Instruction: Generate impression based on findings.

Input: 71 year old man with history of reported hypertrophic CM, longstanding HTN, question of aortic stenosis on recent echocardiogram with exertional dyspnea and chest pain, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 92 g/m2 (normal range 85+/-15), and the LV mass is 177 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is asymmetric hypertrophy of the left ventricle. It is severely hypertrophied in the basal anteroseptum and moderately hypertrophied in the basal lateral wall and the mid to apical septum . The remainder of the ventricle is relatively normal wall thickness. The maximum wall thickness is 18mm. There is patchy late gadolinium enhancement in the basal to mid inferior wall at the RV insertion point which is atypical for previous myocardial infraction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is flow acceleration noted in the LVOT (See below). Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet with thickening/ calcified of the cusps. By planimetry and peak velocity, there is at least moderate aortic valve stenosis. There is additionally mild aortic regurgitation. Mitral ValveThe mitral valve opens widely. There is systolic anterior motion of the mitral valve leaflets associated with mild to moderate mitral regurgitation and a left ventricular outflow tract gradient. 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 ascending aorta measures 37 x 38mm. 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral renal cysts. Moderate right pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: ]1. There is evidence of both aortic valve stenosis and hypertrophic cardiomyopathy. 2. The LV is normal in size with normal systolic function (EF 64%). There is asymmetric hypertrophy of the LV. It is severely hypertrophied in the basal anteroseptum and moderately hypertrophied in the mid to apical septum and the basal lateral wall . The remainder of the ventricle has relatively normal wall thickness. The maximum wall thickness is 18mm. 3. There is patchy late gadolinium enhancement in the basal to mid inferior wall at the RV insertion point which is atypical for previous myocardial infraction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. 4. The RV is normal in size with normal systolic function (EF 56%). 5. At least moderate aortic valve stenosis. 6. There is systolic anterior motion of the mitral valve leaflets associated with mild to moderate mitral regurgitation and a left ventricular outflow tract gradient. 7. Severe left atrial dilation .8. Mild ascending aortic dilation. 9. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache. There is scattered periventricular and subcortical T2/FLAIR hyperintensity, probably chronic microvascular ischemic disease. There is no restricted diffusion to suggest infarct. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. An empty sella is incidentally noted. The calvarium appears diffusely thickened with a heterogeneous appearance. There are mild degenerative changes of the upper cervical spine.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Scattered periventricular and subcortical T2/FLAIR hyperintensity,compatible with chronic microvascular ischemic disease.3. Nonspecific diffuse thickening of the calvarium. In the absence of any known malignancy (for which a bone scan would be recommended), correlate for metabolic abnormality.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, right sideClinical question: r/o disc path, spinal stenosisSigns and Symptoms: back pain with right sciatica; not better with PT Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present. The marrow within the lumbar vertebrae has a somewhat mottled appearance on the T1 and T2 images with multiple foci of focal fatty replacement. These suppress on the fat suppressed images.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a diffuse disc bulge at this level associated with mild to moderate bilateral facet and ligamentum flavum hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is facet and ligamentum flavum hypertrophy present at this level associated with mild anterior subluxation of L3 and L4. There is loss of disc space height 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.A cyst is present along the inferior pole of the right kidney and another one is present along the midportion of the right kidney. Smaller cysts are present in the left kidney.

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


Instruction: Generate impression based on findings.

Input: Clinical question: chronic headaches post head-injury w/o prior imaging. Signs and Symptoms: headache Pre and post enhanced brain MR:No acute intracranial finding and negative diffusion weighted series.There is normal anatomical development and morphology of brain with normal signal intensity on all MRI sequences, including susceptibility sequence.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination. Normal signal void of all major arterial branches are identified.There is no abnormal enhancement of brain or the leptomeninges.There is normal signal intensity of the intracranial venous sinuses with normal pattern of enhancement. Normal signal intensity of calvarium and scalp without abnormal enhancement.Unremarkable images through the orbits and without abnormal enhancement.Normal signal intensity of all paranasal sinuses, mastoid air cells and the middle ear cavities.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 16-year-old female with a history of lymphoma and C. Diff presenting with facial swelling, CNVII deficit, and toe walking on exam. Evaluate meninges and white matter to rule out possible structural etiology, special attention to CN VII. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI IACs:The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. No abnormality of the IACs is appreciated.


Instruction: Generate impression based on findings.

Input: Clinical question: History of head and neck cancer with brain metastases status post SRS, surveillance MRI. Signs and symptoms: None. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates significant interval improvement of postoperative changes of left temporal lobe surgery for removal of tumor. There is significant interval decreased postoperative enhancement at the site with trace residual enhancement. Examination also demonstrates significant interval decreased parenchymal FLAIR hyperintensity at this site.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest new metastatic disease since prior exam. Stable few punctate nonspecific FLAIR hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres. There is revisualization of a tiny left anterior frontal developmental venous anomaly without detectable associated cavernoma.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise for age.Unremarkable calvarium other than expected postoperative changes of prior left sided craniotomy.Unremarkable images through the orbits and including axial fat sat post enhanced images.All paranasal sinuses and bilateral mastoid air cells demonstrate normal pneumatization signal pattern.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Significant interval improvement of postoperative changes of left temporal lobe without residual tumor.3.No detectable metastatic lesion of the brain, leptomeninges or the calvarium.4.Stable few punctate nonspecific FLAIR hyperintensity in bilateral cerebral hemispheres.5.Revisualization of a tiny left anterior frontal developmental venous anomaly without associated cavernoma.


Instruction: Generate impression based on findings.

Input: 75 years, Male, altered mental status, posterior reversible encephalopathy syndrome. Neck pain, rule out stenosis. Brain: There is a focus of restricted diffusion involving the right post central gyrus and right parietal centrum semiovale. There is extensive T2/FLAIR hyperintensity in the bilateral cerebral hemispheres predominantly involving the periventricular and subcortical white matter of the bilateral frontal, parietal, and to a lesser degree temporal and occipital lobes. Small foci of FLAIR hyperintensity within the cortex also noted in the bilateral frontal lobes. Patchy FLAIR hyperintensity is also evident in the brainstem and bilateral cerebellar hemispheres. Multiple lacunar infarcts are also noted within the left greater than right basal ganglia and thalami. There is global parenchymal volume loss. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. There are multiple foci of susceptibility effect involving the basal ganglia, thalami, brainstem, and cerebellum with a distribution favored to be related to chronic hypertension. Additional scattered foci in the lobar distribution such as in the right frontal lobe and left parietal and occipital lobes may be related to amyloid angiopathy.Cervical spine:There is reversal of cervical lordosis centered at the C3-C4 level. Vertebral body heights are maintained. Bone marrow signal is benign. No obvious cord signal abnormality is evident although STIR sequence could not be obtained due to significant patient motion, there by limiting sensitivity for cord signal abnormality. Multilevel degenerative changes are seen which are suboptimally evaluated, individual levels as below:C2-3: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal stenosis. C3-4: Disc osteophyte complex with moderate spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis.C4-5: Disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis and moderate bilateral neural foraminal stenosis, left worse in right.C5-6: Disc osteophyte complex and ligamentum flavum thickening. There is moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.C6-7: Small disc extrusion with mild spinal canal stenosis at this level. There is mild bilateral neural foraminal narrowing.C7-T1: Disc bulge without significant spinal canal stenosis at this level. There is mild left greater than right neural foraminal narrowing.

Output: 1. Small focus of acute infarct in the right parietal lobe.2. Extensive patchy supratentorial and infratentorial T2/FLAIR hyperintensity which is nonspecific and much of which may represent advanced chronic small vessel ischemic disease. Some of these areas (such as in the posterior fossa) may be reversible/indicative of PRES and can be confirmed with follow-up imaging.3. Multiple chronic microhemorrhages involving the basal ganglia, thalami, brainstem, and cerebellum likely related to chronic hypertension. Additional scattered foci of microhemorrhage in the lobar distribution such as in the right frontal lobe and left parietal and occipital lobes may be related to amyloid angiopathy.4. Cervical spine study is motion degraded but demonstrates moderate spinal canal stenosis at the C3-C4, C4-C5, C5-C6 levels. 5. Please note post contrast brain imaging could not be obtained due to significant patient motion. STIR sequence of the cervical spine could also not be obtained, thereby limiting evaluation for cord signal body. No cord signal abnormality is evident within these limitations.Dr. Ali discussed findings with Dr. Sheikh 1120 hrs on 12/8/2015.


Instruction: Generate impression based on findings.

Input: 76-year-old female with chronic hepatitis C. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver. Stable nonspecific subcentimeter T2 hyperintense lesions in the right hepatic lobe, most likely due to cysts. Increased subcapsular arterial enhancement in the left hepatic lobe without corresponding abnormality on additional sequences, most compatible with transient hepatic arterial differences. No focal lesions suspicious for hepatocellular carcinoma.Cholelithiasis without biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lumbar spinal fusion hardware incompletely evaluated.OTHER: No significant abnormality noted.

Output: Cirrhotic liver without focal lesion suspicious for HCC.


Instruction: Generate impression based on findings.

Input: Meningioma status post CyberKnife in May 2014 and orbital pseudotumor. There are postoperative findings related to left suboccipital craniotomy for resection of a meningioma with encephalomalacia in the left cerebellar hemisphere. There is perhaps slight interval decrease in size of the tumor, which now measures up to 16 mm in thickness, previously 20 mm. However, the signal characteristics of the mass have change somewhat, with apparent increased enhancement. There is an unchanged nodular extra-axial lesion that is markedly T2 hypointense with susceptibility effect and mild peripheral enhancement along the floor of the left posterior fossa, adjacent to the craniotomy defect that measures up to 15 mm. There is unchanged mild nonspecific periventricular T2 hyperintensity. There is no evidence of acute infarct or hemorrhage. The ventricular system is stable in size and configuration. There are postoperative findings related to orbitozygomatic craniotomy with persistent diffuse enhancement of the right orbital fat and multiple extra-ocular muscles with associated impingement upon the optic nerve and proptosis, which is not significantly changed, accounting for differences in technique.

Output: 1.Perhaps slight interval decrease in size of the treated left posterior fossa meningioma, with evolution of the enhancement characteristics.2. An unchanged nodular extra-axial lesion min left posterior fossa adjacent to the craniotomy margin may represent an organizing hematoma. 3. Persistent inflammatory process in the right orbit with impingement upon the optic nerve.


Instruction: Generate impression based on findings.

Input: 12 year old female with right anterior trapezial pain. Evaluate for compressive lesion. A marker was placed along the anteromedial aspect of the shoulder near the base of the neck. We see no abnormalities of the musculature deep to this marker. The signal intensity of the musculature is within normal limits. Please note that this study was not protocoled for detailed evaluation of the rotator cuff. We see no abnormal enhancement of the shoulder joint. There is increased signal intensity within the lower scapula and STIR sequences which likely reflects prominent red marrow. The bone marrow signal intensity is otherwise within normal limits.There are prominent level II cervical lymph nodes of the right neck that are incompletely imaged on the coronal STIR sequence, however, on the axial sequences they appear within normal limits. If clinically warranted, MRI of the neck may be considered, particularly if there is palpable lymphadenopathy.

Output: 1. No specific findings to account for the patient's right anterior trapezial pain.2. Prominent level II cervical lymph nodes of the right neck that are incompletely imaged. If clinically warranted, MRI of the soft tissues of the neck may be considered, particularly if there is palpable lymphadenopathy.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There is no evidence of intracranial hemorrhage or acute infarct. There are few scattered small foci of T2 hyperintensity within the supratentorial and infratentorial white matter most compatible with chronic small vessel ischemic disease. There are a few small linear flow voids within the right temporal lobe best seen on series 501 images 17 and 18 with a large associated vein best seen on series 802 image 107. These findings are most compatible with a developmental venous anomaly. 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 unremarkable. There are two moderately sized nasopharyngeal T1 and T2 hyperintense well-defined lesions that measure up to 2.2 cm and are located just anterior to the longus coli muscles. There is resultant eustachian tube obstruction and fluid within the bilateral mastoid air cells.

Output: 1.No evidence acute ischemia.2.Mild supratentorial and infratentorial chronic small vessel ischemic disease.3.Two moderately size cystic lesions within the nasopharynx with eustachian tube obstruction and resultant mastoid air cell fluid. These may represent retention cysts although a contrast enhanced CT or MR of the neck is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: Examination is significantly motion degraded. Again seen is intraparenchymal hemorrhage involving the right temporal lobe with surrounding vasogenic edema. There is restricted diffusion associated with blood products but without evidence of acute infarct surrounding this region. Small subdural hematoma along the bilateral cerebral convexities are noted including along the left anterior frontal region as seen on recent CT. There are additional extra-axial collections along the bilateral cerebral convexities measuring up to 11 mm on the left and 5 mm on the right with predominant CSF signal features; there is mildly increased FLAIR hyperintensity within these bilateral subdural collections although some of this may be artifactual related to motion. Minimal scattered subarachnoid blood products are better appreciated on recent CT given the significant motion degradation on the current MRI.There are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. No obvious underlying mass is evident in the limitations of noncontrast MRI. No significant midline shift, herniation, or hydrocephalus. Global parenchymal volume loss is evident.MRA HEAD

Output: 1. Examination is significantly motion degraded. Again seen is intraparenchymal hematoma in the right temporal lobe with surrounding edema. There are also bilateral acute subdural hematomas which appear superimposed on underlying bilateral chronic subdural hematomas/hygromas. Additional scattered subarachnoid blood products are also again seen. No underlying infarct or intracranial masses are evident. Given the motion degradation and lack of contrast, follow-up MR imaging may be considered as clinically appropriate.2. No findings to suggest an arteriovenous malformation. MR venogram demonstrates a nondominant right-sided venous system with some flow in the right sigmoid sinus and proximal internal jugular vein. Patency of the right transverse sinus and vein of Labbe cannot be confirmed on this study. If repeat examination with sedation cannot be obtained, CTV may be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: 29 years Female (DOB:9/8/1987)Reason: intracranial abnormality? mass? History: HAsPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI 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.

Output: No abnormal mass lesions are appreciated intracranially to explain the patient's headaches.


Instruction: Generate impression based on findings.

Input: 34 years, Male, uncontrolled HIV/AIDS with HIV retinitis and new lesion on CT head. There is a peripherally enhancing lesion involving the right posterior aspect of the right inferior temporal gyrus near the occipital lobe junction with associated T1 hyperintensity and susceptibility indicative of subacute hemorrhage. There is central restricted diffusion which may represent pus. There is mild surrounding edema. The enhancing lesion measures approximately 24 x 8 mm in the axial plane and up to 18 mm in the craniocaudal dimension. Elsewhere in the brain there are multiple scattered linear foci of FLAIR hyperintensity involving the sulci with associated leptomeningeal enhancement. Again seen is prominence of the CSF space involving the posterior fossa which may be related to an arachnoid cyst or mega cisterna magna, without significant mass effect.Additional foci of T2/FLAIR hyperintensity in the bilateral frontal lobes were present previously and are nonspecific. There is no evidence of significant intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. There is moderate chronic mucosal thickening involving the right maxillary sinus and to a milder degree in the right frontal and anterior ethmoid sinus. There is a small left maxillary mucus retention cyst. These findings are similar to prior although the right frontal sinus opacification is improved since 7/30/2015. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.

Output: 1. Multifocal areas of leptomeningeal enhancement and nonsuppression of CSF on the FLAIR sequence in the bilateral cerebral hemispheres are most compatible with meningitis. There is a hemorrhagic lesion involving the right posterior temporal lobe near the occipital junction with enhancement, central restricted diffusion, and mild surrounding edema. This lesion is strongly favored to represent an abscess, although late subacute hemorrhage by itself may also have this appearance as well. No significant associated mass effect. Pyogenic infection as well as atypical organisms are in the differential. 2. Chronic paranasal sinus disease primarily involving the right maxillary sinus. Right frontal sinus opacification is improved since 7/30/2015.


Instruction: Generate impression based on findings.

Input: Yearly follow after resection of an anterior clinoidal meningioma. There are postoperative findings related to right pterional craniotomy with a small amount of unchanged encephalomalacia of the anterior right temporal lobe and the inferior right frontal gyrus and minimal dural enhancement along the superior aspect of the right anterior clinoid process. Otherwise, there is no evidence of measurable tumor in the treatment bed. There is no evidence of intracranial hemorrhage or acute infarct. There are a few unchanged nonspecific scattered small foci of cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are small retention cysts in the left sphenoid and maxillary sinuses.

Output: Postoperative findings without evidence of recurrent anterior clinoid region meningioma.


Instruction: Generate impression based on findings.

Input: Ms. Brown is a 66 year old female with newly diagnosed right breast cancer in two locations. She has a family history of breast cancer. Preoperative MRI is requested at this time. There is heterogeneous amount of fibroglandular tissue in both breasts.There are scattered foci of enhancement seen in both breasts, compatible with mild background parenchymal enhancement. However, no one focus is more suspicious than the rest. In the right upper outer breast, there are two areas of mass-like enhancement identified, that correspond to the two biopsy-proven malignancies. - The first area of mass-like enhancement is in the 11:00 location, measuring approximately 1.6 x 0.9 x 1.5 cm. A biopsy marker clip is seen at the peripheral aspect of this enhancement. - The second area of mass-like enhancement is in the 10:00 location, measuring approximately 1.4 x 1.3 x 1.7 cm. This measures slightly larger on the MRI, likely due to related post-biopsy changes. Of note, a 1.2 cm hematoma with increased T1 signal is identified just abutting the inferior aspect of this area of enhancement. A biopsy marker clip is also seen at the peripheral aspect of this area of enhancement. - Total span of enhancement measures 3.2 x 3.1 x 2.9 cm (AP x ML x CC). The two biopsy clips are separated by approximately 2.0 cm.There is no additional site of abnormal enhancement seen in the right breast. There is no abnormal enhancement seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Biopsy proven multifocal breast cancer in the right breast. No additional MR evidence of malignancy identified. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluate for stroke. Altered mental status, aphasia and worsening of arm weakness. Non-enhanced CT of brain:Images through posterior fossa are unremarkable.Images through the supratentorial brain parenchyma demonstrates very subtle low attenuation of the left frontal cortex with subtle effacement of cortical sulci. This is highly suspect of an acute stroke in follow-up with an MRI is recommended. There is no evidence of hemorrhage. Previously noted old strokes are again identified.No evidence of hydrocephalus or midline shift.

Output: 1.Highly suspected acute nonhemorrhagic cortical stroke of the left frontal lobe with subtle effacement of cortical sulci. Follow-up with an MRI is recommended. 2.Old strokes are identified with no change.3.Above findings were relayed to Dr. Paul Bergl # 2554 utilizing paging tool device on PACS system.


Instruction: Generate impression based on findings.

Input: Presacral lesion on examination. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and presumed bilateral salpingo-oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without acute diverticulitis. No obstruction or bowel inflammation.There appears to be rectal prolapse with soft tissue thickening and enhancement at the anorectal region without a discrete mass comment clinical correlation is recommended.In the presacral space there is a vague 2.1 x 1.9 cm lesion demonstrating mild T2 weighted hypointensity relative to the adjacent fat. It is intrinsically mildly T1 hyperintense uptake with mild postcontrast enhancement. It is unchanged in size when compared to the prior CT (series 3/116).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nonspecific 2.1 cm presacral lesion is stable dating back to 1/29/2015, favoring benignity. 2. Suspected rectal prolapse with soft tissue thickening and enhancement at the anorectal region without a discrete mass, clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: 44-year-old female with knee pain and swelling Alignment is anatomic. Joint spaces are preserved. The knees appear unremarkable for the patient's age bilaterally.

Output: Unremarkable exam for the patient's age


Instruction: Generate impression based on findings.

Input: 14-year-old female with intermittent knee pain x 2 years. MENISCI: The menisci demonstrate normal signal intensity without evidence of tear.ARTICULAR CARTILAGE AND BONE: The tricompartmental articular cartilage is intact. No evidence of osteochondral defect or chondromalacia. The bone marrow signal is normal. No acute fracture identified. LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is normal.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Male 15 years old with Crohn's disease. Evaluate scrotal abscess for tracking or fistula involvement. PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Nondistended and unremarkable.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: An enhancing fistulous tract with surrounding edema extends anteriorly and inferiorly from the right lateral rectal wall along the right aspect of the perineum to the base of the scrotum where it splits into two components. An associated perineal abscess measures 9.1 cm in AP dimension x 5.1 cm CC x 1.2 cm transverse (series 701, image 33 and series 6.1, image 47). There is a second small fistula along the left aspect of the rectum at the 1 o'clock position (series 301, image 32) that does not extend to the skin surface or have an associated fluid collection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a small amount of pelvic free fluid. There is a oval 2.0 x 1.6 cm (series 506, image 368) presacral structure on the left that is non-enhancing and intermediate on T1 and T2 weighted images with restricted diffusion. This may represent an enlarged, likely reactive, presacral lymph node.

Output: A fistula and abscess extends from the right lateral rectal wall to the base of the scrotum. There is a second small fistula along the left rectal wall with no associated abscess.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and weakness. Concern for rotator cuff tear. ROTATOR CUFF: There is a complete tear of the supraspinatus tendon with retraction to the glenohumeral joint. There is moderate atrophy of the supraspinatus muscle. There is also a near-complete to complete tear of the infraspinatus tendon with retraction of fibers to the level of the glenohumeral joint although some fibers inferiorly may extend to the greater tuberosity. There is severe fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon are normal. The subscapularis tendon is thickened indicating tendinosis. The subscapularis muscle appears normal. SUPRASPINATUS OUTLET: Moderate to severe osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa with mild infiltration of fluid into the undersurface of the deltoid muscle. The humeral head is high riding, nearly abutting the undersurface of the acromion. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a moderate sized joint effusion with mild osteoarthritis of the glenohumeral joint. There is degeneration of the glenoid labrum. Small foci of intermediate signal within the glenohumeral joint likely represent synovial or cartilaginous debris. BICEPS TENDON: The tendon of the long head of the biceps within the rotator interval appears thickened and poorly defined, likely representing tendinosis and degenerative tearing. The extra-articular portion of the tendon is situated within the bicipital groove.

Output: Rotator cuff tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: Kyphoplasty 2 weeks ago, now with bilateral leg numbness and worsening weakness There is trace prominence of the central canal in the mid to lower cervical cord, as seen on prior cervical spine study from 2/22/2016. Vertebral body heights in the cervical spine are normal. Again seen is partial fusion of the C3 and C4 vertebral bodies. There is mild reversal of cervical lordosis with apex at the C3-C4 level. There is also mild anterolisthesis of C5 on C6. Alignment is otherwise grossly maintained in the cervical spine. There is mild spinal canal stenosis at the C3-C4 and C4-C5 levels similar to prior. No high-grade spinal canal stenosis in the cervical spine. Again seen is a C6 vertebral body lesion with T1 hyperintensity, which is compatible with a hemangioma.Thoracic vertebral body heights and alignment are maintained. No significant spinal canal stenosis is evident. Trace central canal prominence in the upper and mid thoracic cord also appears grossly similar to prior but can be better assessed on dedicated thoracic study. Intraspinal catheter is again noted.In the lumbar spine, again seen is a severe compression fracture involving the L3 vertebral body with bone marrow edema similar to prior. Interval changes of kyphoplasty are noted. There is moderate to severe spinal canal stenosis at the L2-L3 level similar to prior, and can be better compared with dedicated lumbar spine images. Low-lying conus/distal neural tissue again noted to terminate near the L5 level. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia.

Output: 1. Examination limited to sequences per cord compression protocol. Again seen is moderate to severe spinal canal stenosis at the L2-L3 level which is better assessed on dedicated lumbar spine study. Severe L3 compression fracture again seen, grossly similar to prior, with interval changes of kyphoplasty. Please see separate lumbar spine report.2. No high-grade spinal canal stenosis in the cervical or thoracic spine. Mild spinal canal stenosis at C4-C5 again seen. There is also trace prominence of the central canal/tiny syrinx in the cervical and thoracic cord, better assessed on recent MRI spine study from 2/22/2016. Unchanged appearance of the low-lying conus which extends to the L5 level.


Instruction: Generate impression based on findings.

Input: Left hip pain after fall. Inability to ambulate. The marrow signal intensity of the left proximal femur is normal. There are tiny foci of abnormal signal intensity in the acetabular dome which I suspect are degenerative in etiology. There is a small amount of fluid in the left hip joint, within normal limits. I see no focal injury to the musculature of the left hip.There is extensive signal abnormality noted within the upper sacrum on the large field-of-view images. The right sacral wing is largely replaced with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. There is a bandlike focus of low signal intensity extending vertically through the right sacral wing suggesting an underlying nondisplaced fracture. Similar but slightly less pronounced signal abnormality is noted in the left sacral wing, with findings suggestive of a nondisplaced fracture.Degenerative disc disease affects the lower lumbar spine. Mild osteoarthritis affects the pubic symphysis. There is mild edema-type signal within the subcutaneous fat of the buttocks bilaterally which is nonspecific but could represent a mild contusion.

Output: 1.No evidence of fracture of the left proximal femur or acetabulum.2.Extensive signal abnormality in the upper sacrum is suggestive of nondisplaced fractures involving both sacral wings. I am not certain if these fractures are due to the patient's recent fall or represent insufficiency fractures, but I suspect the former given the degree of edema. Further evaluation with CT may be considered, if clinically warranted. Per the electronic medical record, the patient has been admitted to the hospital. Findings were relayed over the phone to Vanessa Alonso at the time of dictation.


Instruction: Generate impression based on findings.

Input: 82 years, Female, right hemiparesis, evaluate perfusion/stroke.. There is restricted diffusion involving the left posterior frontal corona radiata consistent with acute infarct. There is an area of FLAIR hyperintensity involving the left parietal lobe with gyriform T1 hyperintensity compatible with laminar necrosis and susceptibility effect within this region likely related to mineralization and/or chronic blood products. There is mild enhancement within this region. There is also a tiny focus of restricted diffusion within this region which may suggest ongoing ischemia. There is also a punctate focus of enhancement slightly superiorly involving the left post central gyrus favored to be related to a subacute infarct.There are multiple foci of susceptibility effect in the brain, predominantly involving the bilateral thalami, basal ganglia, and to a lesser degree cerebellum which are favored to be related to chronic hypertension. Additional peripheral foci involving the right temporal lobe and left parietal lobe may be related to amyloid angiopathy.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. No intracranial mass or mass effect. There is global parenchymal volume loss commensurate with patient's advanced age. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are unremarkable.Perfusion images demonstrate relative prolongation of mean transit time at the level of the left inferior frontal lobe and lateral basal ganglia (MTT series 1328 images 13-15) compatible with hypoperfusion in the left MCA territory.

Output: 1. Acute infarct involving the left posterior frontal corona radiata.2. Late subacute to chronic left parietal lobe infarct with evidence of laminar necrosis, mild enhancement, and mild volume loss. Within this region however there is a small cortical focus of restricted diffusion which may suggest ongoing/acute ischemia adjacent to an older infarct.3. Multiple foci of chronic microhemorrhage with distribution predominantly favoring a chronic hypertensive etiology. Few additional peripheral foci of chronic microhemorrhage suggest amyloid angiopathy.4. Perfusion images demonstrate relative prolongation of mean transit time at the level of the left inferior frontal lobe and lateral basal ganglia (MTT series 1328 images 13-15) compatible with hypoperfusion in the left MCA territory. Recent CTA demonstrated stenosis in the left supraclinoid internal carotid and M1 segment of the left middle cerebral artery.


Instruction: Generate impression based on findings.

Input: Clinical question: Any sign of bleed or worsening mass in the head. Signs and symptoms: Weakness Unenhanced CT of brain:Images through posterior fossa demonstrate an old left cerebellar stroke with no interval change.Images through the supratentorial space demonstrate prominence of cortical sulci and ventricular system for patient's age similar to prior exam.Area of low-attenuation involving the white matter of the left posterior temporal and parietal consistent with vasogenic edema/encephalomalacia. The distribution of this finding is fairly similar to prior exam. A subtle mass effect with the above findings. There is revisualization of a mass along the falx on the left in the posterior parietal -- occipital region. This mass appears slightly smaller than prior exam however without dedicated enhanced imaging precise comparison is not possible.No attenuation of periventricular white matter of right hemisphere is similar to prior exam and may represent postradiation change.There is no evidence of intracranial hemorrhage, midline shift or hydrocephalus. Follow-up with an MRI or an enhanced CT is recommended.Stable post craniotomy changes of the left parietal.Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Revisualization of a mass in the left occipital -- posterior parietal lobe with extensive surrounding vasogenic edema/encephalomalacia with no evidence of interval hemorrhage. Without an enhanced study precise comparison is not possible.2.There is no evidence of acute intracranial hemorrhage or midline shift.3.Prominence of ventricular system and cortical sulci for patient of stated age of 56 this is stable since prior exam.


Instruction: Generate impression based on findings.

Input: There is no diffusion abnormality in the brain. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. Mild diffuse enhancement and restricted diffusion is evident involving the calvarium compatible with hypercellular marrow related to known sickle cell disease.MRA HEAD

Output: 1. MRI of the brain appears within normal limits. Specifically no evidence of prior infarct.2. MRA head demonstrates no significant stenosis in the intracranial vasculature.


Instruction: Generate impression based on findings.

Input: Female, 15 years old, with syncope and headache. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with altered mental status, plasma cell leukemia, previous lesions. Evaluate hippocampal lesion and compare size of previous lesions. The previously demonstrated left frontal dural based enhancing lesion has significantly regressed when compared to prior examinations, particularly the exam of 06/15/16. There is no longer any detectable enhancement in this area. The parenchyma which had previously been compressed now shows ill-defined T2 hyperintensity. A small area of extra-axial susceptibility at the site of the prior lesion likely represents hemosiderin staining.Multiple additional smaller dural based enhancing lesions which were evident bilaterally are no longer clearly appreciated. The marrow of the calvarium remains heterogeneously enhancing but there are no longer any extraosseous masslike lesions.Periventricular T2 hyperintensity along the right frontal horn is unchanged relative to the immediate prior examination but has progressed compared to the older study. A few additional punctate foci of FLAIR hyperintensity in the cerebral hemispheres are nonspecific and not significantly changed. No evidence of any hippocampal lesion is seen. No new enhancing lesions are seen. No abnormal extra-axial fluid collections are detected. The ventricular system is normal in size and morphology.The previously demonstrated lesion centered on the right maxillary sinus floor with invasion of the buccal and masticator spaces is partially visualized and does not appear to have changed significantly.

Output: 1.Significant decrease in the size of the previously seen large extra-axial enhancing mass in the left frontal region. A small area of extra-axial hemosiderin staining is seen but no residual pathologic enhancement is detected. T2 hyperintensity within the adjacent frontal parenchyma may represent mild residual edema or gliosis.2.Multiple smaller extra-axial enhancing lesions have also resolved with no residual or new pathologic intracranial enhancement. The marrow of the skull, however, continues to demonstrate heterogeneous enhancement.3.No new intracranial lesions are seen. No specific evidence of any hippocampal lesion is detected.4.The partially visualized lesion involving the right maxillary sinus, buccal space and masticator space does not appear to have significantly changed.


Instruction: Generate impression based on findings.

Input: History of prostate cancer with PSA of 22. Recent biopsy with Gleason 3+3 left mid and apex. PELVIS:PROSTATE:Prostate Size: 4.4 x 2.9 x 3.9 cmPeripheral Zone: There are scattered areas of increased T1 signal most prominent in the left peripheral zone compatible with blood products from recent biopsy which somewhat limits evaluation of enhancement. Within the lateral aspect of the left mid peripheral zone, there is a 3 x 3 mm focus of decreased T2 and ADC (series 704, image 364) signal suspicious for neoplasm. No additional focal suspicious lesions are identified within the peripheral zone.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Single 3 x 3 mm focus of signal abnormality in the lateral aspect of the left mid peripheral zone suspicious for neoplasm.2.Intraprostatic blood products likely from recent biopsy which somewhat limits evaluation of enhancement.


Instruction: Generate impression based on findings.

Input: Evaluate for rotator cuff tear ROTATOR CUFF: There is a partial tear articular surface of the supraspinatus without contraction. Note is made of muscle atrophy. There is also a partial tear of the infraspinatus at its insertion. Subscapularis is unremarkable. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Muscle atrophy of the supraspinatus with partial articular surface tear. Also partial tear of the infraspinatus at its insertion.


Instruction: Generate impression based on findings.

Input: Male, 20 years old. Shoulder pain. Evaluate for posterior labral tear. ROTATOR CUFF: There is minimal streaky intermediate signal intensity in the distal subscapularis tendon, which may represent tendinosis, but this is equivocal. The rotator cuff otherwise appears normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No fluid or gadolinium is seen in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The glenoid labrum appears normal. Specifically we see no posterior labral tear.BICEPS TENDON: The tendon of the long head of the biceps appears normal.

Output: Minimal streaky intermediate signal in the distal subscapularis tendon may represent tendinosis, but we otherwise see no findings to account for the patient's pain. Specifically, the posterior labrum appears normal.


Instruction: Generate impression based on findings.

Input: Elbow pain LIGAMENTS: No significant abnormality noted.TENDONS: Particular attention was placed overlying the triceps insertion given the marker. Tendons are intact, however mild induration of the superficial soft tissues are observed with minimal thickening and signal abnormality in the subcutaneous fat. The triceps tendon specifically is grossly unremarkable and uniform, however mild overlying artifact limits the exclusion of subtle abnormality and possible minimal tendinitis. No focal discrete masses or abnormality is otherwise discerned in the surrounding overlying superficial subcutaneous soft tissues.ARTICULAR SURFACES AND BONE: Osseous structures are well visualized and unremarkable. Marrow signal is normal SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Minimal subcutaneous soft tissue induration without underlying abnormality of the tendons or deep muscular compartments. Osseous structures are normal. Please correlate with physical exam


Instruction: Generate impression based on findings.

Input: A multilobulated aneurysm arises from the left carotid terminus and projects anteriorly and superiorly. The lesion measures 6 to 7 mm in length and up to 5 mm in width at its midpoint. The exact configuration of the neck is difficult to assess due to technical limitations, but it appears to be narrow perhaps measuring as little as 2 mm.No additional aneurysms are detected. No areas of significant vascular stenosis or occlusion are seen.

Output: A 7 x 5 mm multilobulated aneurysm is present at the left ICA terminus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right hip pain ACETABULAR LABRUM: Evaluation of the labrum is limited given the lack of intra-articular contrast. Within these limits, there is suggestion of tearing of the anterior labrum without evidence of detachment.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: There is mild increased signal intensity of the gluteus minimus tendon at its insertion upon the greater trochanter. There is no evidence of a full-thickness tear. A mild amount of increased signal intensity is also seen overlying the greater trochanter. The musculature of the pelvis is otherwise normal in caliber and signal.ADDITIONAL

Output: 1. Mildly increased signal intensity of the gluteus minimus tendon at its insertion upon the greater tuberosity suggesting tendinosis or partial thickness tearing. A mild amount of trochanteric bursitis is also present.2. Evaluation of the labrum is limited given the lack of intra-articular contrast however within these limits, there is a suspected anterior labral tear.


Instruction: Generate impression based on findings.

Input: A 47 year old female with hyperlipidemia, coronary artery disease with a non-ST elevation myocardial infarction (8/2015) with significant stenosis of the proximal circumflex which was opened with a stent. Because of recurrent chest pain a new catheterization on 9/2015 showed patent stent with no other stenosis. Referred to stress cardiac MRI for further evaluation.MEDICATIONS: amlodipine, aspirin, atorvastatin, brilinta, clonazepam, cymbalta, metoprolol, nitrostat. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Quantitative analysis by myocardium perfusion reserve index showed normal values (1.73).Viability/ Myocardial ScarThere is late gadolinium enhancement in the inferior wall at the base and middle segments and in the infero-lateral wall at the base. This finding is in a coronary pattern and compatible with an infarct. This high signal enhancement involves approximately 80% of the thickness of the wall and thus suggest likely no viability in this area. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 57 ml (normal range 31+/-10), the LV mass index is 43 g/m2, and the LV mass is 75 g. There is hypokinesis in the inferior wall at the base and middle segments and in the infero-lateral wall at the base. There is no intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsBilateral breast prosthesis.

Output: 1. During hyperemia, no perfusion defects were present. Quantitative analysis by myocardium perfusion reserve index showed normal values (1.73).2. There is late gadolinium enhancement in the inferior wall at the base and middle segments and in the infero-lateral wall at the base. This finding is in a coronary pattern and compatible with an infarct. This high signal enhancement involves approximately 80% of the thickness of the wall and thus suggest likely no viability in this area. 3. Normal LV size and systolic function (LVEF 53%). There is hypokinesis in the inferior wall at the base and middle segments and in the infero-lateral wall at the base. 4. Normal RV size and systolic function (RVEF 60%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Lumbar back pain with left sided radicular symptoms, prior L5 diskectomy. There is multilevel degenerative spondylosis. In particular, at L3-4, L4-5, and L5-S1, there are small disc bulges with annular fissures, with mild spinal canal narrowing and perhaps impingement upon the nerve roots in the left lateral recess at L4-5 and L5-S1 levels. The vertebral column alignment is within normal limits. The vertebral body heights are preserved, aside from a small intravertebral disc herniation in the inferior endplate of L5. The vertebral bone marrow signal is unremarkable, aside form degenerative endplate alterations at L5-S1. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative spondylosis. In particular, at L3-4, L4-5, and L5-S1, there are small disc bulges with annular fissures, with mild spinal canal narrowing and perhaps impingement upon the nerve roots in the left lateral recess at L4-5 and L5-S1 levels.


Instruction: Generate impression based on findings.

Input: Pain, clinical suspicion for soft tissue mass. There is soft tissue fullness surrounding the dorsal and volar aspect of the first interphalangeal joint. This is nonspecific and a soft tissue mass is not excluded. If there is clinical suspicion for a mass, an MRI is recommended for further evaluation.Minimal arthritic changes are noted at the first CMC joint, otherwise alignment and joint spaces are maintained.

Output: Nonspecific soft tissue fullness surrounding the first IP joint. If there is clinical suspicion for a soft tissue mass, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: There is no evidence of cervical or axillary mass or lymphadenopathy. There is no abnormal signal or enhancement involving the right brachial plexus. The visualized cervical spine is unremarkable.

Output: No evidence for right brachial plexus abnormality.


Instruction: Generate impression based on findings.

Input: cT4a N2c right oral tongue squamous cell carcinoma treated with induction chemo on protocol 12-1712. There is a an ill-defined lesion centered in the right oral tongue, with slight extension across the midline, which measures approximately 25 x 30 mm in axial cross-section, previously 30 x 45 mm. There is also interval decrease in size of a necrotic left level 1B lymph node, which measures 10 x 12 mm in axial cross-section, previously 14 x 17 mm, a left level 4 lymph node measures 7 x 10 mm, previously 9 x 12 mm, and a right level 2A lymph node measures 10 x 24 mm, previously 11 x 25 mm., for example. There is a punctate left thyroid cyst. The salivary glands, orbits, and imaged intracranial structures are unremarkable. There are small posterior disc-osteophyte complexes at C5-6 and C5-6 and reversal of the usual cervical lordosis.

Output: Interval decrease in size of the right oral tongue squamous cell carcinoma and associated lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 55 year old woman with AL amyloidosis and cardiac involvement, referred for interval assessment of cardiac amyloid. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 142 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 50 g/m2 (normal range 67+/-11), and the LV mass is 93 g (normal range 114+/-24). There is mild concentric LVH (IVSd=12mm). There are no regional wall motion abnormalities present. The native myocardial T1 relaxation time is 1160ms in the basal septum. Based on native myocardial T1 mapping, the T1 time is moderately elevated throughout the ventricle. This is elevated, indicative of an infiltrative process (such as amyloid). The T1 time is not significantly different from the prior cardiac MRI on 6/9/15 (1150ms). Left AtriumThe left atrium is normal in size. There is lipomatous hypertrophy of the inter-atrial septum.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 104 ml (normal range 110+/-24), the RV end systolic volume index is 19 ml/m2 (normal range 22+/-8), and the RVESV is 35 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%. 2. The native myocardial T1 relaxation time is 1160ms. This is elevated, indicative of an infiltrative process (such as amyloid). The T1 time is not significantly different from the prior cardiac MRI on 6/9/15 (1150ms). 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%.4. Overall, there is no significant change from prior study on 6/9/15.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is an unchanged 12 mm lesion within the left parietal cortex and subcortical white matter that demonstrates heterogeneous T2 signal with surrounding T2 hypointensity. There is also an unchanged 6-mm T2 hyperintense exophytic lesion within the right frontal bone just superior to the orbit. 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 paranasal sinuses are unremarkable.

Output: 1.Unchanged 12 mm left parietal cortical/subcortical cavernous malformation.2.Unchanged 6 mm right frontal bone presumed hemangioma.


Instruction: Generate impression based on findings.

Input: Known metastatic thoracic vertebral body metastasis follow-up. Redemonstration of the T7 vertebral metastasis especially on the right and more on the posterior compartment. Specifically the lesion is involving posterior 1/3 of T6 vertebral body extends up to the level of midline the lesion involves right side pedicle, superior and inferior articular process and right side lamina, no change since prior exam. The lesion shows subtle enhancement but most of the lesion shows low signal intensity on both T1 and T2 weighted images indicating sclerotic lesion, again no change since prior exam. Subtle high signal intensity lesion on the right lower lobe on T1 weighted image around T6 level does not show any significant interval change since prior exam.There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. Redemonstration of T6 metastatic lesion, no significant interval change since prior exam.2. No change of right lower lobe lesion since prior exam.3. No evidence of new lesion on this scan.4. Normal spinal cord and no evidence of spinal stenosis.


Instruction: Generate impression based on findings.

Input: 53 year old woman with history of palpitations, LV dysfunction and previous non-sustained ventricular tachycardia who presents for cardiac MRI to evaluate for possible etiologies of her cardiomyopathy. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 39%, the LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), the LVEDV is 179 ml (normal range 109+/-23), the LV end systolic volume index is 57 ml/m2 (normal range 18+/-5), the LVESV is 110 ml (normal range 31+/-10), the LV mass index is 49 g/m2 (normal range 67+/-11), and the LV mass is 94 g (normal range 114+/-24). There is global hypokinesis. There is no definitive areas of late gadolinium enhancement to suggest the presence of underlying focal myocardial fibrosis, inflammation, or infiltration. The global relative enhancement and T2-STIR ratios are both within normal limits. However, the inversion time on the TI scout is lower than expected and the native myocardial T1 time is moderately elevated (between 1130 and 1160ms) throughout most of the myocardium, which is elevated, and the extracellular volume fraction is 50%, which is very elevated. The findings suggest that there may be a significant increase in the extracellular volume due to diffuse fibrosis, inflammation, or infiltration.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 34%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 82 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 no significant mitral regurgitation. There is thickening of the anterior mitral leaflet tip. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mildly dilated left ventricle with moderately reduced systolic function (39%), with global hypokinesis.2. There is no definitive areas of late gadolinium enhancement to suggest the presence of underlying focal myocardial fibrosis, inflammation, or infiltration. The global relative enhancement and T2-STIR ratios are both within normal limits. However, the inversion time on the TI scout is lower than expected and the native myocardial T1 time is moderately elevated (between 1130 and 1160ms) throughout most of the myocardium, which is elevated, and the extracellular volume fraction is 50%, which is very elevated. The findings suggest that there may be a significant increase in the extracellular volume due to diffuse fibrosis, inflammation, or infiltration. Cardiac PET may be helpful to determine if these findings are secondary to an inflammatory process.3. Normal size right ventricle with moderately reduced systolic function (EF 34%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 64-year-old woman with recurrent herniated disks in the lumbar spine with sudden recurrence leg, buttock, and back pain. She has a history of L4-5 fusion and L5-S1 microdiscectomy. There are five lumbar type vertebral bodies are present. There is mild retrolisthesis of L5 on S1 and straightening of the normal lumbar lordosis. Vertebral body heights are well-maintained. There are postoperative changes of L4-5 fusion and laminectomy which appear unchanged. At L5-S1 there are findings compatible with interval surgery likely correlating with microdiscectomy. No focal marrow signal abnormality is appreciated. The conus medullaris terminates at L1. A prominent Schmorl's node is noted at T12.T12-L1 and L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: Mild laterally bulging disc and very mild bilateral neural foraminal narrowing which does not appear significantly changed.L3-L4: There is diffuse disc bulge, facet joint hypertrophy and ligamentum flavum thickening resulting in mild left and moderate right neural foraminal narrowing and mild to moderate spinal canal stenosis.L4-5: Status post L4-5 laminectomy, posterior fusion and placement of interbody cage device. The spinal canal is widely patent and there is no significant compromise to the neural foramina.L5-S1: Persistent left paracentral zone disc protrusion appears broader than on the prior exam. Disc bulge, facet joint hypertrophy, and ligamentum flavum thickening with mild spinal canal narrowing and severe bilateral neural foraminal narrowing.Simple appearing cysts are seen in the left kidney. There is mild atrophy of the paraspinal muscles.

Output: 1.Status post L4-5 laminectomy and fusion.2.Status post L5-S1 discectomy with residual/recurrent left paracentral disc protrusion. There is severe bilateral neural foraminal narrowing and mild spinal canal stenosis at this level.


Instruction: Generate impression based on findings.

Input: 57-year-old female with recurrent shoulder pain despite conservative therapy. Assess for labral tear. ROTATOR CUFF: There is supraspinatus and infraspinatus muscles and tendons appear intact. There is mild intermediate signal abnormality and thickening of the supraspinatus tendon consistent with mild tendinosis. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid is identified within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint with a slight impression on the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. No articular cartilage defects are identified. The glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Mild rotator cuff tendinosis without evidence of rotator cuff or labral tear.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: The lateral meniscus is intact. There is blunting of the posterior horn of the medial meniscus with increased signal intensity representing complex tearing which includes a radial component and extends to involve the body.ARTICULAR CARTILAGE AND BONE: There is particular cartilage of the lateral compartment appears intact although there are some areas of heterogeneity along the intercondylar notch suggesting some thinning and degeneration. Note is also made of small notch osteophytes which impinge upon the ACL. The articular cartilage of the medial compartment demonstrates areas of full-thickness loss along the medial femoral condyle posteriorly with associated degenerative subchondral marrow changes. The articular cartilage of the patellofemoral compartment demonstrates a small partial-thickness defect of the medial patellar facet but otherwise there are no full-thickness defects.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the medial meniscus involving the posterior horn and body.2. Areas of full-thickness cartilage loss of the medial femoral condyle. There are no full-thickness defects identified within the patellofemoral or lateral compartments.


Instruction: Generate impression based on findings.

Input: 48-year-old male patient with history of bladder cancer status post partial cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Postsurgical findings of partial cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Again seen is a nonenhancing fluid collection of the right inguinal region that measures 2.1 x 1.4 cm (series 12 image 58), unchanged.

Output: 1.No evidence of metastatic disease.2.Stable right inguinal fluid collection, which may represent a lymphocele.


Instruction: Generate impression based on findings.

Input: 54-year-old with history of a right lumpectomy for ADH in 2014. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Mild postsurgical distortion in the right breast underlies the scar marker. A stable benign morphology mass in the right inner breast is compatible with a cyst as is seen on prior MRI.Benign appearing lymph nodes are projected over the left axilla.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Finger trauma. DIP joint Diffuse mild soft tissue swelling without an associated underlying osseous abnormality. Specifically no fracture or malalignment. In light of the patient's history of a bony prominence, this may represent a soft tissue abnormality, MRI may be helpful if a ligamentous or soft tissue injury is suspected.

Output: Mild soft tissue swelling


Instruction: Generate impression based on findings.

Input: Anal pain. Rule anal abscess. PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: There is a 2.7 x 2.6 cm low-density collection adjacent to the anal verge which is suspicious for a small abscess (image 66; series 3). This is difficult to appreciate on this unenhanced study. I would recommend either an enhanced CT or MRI for further evaluation as clinically indicated to confirm this finding.OTHER: No significant abnormality noted

Output: Possible perianal abscess as described above.The ER was notified of this finding at the time of final dictation.


Instruction: Generate impression based on findings.

Input: Reason: assess stenosis History: assess stenosis The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient is status post anterior fusion at C4, C5 and C6.A T1 hyperintense 10-mm lesion within the T2 vertebral body probably represents a vertebral body hemangioma.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes at this level which appear smaller when compared to the previous.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Status post cervical spine surgery. There is no significant compresses spinal canal or neural foramina of the cervical spine at this time.


Instruction: Generate impression based on findings.

Input: 52 years Female (DOB:3/28/1964)Reason: assess for lesion History: patient had a fall in 2014, was put on plavix by OSH but reports she did not have a stroke. Also having post-concussive headache.PROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This has not changed significantly when compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. These appear to be relatively stable compared to the prior exam from last year.


Instruction: Generate impression based on findings.

Input: Restaging lung cancer There is no definite evidence of intracranial metastatic disease. There is a 5 mm focus of enhancement in the left superior parietal lobule seen only on the sagittal post gadolinium series 1101, image 10, and favored to represent artifact. Unchanged punctate foci of susceptibility, likely representing chronic blood products or mineralization, are noted in supra- and infratentorial locations at sites of prior metastases. There is no mass effect or midline shift. There is mild cerebral volume loss with extensive white matter T2 hyperintensity, which appears more confluent in the parietal lobes compatible with chronic small vessel ischemic changes and probable superimposed post treatment changes. There is no restricted diffusion, evidence for acute intracranial hemorrhage or extra-axial collection. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: There is no definite evidence of intracranial metastatic disease. There is a 5 mm focus of enhancement in the left superior parietal lobule seen only on the sagittal post gadolinium sequence and is favored to represent artifact. Consider short-term follow-up for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: 52 year old woman with history of diabetes, hypertension and hyperlipidemia referred for cardiac MRI stress to evaluate for ischemia. MEDICATIONS: Aspirin, Insulin, Metformin, Atenolol, Atorvastatin, Lisinopril and Nitro First Pass PerfusionDuring hyperemia, no perfusion defects were present. There was dark rim artifact noted.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 59 ml/m2 (normal range: 65+/-11), the LVEDV is 119 ml (normal range 109+/-23), the LV end systolic volume index is 20 ml/m2 (normal range 18+/-5), the LVESV is 39 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 80 g. There are no regional wall motion abnormalities present. There is no LV thrombus present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 59 ml/m2 (normal range 69+/-14), the RVEDV is 118 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 51 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial 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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and hyperdynamic systolic function (LVEF 67%).4. Normal RV size and systolic function (RVEF 57%).


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right knee was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 20 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1:05 min

Output: Successful gadolinium injection of the right knee.


Instruction: Generate impression based on findings.

Input: 77-year-old male with history of stroke. Now with mental status changes. Evaluate for bleed/mass Large low attenuation area involving the left cortical and subcortical temporoparietal lobe in the territory of the left MCA consistent with encephalomalacia. MRI recommended for further evaluation if clinical concern remains for acute stroke. There is no evidence for mass or hemorrhage. There is associated ex vacuo dilatation of the left lateral ventricle.The 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: Chronic left MCA infarct. MRI recommended for further evaluation if clinical concern remains for acute stroke.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion, especially on postcontrast images, particularly the 3-D T1 post contrast images. Within these limitations, there has been interval decreased size and conspicuity of multiple scattered intra-axial enhancing supratentorial metastases compared to the prior MRI, consistent with the improved appearance of areas of associated low density vasogenic edema on recent CT. For example, the previously referenced left inferior parietal lobule lesion now measures 4 x 6 mm on 13 101/25, compared to previous remeasurement of 6 x 11 mm on prior 10/11. There is slight increased conspicuity of susceptibility associated with a right posterior frontal subcortical lesion which may indicate minimal microhemorrhage. Overall, extensive abnormal T2/FLAIR hyperintensity surrounding enhancing lesions is decreased, with decreased localized mass effect.The ventricles and sulci are prominent, consistent with mild-moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There is no new pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Fluid opacification of right much greater than left mastoid air cells is noted.

Output: 1.Motion limited 3-D T1 post contrast images, although with overall improved appearance of scattered metastatic lesions and decreased associated vasogenic edema.2.Slight increased conspicuity of susceptibility associated with a right posterior frontal lobe white matter metastatic lesion which may indicate minimal interval microhemorrhage.3.Stable underlying moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 31-year-old female with posterolateral knee pain MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is within normal limits. The bone marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact. ADDITIONAL

Output: Mild asymmetry of the trochlear facets and edema in the superolateral aspect of Hoffa's fat pad, which can be associated with patellofemoral instability, but is of uncertain clinical significance in this patient. The knee otherwise appears normal.


Instruction: Generate impression based on findings.

Input: 65-year-old female with bilateral breast masses on recent mammographic and ultrasound examination presents for Alan Penn research MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Left breast:Note is made of an 6 x 6 x 8 mm (AP x TR x CC) heterogeneously enhancing irregular mass at the 2 o'clock position of the left breast which demonstrates washout kinetics on dynamic contrast-enhanced images. This mass corresponds to the suspicious mass detected on the recent mammogram and ultrasound study.Additionally note is made of a 9 x 6 x 8 mm (AP x TR x CC) spiculated enhancing mass at the 5 o'clock position of the left breast at mid depth which demonstrates washout kinetics on dynamic contrast enhanced images. This mass is mammographically occult.There one abnormal left axillary lymph nodes measuring 14 x 9 x 12 mm (AP x TR x CC).Right breast:Note is made of a 10 x 9 mm nonenhancing lobulated mass at the 6 o'clock position of the right breast which demonstrates decreased signal abnormality on T2-weighted images, consistent with a benign etiology. This benign mass corresponds to the mass detected on the recent mammographic and ultrasound study. There is no evidence of right axillary lymphadenopathy.

Output: 1. Two suspicious masses in the left breast, one of which corresponds to findings on recent ultrasound examination, and the other of which is mammographically occult. Both masses were detected on ultrasound later today and ultrasound guided biopsy was performed.2. One abnormal left axillary lymph node. Ultrasound guided biopsy was performed later today. 3. Benign morphology non enhancing mass at the 6 o'clock position of the right breast corresponding to the findings on recent mammographic and ultrasound examination. Because this is highly likely benign, ultrasound guided biopsy was NOT performed.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Upper extremity weakness. History of osteogenesis imperfecta with developmental delay, and severe myopathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with right-sided lumbar back pain. A mild scoliotic curvature of the thoracic lumbar spine is seen. Alignment is otherwise unremarkable. Vertebral body height and morphology are normal.Hemangiomas are present within the T10 and L1 vertebral bodies. There may be mild fatty degenerative signal abnormality along the superior L4 endplate. Note is made, however, of STIR hyperintense signal within the right L4 pedicle (see image 17 series 4) compatible with edema. This is seen in the context of marked facet arthropathy at L4-5.The visualized spinal cord and conus are unremarkable. Additional details pertaining to the spinal canal are as follows:T12-L1: L1-2: Facet hypertrophy with small effusions. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. Mild left foraminal narrowing.L3-4: Facet hypertrophy, worse on the left, and ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal stenosis. Severe left and moderate right foraminal narrowing. L4-5: Marked bilateral facet hypertrophy. Ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. L5-S1: Marked bilateral facet hypertrophy. Mild bulging disc. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: 1.Marked facet arthropathy is evident at L4-5. Edema within the right L4 pedicle may be reactive to this arthropathy.2.Moderate to severe posterior element hypertrophy is seen at additional levels as above.3.Relatively mild degenerative disc disease is seen without evidence of high-grade spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: Patient with h/o scalp lesion that has increased in size over the last year. Patient presents today with new neck mass, please evaluate. Brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are subdural effusions present bilaterally and symmetrically measuring up to 9 mm in thickness within the supratentorial brain there are subdural effusions in the posterior fossa measuring up to 10 mm in thickness. These are likely related to brain atrophy.There is a mass present along the scalp soft tissues extending to the level of the calvarium just behind the level of the coronal suture eccentric to the left side just to the left of midline measuring 50 x 22 mm in sagittal dimensions and 60 x 22 mm in coronal dimensions. It does not invade the marrow. It is visually contiguous with the calvarium.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus which has high signal on T1 and intermediate signal on T2 suggestive of inspissated secretions.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Neck:There is a 36 x 26 mm axial dimension mass at the left posterior triangle which abuts the left carotid sheath at the level of the angle of the mandible. It has some heterogeneous enhancement. It is heterogeneous in signal on T1 and T2-weighted imaging. It is well-circumscribed. It is bright on diffusion-weighted imaging and low signal on ADC map suggesting diffusion restriction.There is a 20 x 13 mm axial dimension lesion just behind the left submandibular gland which has similar signal characteristics to the above described lesion. Smaller similar lesions are present in the right submandibular space just behind the submandibular gland measuring 15 x 7 mm and scattered elsewhere.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact . There are degenerative changes present in the cervical spine with narrowing of the spinal canal at C3-4, C4-5, C5-6 and C6-7 suspicious for spinal stenosis. There is also suspicion for multilevel neural foramen encroachment of exiting nerve roots.Diffuse marrow replacement in the visualized portions of the cervical spine is a nonspecific finding which could relate to anemia, lymphoproliferative disorder, or chronic disease.

Output: 1.There is a mass present within the scalp soft tissues adjacent to the left parietal bone. Although it abuts the left parietal bone, there is no convincing evidence that it invades it. If clinically appropriate a CT of the head may be useful in determining whether there is calvarial erosion.2.A large mass in the suprahyoid neck along the posterior triangle on the left side just behind the left carotid sheath. This location would indicate this most likely represents lymphadenopathy. An additional similar lesion in the left submandibular space is also suspected to represent lymphadenopathy. Smaller lymph nodes not meeting size criteria for adenopathy or present throughout the soft tissues of the neck.3.There are multilevel degenerative changes present cervical spine with findings suspicious for spinal stenosis at multiple levels and multilevel neural foramen encroachment.4.Diffuse marrow replacement in the visualized portions of the cervical spine is a nonspecific finding which could relate to anemia, lymphoproliferative disorder, or chronic disease.


Instruction: Generate impression based on findings.

Input: Left breast ADH underwent a recent MRI that showed areas of non-Mass enhancement in the left upper, outer quadrant, corresponding to the calcification seen on mammogram. Enhancing, lobulated mass right breast 12 o'clock position measuring 15 mm is noted for which second look ultrasound is recommended. Dr. Chhablani recommends a left breast second look ultrasound to evaluate any suspicious area that can be targeted by an ultrasound-guided biopsy. A targeted bilateral breast ultrasound was performed. Right breast 12 o'clock position does not demonstrate a correlate to the enhancing mass on MRI. Clip is identified in the left upper, outer quadrant from prior stereotactic biopsy. Hypoechoic area with calcifications are seen adjacent to the clip approximately, measuring 1.6 x 0.7 by 2.1 cm with increased blood flow.

Output: No correlates identified to the enhancing mass seen on MRI in the right breast 12 o'clock position, MR guided biopsy is recommended.Suspicious hypoechoic area's with calcifications identified on ultrasound adjacent to the clip, ultrasound guided core biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with decreased movement of the left upper and lower extremity, history of TIA. Evaluate for past stroke. Please note that some sequences were omitted as the patient required to terminate the examination early due to chest pain.No restricted diffusion is seen. No areas of significant parenchymal signal abnormality, edema or mass effect are detected. No large acute intracranial hemorrhage is suspected. No abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology. Patchy mucosal thickening and/or secretions are seen in the ethmoid air cells.

Output: 1.No evidence of acute or chronic ischemic injury is seen.2.No other specific findings are demonstrated which would account for the patient's symptoms.