-old female. Patient presented with painless jaundice. CT scanning and EUS here with no definitive lesion on CT scan. Needs MRCP. Probably cholangiocarcinoma. EPIC history: CBD mass suspicious for cancer on ERCP, CA 19-9 206. Images are variably degraded by motion artifact, somewhat limiting evaluation.ABDOMEN:LUNG BASES: Bilateral moderate pleural effusions and nonspecific basilar opacities, possibly atelectasis.LIVER, BILIARY TRACT: No suspicious hepatic mass. No biliary ductal dilatation. CBD stent with small amount of pneumobilia and dependent debris; susceptibility artifact produced by the stent limits evaluation of the duct itself. Within this limitation, no discrete enhancing common duct mass is identified. Patent hepatic vasculature.Susceptibility artifact from cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: 6 x 5-mm cystic focus in the uncinate process, likely a sidebranch IPMN (series 801, image 4). A second subcentimeter cystic focus in the pancreatic neck which appears to connect to the pancreatic duct (series 801, image 6) is suspicious for another IPMN. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense foci in the right kidney, too small to characterize, likely cysts.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Subcentimeter small gastrohepatic ligament lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality noted.

Output: 1.CBD stent with expected mild pneumobilia and no biliary ductal dilatation. Known CBD mass seen on prior ERCP is not visualized possibly due to artifact from the stent.2.No evidence of metastatic disease in the abdomen.3.Moderate bilateral pleural effusions.4.Cystic subcentimeter foci in the pancreatic uncinate process and neck, likely side branch IPMNs.


Instruction: Generate impression based on findings.

Input: Other convulsions [780.39], Reason for Study: ^Reason: rule out structural lesion that may exl History: seizures >5x PTA, left hemihypoesthesia, left lower extremity weakness No evidence of acute ischemic or hemorrhagic lesion.There is evidence of right occipital craniectomy.Underlying brain parenchyma shows encephalomalacia on the right parieto-occipital lobe with ex focal changes of right lateral ventricle occipital horn indicate prior ischemic stroke.Gradient echo images shows susceptibility artifacts on transabdominal osseous area as well as the left occipital lobe indicate chronic blood products.There is no abnormal enhancement.The ventricular system is unremarkable.The cranial-cervical junction is normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Opacification with mucosal thickening was seen on bilateral maxillary sinus as well as ethmoid sinuses

Output: Right occipital craniectomy with temporo-occipital encephalomalacia as described above.No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: MRI CARD WWO CNTRST, VIABLTY/SCAR IMAG.MORPH/FUNCT,W/FLOW/VELOCITY MEASURE, 12/18/2015 2:16 PM Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 82 ml/m2 (normal range: 74+/-15), the LVEDV is 162 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 78 ml (normal range 47+/-19), the LV mass index is 38 g/m2 (normal range 85+/-15), and the LV mass is 76 g (normal range 164+/-36). The LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The shape of the RV is mildly distorted by the patient's pectus. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 165 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 82 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 has a common origin of the right subclavian and left common carotid arteries ("pseudo-bovine arch"), which is a normal variant. No evidence of thoracic aortic aneurysm, dissection, or coarctation. The aortic measurements are as follows: Sinus of Valsalva: 32 x 32 x 30 mmSinotubular Junction: Ascending aorta (4 cm from aortic valve): 29 x 28 mmAortic arch (mid portion): 22 x 21 mmDescending thoracic aorta: 18 x 17 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA mild pectus excavatum is noted. The minimal AP dimension in the chest is 5.8cm. 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. Normal LV size with low normal systolic function (LVEF 52%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. Normal RV size with low normal systolic function (RVEF 50%). The shape of the RV is mildly distorted by extrinsic compression from the chest wall.3. Normal thoracic aorta anatomy.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with GBM, follow-up examination. Postoperative changes are again seen compatible with left temporal/parietal craniotomy and tumor resection. The treatment bed shows a dense accumulation of susceptibility effect likely representing chronic hemosiderin, unchanged.Ill-defined T2 hyperintensity surrounding the treatment bed and extending through the left temporal, occipital, parietal and frontal lobes is unchanged. Irregular enhancement within the treatment bed centered on the ventricular atrium has not significantly changed in size or extent. Ependymal enhancement along the left occipital horn may be minimally thicker when compared to prior examination but this could also be technical in nature.No new enhancing or T2 hyperintense lesions are seen. Ill-defined T2 hyperintensity around the right lateral ventricle, and scattered small foci elsewhere in the brain, are unchanged. Ventricles are stable in size and morphology.

Output: No definite or significant interval change is seen in the size and distribution of irregular enhancement in the left parietotemporal treatment bed. Ependymal enhancement along the left occipital horn may be minimally increased in thickness but this could also be technical.


Instruction: Generate impression based on findings.

Input: Reason: Worsening lower back pain; evaluate for disease progression History: Stage IV melanoma There are multiple foci of abnormal signal intensity noted within the bones of the pelvis bilaterally, including the sacrum, as well as within the proximal femora. The lesions are of variable signal intensity on T1-weighted images with some being iso- to hypo-intense to skeletal muscle and others that appear hyper-intense to skeletal muscle, perhaps due to melanin. The majority of the lesions are increased in signal intensity on T2-weighted images, although some show low signal intensity centrally on the STIR sequence. Some, but at all, of the lesions appear to enhance following contrast administration. There is a lesion within the femoral neck, on the left, that abuts the superolateral cortex, but the cortex itself appears intact and we see no extraosseous spread of tumor at this location. Another lesion is situated in the right proximal femur at the level of the lesser trochanter, adjacent to the lateral cortex. There is an associated small amount of edema within the adjacent soft tissues, but there is no visible cortical destruction. There is a small amount of fluid within both hips, but no joint effusion is evident. There is mild edema noted within and along the musculature of the hips bilaterally, which is nonspecific. We see no fluid collection to indicate an abscess. Please refer to the lumbar spine MRI report for additional details regarding the lumbar spine.

Output: Multiple metastatic foci involving the bones of the pelvis and proximal femora.


Instruction: Generate impression based on findings.

Input: Reason: CCM Protocol/QSM/Permeability 3T Scanner History: CCM Yearly Surveillance. Multiple supratentorial cavernomas are redemonstrated, overall stable in size and number compared to prior examination. No new lesions are evident. The largest lesion is located in the right frontal lobe and is overall stable in size. There is no perilesional edema. No new lesions are identified. A few lesions contain intrinsic T1 shortening, unchanged. Prominent right pontine lesion is again seen, unchanged. Smaller cerebellar punctate lesions are again identified. There is no significant enhancement associated with the cavernoma. No significant perilesional edema. There is no evidence of diffusion restriction. The sulci and ventricles are stable. Major vascular flow voids are preserved.

Output: Multiple cavernomas are overall stable in size and number.


Instruction: Generate impression based on findings.

Input: Male 29 years old Reason: eval for fai; djd; labral tear History: hip pain with sports for months and back pain right > left with a click ACETABULAR LABRUM: The acetabular labrum is intact. No fluid enters the labrum to suggest tear.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits for patient's age. Articular cartilage is intact.SOFT TISSUES: Muscles and ligaments are within normal limits. There is no T2 abnormality to suggest trochanteric bursitis or other tendinous injury.ADDITIONAL

Output: MRI of the hip within normal limits. No labral tear as clinically questioned.


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:4/8/1967)Reason: right back pain with symptoms of herniated disc History: right flank pain with clinical sciaticaPROVIDER/ATTENDING NAME: MINDY ALYCE SCHWARTZ MINDY ALYCE SCHWARTZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a broad-based central disc protrusion at this level. There is mild/minimal ligamentum flavum hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are some mild degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots. There is a central disc protrusion at L5-S1.


Instruction: Generate impression based on findings.

Input: History of inflammatory breast cancer with possible new CNS metastasis. There is subcortical vasogenic edema in the left precentral gyrus and to a lesser extent the right postcentral gyrus. There are otherwise scattered areas of cerebral and pontine white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Subcortical vasogenic edema in the left precentral gyrus and to a lesser extent the right postcentral gyrus may represent metastatic disease, although characterization is limited due to the lack of intravenous contrast. Otherwise, scattered areas of cerebral and pontine white matter T2 hyperintensity may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained.  DynaCad was used to localize the left anterior mid-gland lesion of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left anterior mid-gland lesion of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the 2.0 x 1.0 cm left anterior mid-gland prostate gland lesion.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with tuberous sclerosis, evaluate subependymal giant cell astrocytoma and cortical tubers for change. Artifact from presumed orthodontic braces renders the susceptibility weighted and diffusion weighted images nondiagnostic. The other sequences are less severely affected.Multiple areas of cortical and subcortical T2 hyperintensity are redemonstrated without significant interval change in size. Radial migration lines are seen traversing the cerebral white matter. Multiple subependymal nodules are also seen, most of which demonstrate susceptibility indicating calcification and some degree of enhancement. A lesion at the right foramen of Monro measures approximately 10 x 10 x 5 mm, previously 11 x 10 x 7 mm. None of the additional subependymal lesions appears to have changed significantly in size. No new lesions are appreciated. Ventricular size and morphology are within normal limits. A small area of prominent CSF along the right frontal lobe is unchanged and could reflect anatomic variation or a small arachnoid cyst.

Output: Stigmata of tuberous sclerosis are redemonstrated without significant interval change including numerous cortical and subependymal tubers. A potential subependymal giant cell astrocytoma at the right foramen of Monro likewise shows no evidence of progression.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of brain, unspecified [D33.2], Reason for Study: ^Reason: Inflammatory pseudotumor; f/u progression History: Headaches There is no evidence of acute ischemic lesion on this scan.Previously seen non enhancing bilateral mesial thalami lesions with high T2/FLAIR signal intensity are again seen, no change since prior scan.Multifocal susceptibility lesions on bilateral hemispheres are seen which indicate possible small chronic hemorrhagic foci, however, there are a couple of new lesions especially on the left occipital lobe and parahippocampal gyrus posterior aspect (series 1002, image 14/35) indicate interval development. Since there is no associated surrounding edema, they are again most likely non-acute likely chronic lesions.There is no abnormal enhancement seen. The ventricles, sulci and cisterns are symmetric and unremarkable with ventriculostomy tube inserted through the right frontal burr hole, no change since prior scan. 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 mastoid air cells are clear. Left maxillary sinus shows a retention cyst.

Output: 1. No evidence of acute ischemic lesion.2. No change of bilateral mesial thalami lesion in terms of extent and MR characteristics.3. Interval increase of the number of susceptibility lesions as described above.4. Stable ventricle size and ventriculostomy tube location.


Instruction: Generate impression based on findings.

Input: There is an ill-defined transspatial lesion involving the soft tissues of the face extending posteriorly to the left parotid gland, anteriorly involving the left buccal space space and lips and medially into the left masticator space where there is enlargement of the left masseter muscle. Abnormal signal is also noted to involve the left pterygoid musculature as well as the left aspect of the hard palate. Extension into the left inferior lateral aspect of the extraconal left orbit is also noted. Superiorly signal abnormality involving the left temporalis muscle is also noted. No mass effect on the globe.This finding was partially seen on noncontrast CT from 8/14/2013. There is T2 hyperintensity involving the lesion and enhancement. Two foci of calcifications are noted within the lesion which may represent phleboliths. No discrete fluid collections or abnormal enhancement to suggest abscess.Small scattered left-sided cervical lymph nodes. Left submandibular gland is asymmetrically larger which is nonspecific. Visualized brain parenchyma demonstrates scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. No evidence of intracranial mass effect or herniation.

Output: Extensive transspatial mass involving the soft tissues of the face including the left masticator space, buccal space, parotid space, as well as medial extension to involve the left hard palate and inferior lateral aspect of the left orbit. No prior MRI is available for direct comparison although the lesion is present on prior CT from 8/14/2013. Phleboliths are also suspected based on prior CT. Overall findings are favored to represent a venous malformation.Due to this extensive abnormality, underlying superimposed lesions are difficult to detect. There is however no appreciable evidence of an inflammatory process or fluid collections to suggest abscess. There is asymmetric prominence of the left-sided cervical lymph nodes which are not pathologically enlarged and nonspecific.


Instruction: Generate impression based on findings.

Input: Patient with history of chondromalacia of right knee, presenting with pain. Mild osteoarthritis affects the right knee, with small osteophytes and subchondral lucency in the lateral aspect of the femoral trochlea, corresponding to cyst seen on the prior MRI. There is no joint effusion.

Output: Mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: Clinical question : History of lung cancer, base of toque cancer, status post CRT. Evaluate for disease, compared with prior. Signs and symptoms: As above. Enhanced CT of soft tissues of neck: 80 cc of Omnipaque 350 is administered for this exam.Images through the skull base and including cavernous sinuses are unremarkable with the exception of extensive vascular calcification of cavernous carotid.Images through the neck demonstrate very extensive post therapy/surgical changes of the neck and including a large anterior flap. There is however no detectable tumor or any pathologic adenopathy neck.Limited images through the apices of the lungs demonstrate complete opacification of right upper lung field similar to what was noted on prior exam. Pleural effusion bilaterally is also noted (left greater than right). This is a new finding since prior exam. Please review dedicated report of CT of the chest performed the same date which he upper lung fields with better advantage.Enhanced head CT:Examination demonstrates extensive findings suspect for a mass to small vessel disease of indeterminate age. There is a small focal area of low cortical enhancement in the right frontal lobe (axial image 15 and coronal reformatted image 48). This finding was present on prior exam however it appears more prominent on the current study. Recommend further follow with an MRI exam to exclude the possibility of metastatic disease. The finding could represent a small enhancing cortical stroke as well. This examination is otherwise unremarkable and there are no additional foci of abnormal enhancement brain parenchyma or leptomeninges.

Output: 1.No evidence of recurrence of disease in neck and the stable exam since prior study.2.CT examination of brain demonstrates small focus of cortical enhancement in the right frontal lobe (axial image 15 & coronal reformatted image 48). This finding was present on prior study however appears slightly more pronounced on the current study and recommend further follow-up with an MRI to exclude metastatic disease.


Instruction: Generate impression based on findings.

Input: Images are limited by patient motion, resulting in misregistration of axial and sagittal images. There is normal lumbar lordosis. Rounded areas of bright T1 and T2 signal is seen in the vertebral bodies of L2 and L5, likely representing hemangiomas. The conus medullaris tip is at the lower limits of normal, at L2-L3. There is no evidence of fatty filum.The partially visualized T11-T12 disc space demonstrates mild desiccation of the disc.The level of T12-L1 demonstrates normal height of the disc with mild desiccation. There is no evidence of disc herniation. No compromise of the neural foramina or the nerve roots.The level of L1-L2 demonstrates normal height of the disc with no evidence of disc herniation. No compromise of the neural foramina or the nerve roots. There is ligamentum flavum thickening with facet hypertrophy.The level of L2-L3 demonstrates normal height of the disc with no evidence of disc herniation. No compromise of the neural foramina or the nerve roots. There is ligamentum flavum thickening with facet hypertrophy.The level of L3-L4 demonstrates right foraminal lateral disc extrusion with possible sequestered disc material that migrates 4 mm cranially. There is impingement of the disc material on the exiting right L3 nerve root. There is mild spinal stenosis with moderate right foraminal stenosis. There is ligamentum flavum thickening with facet hypertrophy.The level of L4-L5 demonstrates 3 mm of minimal anterolisthesis grade 1 of L4 on L5 with uncovering of the disc. There is a minimal disc bulge. There is mild narrowing and desiccation of the disc. There is a moderate spinal stenosis. There is ligamentum flavum thickening with facet hypertrophy.The level of L5-S1 demonstrates minimal retrolisthesis of L5 on S1. Minimal shallow left foraminal disc protrusion seen.A dorsally projecting synovial cyst is seen emanating from the left facet of L5-S1. There is ligamentum flavum thickening with facet hypertrophy.

Output: 1. At the level of L3-L4 there is a right foraminal lateral disc extrusion with possible sequestered disc material that migrates 4 mm cranially. There is impingement of the disc material on the exiting nerve of right L3. There is mild spinal stenosis with a moderate degree of foraminal stenosis.2. At the level of L4-L5 there is a moderate spinal stenosis. Minimal disc bulge, narrowing of the disc space, and disc desiccation is visualized at this level. 3. Minimal shallow left foraminal disc protrusion is visualized at the level of L5-S1.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for spinal dysraphism, tethered cord, mass or lesion. Signs and symptoms: New onset of diurnal enuresis, sacral dimple, scoliosis. Nonenhanced cervical spine MRI:There is normal anatomical developmental vertebral column and with normal anatomical alignment.Unremarkable images at the level of foramen magnum.No evidence of spinal stenosis or neural foraminal compromise at any level.There is normal signal intensity and caliber of the cervical cord.Nonenhanced thoracic and lumbar MRI:Examination demonstrates congenital anatomical anomaly of T9 hemivertebrae on the right and partial articulation of T8 and T10 vertebral bodies. Finding is best appreciated on sagittal T2 series on images 3 through 8. Changes at this level results in significant dextroscoliosis. Counting from above the right hemivertebrae counts as T9. The rest of the thoracic spine demonstrate normal signal intensity and morphology of vertebral column however with 2 normally developed extra vertebral bodies. Evaluation of the lumbosacral spine demonstrate normal anatomical development of the vertebral column. With best estimate counting from L5-S1 superiorly there is apparent normal termination of the cord at L1-L2 disc level. However note should be made that accounting of the levels on this exam are complicated due to extra vertebral bodies. The signal intensity and caliber of the thoracic cord remains within normal and without evidence of syrinx. There is however evidence of fatty filum terminale extending from approximately L4 inferiorly to the bottom of the thecal sac suggestive of tethered cord.There is lack of any detectable anterior movement of the conus or cauda equina on prone sagittal T2-weighted images when compared to the supine sagittal series suggestive of cord tethering.

Output: 1.Unremarkable MRI of cervical spine.2.MRI of the thoracic spine demonstrate a right T9 hemivertebrae and with evidence of 2 extra anatomical well-developed vertebral bodies. Significant dextroscoliosis at the level of T9 hemivertebrae is present.3.MRI of lumbosacral spine demonstrate normal signal intensity and anatomical development of the spine without evidence of dysraphism.4.There is however evidence of fatty filum terminale and there is no detectable anterior movement of the conus or the cauda equina on prone sagittal series which are both suggestive of tethered cord.5.Due to extra vertebral bodies precise level of termination of the cord is difficult to assess. However counting from L5-S1 level superiorly (not considering additional vertebral bodies) the cord terminates at L1-L2 disc level.6.Mild dilatation of the bladder with subtle thickening of bladder wall is noted.


Instruction: Generate impression based on findings.

Input: Female 37 years old; Reason: Evaluate for medial meniscal tear and possible chondromalacia patella. The exam is slightly limited due to patient motion artifact, particularly on the axial sequence.MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: Subjectively there appears to be thinning of the articular cartilage along the lateral facet of the patella superiorly, with what appears to be more focal degeneration along the medial eminence. A focus of low signal intensity within the articular cartilage of the medial facet of the patella likely represents additional degeneration, but the cleft seen on the prior study is no longer visible. The articular cartilage of the medial and lateral compartments appears intact. Bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Mild degeneration of the articular cartilage of the patella, that has perhaps progressed slightly when compared to the prior study, but we see no meniscal tear.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:10/22/1973)Reason: saroid vs meningioma History: CNS lesionPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. Previously noted enhancing lesion along the planum sphenoidale has significantly regressed relative to the prior exam. It now measures approximately 1 mm thick whereas previously measured 6 mm in thickness.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 mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some metal artifact of the long the patient's left-sided scalp which could relate to something related patient's hair. It partially secures visualization of the skin in that location. On susceptibility imaging the left middle frontal gyrus is obscured by this artifact.

Output: 1.Previously noted enhancing lesion along the planum sphenoidale has significantly regressed relative to the prior exam. Differential considerations include sarcoid as well as meningioma.2.Small amount of metallic artifact is present along the patient's left frontal scalp which create some mild obscuration of the left middle frontal gyrus.


Instruction: Generate impression based on findings.

Input: Evaluate for cardiac amyloid in setting of increased gastric amyloid burden Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 180 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 78 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 mildly dilated at 4.2 cm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProbable small left renal cyst again 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. Normal LV systolic function.2. No late gadolinium enhancement to suggest of infiltrative disease3. Again, noted mildly dilated aorta.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Amyotrophic lateral sclerosisClinical question: r/o stenosis, radiculopathySigns and Symptoms: BL shooting leg 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.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge and some disc desiccation at this level.At L4-5 there is loss of disc space height as well as diffuse disc bulge associated bilateral ligamentum flavum hypertrophy. The disc is T2 signal hyperintense. Some disc material extends behind the adjacent L4 inferior endplates and L5 superior endplates. The endplates appear fairly well-preserved. There are endplate reactive changes which are high signal on T1 and low signal on STIR T2 TSE imaging. Disc material extends into the neural foramina bilaterally. There is partial effacement of the fat surrounding the right-sided exiting nerve root at this level there is milder encroachment in the left neural foramen. There is triangulation of the thecal sac at this level. There is effacement of the fat at the left lateral recess and to a lesser degree there is effacement of the fat at the right lateral recess. Overall there is mild to moderate spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are parapelvic renal cysts present.There are some endplate reactive changes at T10-T11.

Output: 1.There are degenerative changes present in the lumbar spine which are worse at L4-5 where there is a mild to moderate degree of spinal stenosis as well as some encroachment of the right-sided exiting nerve roots within the neural foramina.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with spina bifida and syrinx, six month follow-up. Surgical changes are redemonstrated in the lower lumbar spine compatible with prior repair of a lipomyelomeningocele and cord de-tethering. Syringohydromyelia of the distal spinal cord is redemonstrated showing no significant interval change. The syrinx begins at T12 and continues down to the L2 level with a maximal caliber of approximately 5 x 3 mm. The distal spinal cord remains atrophic.The distal spinal cord remains closely opposed to the dorsal thecal sac. The neural elements become indistinguishable in the lower spinal canal in an area of posterior element deficiency which is filled by prominent fatty material. The distal thecal sac is ectatic and septated. On prone imaging, no definite shift in position is seen in the distal spinal cord or cauda equina.The thoracic kyphosis and lumbar lordosis are both exaggerated similar to prior. Alignment is otherwise unremarkable. Fusion of the posterior aspects of the L4 and L5 vertebral bodies is unchanged. The spinal canal is not significantly compromised at any level. Minimal degenerative findings including small disc protrusions at T10-11 and T12-L1 are unchanged.

Output: 1.Redemonstrated are postoperative findings compatible with lipomyelomeningocele repair and cord untethering.2.Stable distal spinal cord syringohydromyelia.3.Findings suggestive of tethered cord are unchanged.4.Mild degenerative findings are unchanged.


Instruction: Generate impression based on findings.

Input: Female 67 years old Reason: left knee pain; evaluate for tendon/meniscus/ligament injury History: left knee pain MENISCI: There is intrasubstance signal in the posterior horn of lateral meniscus that does not appear to contact the articular surface. There is a radial tear of the posterior horn root junction of medial meniscus causing mild extrusion of the medial meniscus.ARTICULAR CARTILAGE AND BONE: Areas of full-thickness cartilage loss involving the medial femoral condyle and medial tibial plateau with subchondral sclerosis.Full-thickness cartilage loss involving the lateral femoral condyle especially in the trochlea. Full-thickness cartilage loss with bony remodeling of the patella and trochlea there is extensive subchondral sclerosis.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Radial tear of the posterior horn of the medial meniscus with mild extrusion.Mild osteoarthritis of the lateral compartment with cartilage loss.Moderate to severe osteoarthritis of the medial compartment with cartilage loss.Soft tissue mass arising from the tibial nerve posterior to the knee with imaging features compatible with a peripheral nerve sheath tumor. Likely represents a schwannoma but cannot be completely classified with a noncontrast MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out structural lesion. Signs and symptoms: Seizure. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate normal anatomical morphology of brain parenchyma and with normal signal intensity on all MRI sequences.Note however is made of punctate foci of nonspecific FLAIR hyperintensity in the subcortical white matter of left hemisphere.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Post contrast images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and mid normal pattern of enhancement.Unremarkable calvarium and orbits without abnormal enhancement.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with cognitive decline and poorly defined lesion in the left temporal lobe on prior exam. Image quality is slightly reduced by motion artifact. Furthermore, the patient was unwilling to receive IV contrast and therefore only noncontrast imaging was obtained.T2 hyperintensity is redemonstrated within the left amygdala and hippocampal head. As before, this abnormal tissue seems to contain one or two small cystic spaces. There is no associated mass effect. No susceptibility or restricted diffusion is seen. Cystic spaces in the adjacent temporal stem likely represent dilated perivascular spaces. No significant change is seen in the size or morphology of this abnormal tissue when compared to both prior examinations.Elsewhere in the brain, numerous foci of white matter T2 hyperintensity are redemonstrated, similar in number and distribution to the prior exam. No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricular system is normal in size and morphology.

Output: Abnormal signal involving the left amygdala and hippocampal head is again seen without significant interval change. Notably, this lesion is associated with no mass effect or other concerning secondary features.The lesion remains nonspecific, but given the absence of mass effect and its stability dating back to January 2015, chronic sequela of prior parenchymal injury or inflammation is favored over an active inflammatory or neoplastic process. If continued follow-up is desired on clinical grounds, a longer interval (at least 6-12 months) would probably be appropriate.Elsewhere, numerous foci of cerebral white matter signal abnormality are seen which statistically most likely reflect chronic small vessel ischemic disease. No definite acute intracranial abnormalities are seen.


Instruction: Generate impression based on findings.

Input: Male, 80 years old, with imbalance. Spondylolisthesis noted on report. Assess for cord impingement. The cervical lordosis is mildly exaggerated, but sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. No worrisome marrow replacement is seen. Mild degenerative endplate edema is seen at C5-6.Except as discussed below, the visualized spinal cord demonstrates normal morphology. No areas of cord signal abnormality are detected.C2-3: Mild facet hypertrophy. No spinal canal stenosis. No significant foraminal narrowing. C3-4: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe left and moderate to severe right foraminal narrowing. C4-5: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal narrowing with perhaps a very slight contact between the disc osteophyte and the cord. No significant cord deformation is seen. No abnormal cord signal is detected. Severe bilateral foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis with mild impingement of the ventral cord. No cord signal abnormality. Moderate bilateral foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. Perineural root sleeve cysts are evident in several of the upper thoracic neural foramina.

Output: At least moderate multilevel disc degeneration is seen. Most severely affected are the C4-5 level, with a moderate generalized spinal canal stenosis and minimal if any cord impingement; and C5-6 where there is a moderate generalized spinal canal stenosis and mild cord impingement. Scattered neuroforaminal narrowing is also evident ranging from mild to severe.


Instruction: Generate impression based on findings.

Input: A 53 year-old female with tetralogy of Fallot repaired at the age of 4 years, paroxysmal SVT, a recent echocardiogram showed enlarged right ventricle with decreased systolic function and significant pulmonic regurgitation. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with preserved systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 55 ml/m2 (normal range: 65+/-11), the LVEDV is 85 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 32 g/m2 (normal range 67+/-11), and the LV mass is 50 g (normal range 114+/-24). There is localized area of hypokinesis in the mid-anterior wall which appears to be associated with a focal transmural area of late gadolinium enhancement that could suggest the presence of an underlying fibrosing or infiltrative myopathy. No thrombus was noted. Left AtriumThe left atrium is normal in size. The right atrium is severely enlarged. There is a secundum type atrial septal defect with predominantly from left to right flow. The diameter of the defect is about 11 mm on cine images.Right VentricleThe right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 127 ml/m2 (normal range 69+/-14), the RVEDV is 196 ml (normal range 110+/-24), the RV end systolic volume index is 77 ml/m2 (normal range 22+/-8), and the RVESV is 120 ml (normal range 35+/-13). 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, no stenosis was seen. There is moderate pulmonic regurgitation. Regurgitant volume is 22 mL and regurgitant fraction 32%. Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Aortic sinus of valsalva = 36 29 mm, proximal ascending aorta = 26 x 26 mm, distal ascending aorta = 23x 23 mm and descending aorta = 17 x 16 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery measures 35 x 25 mm. The left branch PA has an ostial narrowing which measures 14 x 20 mm with a more distal measurement of 24 x 23 mm.The right branch PA measures 20 x 21 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with preserved systolic function, the LVEF is 52%. There is a localized area of outpouching in the mid-distal anterior wall which appears to be associated with a small area of late gadolinium enhancement. The significance of this finding is unclear. 2. The right ventricle is severely dilated with moderately reduced systolic function The ejection fraction is 37% and the RV end-diastolic volume (indexed) was measured to be 127 ml/m2 on this study3. There is a secundum-type atrial septal defect with predominantly left to right flow. The rims of this defect appear adequate.4. The pulmonic valve opens widely, no stenosis was seen. There is moderate pulmonic regurgitation. 5. There appears to be ostial narrowing of the left PA with post narrowing dilatation. Dimensions are given above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 21-year-old female with history of IV drug through presents with back pain and new right foot drop. For the purposes of numbering, there are 5 lumbar type vertebral bodies. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact. There is desiccation involving the L4-L5 disc. There is a Schmorl's node noted within the inferior endplate of the L4 vertebral body. There is no significant compromise to the spinal canal or neural foramina at any level of the lumbar spine. There are no significant inflammatory changes or fluid collections involving the epidural or paraspinous soft tissues. No abnormal enhancement in the spine or paraspinous soft tissues.

Output: 1. No evidence of epidural abscess or discitis-osteomyelitis. 2. No significant spinal canal or neuroforaminal stenosis at any level.3. Early degenerative changes at L4-L5 with disc desiccation and small Schmorl's node.


Instruction: Generate impression based on findings.

Input: Metastatic prostate cancer needs reevaluation and comparison to prior examinations with measurements, IRB 09 -- 267 ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No biliary ductal dilation. The hepatic vasculature is patent. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild cortical atrophy bilaterally. Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Right lower quadrant ostomy. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. Fluid collection in the surgical bed measures 5.1 x 4.1 cm in oblique transaxial dimensions (series 4, image 31), near stable.BLADDER: Status post cystectomy.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fatty bone marrow replacement in the pelvis without suspicious lesions.

Output: 1.Postsurgical findings related to prior cystoprostatectomy with a fluid collection in the surgical bed, near stable.2.No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: recently newly diagnosed rectal cancer staging History: rectal cancer Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Enlarged, heterogeneous prostate gland measuring up to 4.1 x 5.3 cm.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: 3, the largest of which measures 1.7 x 1.7 cm at the left aspect of the sigmorectal junction (image 570/series 1209).Lymph nodes outside the mesorectal fascia: 0BOWEL, MESENTERY: Rectal Tumor:Size: 3.3 x 3.5 x 5.9 cm (AP by transverse by craniocaudal) (image 375/series 1209, image 21/series 901)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Upper-thirdCircumference of the rectum involved: 100%Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): No abutment or invasion.MRI T-stage: T3b - Tumor invades 0.5cm to 1cm into perirectal fat or extramural.Tumor Distance to Mesorectal Fascia: 2mm (image 54/series 601).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Rectal cancer with metastatic perirectal lymph nodes.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: SEIZURE ETIOLOGY History: SEIZURE No evidence of acute ischemic or hemorrhagic lesion on the scan.Multiple scattered bihemispheric periventricular white matter FLAIR/T2 high signal intensity lesions are seen, indicating nonspecific small vessel ischemic disease.Slitlike linear tissue defect on the left posterior thalamus, representing chronic infarct with encephalomalacia (series 501, image 17).The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear. Opacification are seen on the right mastoid air cells.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Abnormal LFTs. History of bladder cancer. ABDOMEN:LIVER, BILIARY TRACT: Numerous intermediate T2-weighted signal intensity lesions in the liver incompletely characterized without contrast. The signal intensity is suspicious for metastatic disease. For future reference a right hepatic dome lesion measures 4.3 x 3.4 cm (series 501/46).The common bile duct measures 1.5 cm to the level of the pancreatic head. No filling defect or discrete mass lesion is seen on this limited nonenhanced study. The gallbladder is dilated without specific evidence of inflammation.SPLEEN: Normal size without a focal lesion.PANCREAS: The main pancreatic duct is dilated up to 6 mm to the level of the pancreatic head. Mild pancreatic parenchymal atrophy.ADRENAL GLANDS: Right adrenal gland nodule measuring 2.7 x 1.4 cm, increased from prior CT.KIDNEYS, URETERS: Postsurgical changes from right nephroureterectomy. Simple appearing left renal hyperintensities are incompletely characterized, likely cysts.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Several vertebral bodies demonstrate heterogeneous marrow signal intensity which is incompletely characterized. Correlate with nuclear medicine bone scan findings.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left pleural effusion.

Output: 1.Numerous hepatic masses are increased in size and number, compatible with metastatic disease.2.Increasing right adrenal nodule, suspicious for metastatic disease.3.Common bile and pancreatic duct dilatation to level of the pancreatic head. No discrete mass lesion is seen on this limited nonenhanced study. Correlation with ERCP/EUS is recommended as an underlying lesion and/or stricture is suspected.


Instruction: Generate impression based on findings.

Input: 67-year-old female status post fall with traumatic subarachnoid hemorrhage and small subdural/epidural. Reidentified along the right high parietal convexity, is a high density focus within the cortex with additional focus of high density seen on image 19/28 which is mostly resolved. These findings remain consistent with cortical hemorrhage given the history. No new areas of hemorrhage or associated extra-axial hemorrhage. Otherwise, there is no evidence of mass or edema. Bifrontal prominence of the subdural space within the high convexity appears slightly more dense than expected and may represent chronic bifrontal subdural hematomas or prominent extra-axial space. MRI may be considered for further evaluation as clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Resolving hematomas as described above.2. Prominence of the bifrontal extra axial space may represent chronic subdural hematomas or prominent extra-axial space. MRI may be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: The study is degraded by motion. There are no T2/FLAIR abnormalities. Ventricular size is normal with no midline shift. Basal cisterns are patent. There are no restriction or susceptibility abnormalities. There is no abnormal enhancement. There are no structural abnormalities. Vascular flow voids are normal.There is fluid in the maxillary sinus bilaterally.

Output: 1. There are no structural brain abnormalities. Specifically there is no MRI evidence of AVM.2. Fluid is noted within the maxillary sinuses bilaterally.