Instruction: Generate impression based on findings.

Input: Pain and weakness. Question of rotator cuff tear. ROTATOR CUFF: There is mild thickening and increased signal intensity of the supraspinatus and infraspinatus tendons indicating mild tendinosis. Additionally, there is insertional intrasubstance tearing involving the posterior fibers of the supraspinatus tendon and perhaps anterior fibers of the infraspinatus tendon. This measures approximately 8 mm in the AP dimension and spans a majority of the width of the tendon but does not appear to disrupt the articular or bursal surface fibers. There is no atrophy of the supraspinatus or infraspinatus muscles. The teres minor and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. We see no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is no joint effusion. There is detachment of the superior aspect of the anterior labor from the underlying glenoid which may represent variant anatomy rather than a tear. The inferior labrum is normal.BICEPS TENDON: The biceps tendon is intact.

Output: 1. Rotator cuff tendinosis and concealed insertional tear as described above.2. Mild acromioclavicular joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: Retroclival mass is better assessed on recent cervical spine MRI dated 3/25/2016. Images of the thoracic spine again demonstrate postoperative changes of laminectomy and posterior spinal fusion from T3 to T6. Susceptibility artifact limits evaluation of the surrounding structures. Compared to prior thoracic spine study dated 9/18/2015 there is slight increase in size of enhancing dural based mass with low T2 signal extending from T1 to the T4 levels. The increased thickening measures for example approximately 7 mm at the T2 level, previously 6 mm, and approximately 8-9 mm at the T3-4 level, previously 4 mm (measured in the sagittal plane). Craniocaudal extent is not significantly changed. There is slight increase in effacement of the dorsal thecal sac and anterior displacement of the cord. There is up to mild to moderate spinal canal stenosis at the T2 and T3-T4 levels. No evidence of frank cord compression or cord signal abnormality.There is trace grade 1 anterolisthesis of T2 on T3 which is unchanged. Exaggeration of the thoracic kyphosis is again seen. Mild multilevel degenerative changes are again seen including disc desiccation at multiple levels and small disc bulges involving the lower thoracic spine. There is no significant associated spinal canal or neural foraminal stenosis.

Output: Compared to prior thoracic spine MRI study dated 9/18/2015, there is slight increase in dorsal dural-based thickening involving the upper thoracic spine suspected to represent mild progression of known idiopathic pachymeningitis. There is associated increase in effacement of the dorsal thecal sac without evidence of high-grade spinal canal stenosis or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with history of grade 3 meningioma status post radiation therapy, status post biopsies showing radiation necrosis, with recent development of orbital lesions. Now on steroids. Redemonstrated are surgical findings related to prior wide left pterional craniotomy. Patchy gyriform enhancement with scattered susceptibility along the left frontal brain parenchyma is redemonstrated showing no significant interval change. Ependymal enhancement along the left frontal horn, and a few additional disparate foci of enhancement including within the left posterior temporal lobe, are also unchanged. The degree of white matter T2 hyperintensity associated with the left frontal parenchymal lesions and along the left ventricular atrium is stable to slightly improved.Nodular enhancing tissue is again seen within the left middle cranial fossa with perhaps some extension extracranially into the infratemporal fossa. This lesion appears to incorporate or at least indent the adjacent left temporal parenchyma. This lesion continues to measure approximately 20 x 14 mm in the axial plane and has not significantly changed in size.Redemonstrated is enhancing tissue within the left orbital apex extending posteriorly to involve the cavernous sinus. The overall size of this lesion is stable to slightly smaller when compared to prior examinations measuring up to 12 mm thickness in the coronal plane. Of note, however, the prominent central nonenhancing component which became evident on the prior examination has either filled or collapsed upon itself.

Output: 1.Stable pattern of patchy gyriform enhancement and associated parenchymal T2 signal abnormality within the left frontal lobe and, to a lesser extent, a few other disparate left cerebral regions. These findings remain compatible with treatment effect.2.Stable appearance of a nodular region of enhancing soft tissue within the left middle cranial fossa. This lesion could represent either treatment effect or residual/recurrent meningioma.3.A soft tissue process involving the left orbital apex and cavernous sinus shows little if any significant interval change in size. The pattern of enhancement, however, has changed in that the previously seen central hypoenhancing component has either filled in or collapsed upon itself.


Instruction: Generate impression based on findings.

Input: 32-year-old female with BRCA mutation and a strong family history of breast cancer. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.Multiple cysts are present in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: evaluate for ligament/tendon damage History: effusion, instability, knee giving out, increased patellar mobility. Due to the patient's body habitus, the high-resolution knee coil could not be used and the flex large array coil had to be used, resulting in slightly suboptimal image quality.MENISCI: Given the aforementioned limitations, the medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Mild edema within the posterior aspect of the lateral tibial plateau and also more anteriorly within the lateral femoral condyle, representing bone contusion. Evaluation of the articular cartilage is suboptimal, but we see no gross defects. The femoral trochlea is slightly shallow which may represent mild dysplasia.LIGAMENTS: The anterior cruciate ligament is poorly defined compatible with full-thickness tear. The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: The visualized components of the extensor mechanism are intact.ADDITIONAL

Output: ACL tear with associated bone contusions and joint effusion.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, with seizures and abnormal CT. Assess for structural lesion, vasculitis. An oval T2 hyperintense, FLAIR hyperintense, non-diffusion restricting lesion is present within the paramedian left superior frontal gyrus. The lesion appears to be based in the cortex and/or subarachnoid space as it seems to displace an adjacent traversing vessel. The rim of this lesion is T2 hyperintense, but no significant associated parenchymal edema is noted.The lesion does not enhance. No evidence of any definite internal nodular tissue is seen. However, a punctate focus of susceptibility is present along the superior aspect of the lesion (see image 181 series 1601).No definite evidence of any additional parenchymal lesion is seen. On a single slice of the T2 weighted axial sequence, there appears to be some hyperintensity at the level of the left inferior medullary olive, but this cannot be confirmed on FLAIR or coronal T2 weighted images and may therefore be artifactual.No areas of parenchymal edema or significant mass effect are detected. No acute intracranial hemorrhage is suspected. The left lateral ventricle is mildly and uniformly larger than the right, but this is favored to represent an anatomic variation.Dedicated imaging of the medial temporal lobe structures shows symmetric morphology and signal characteristics. No discrete temporal lobe lesions are appreciated.MRA images are somewhat degraded by motion artifact, but no evidence of any high-grade stenosis, occlusion, aneurysm or vascular malformation is seen. Dedicated MRV imaging of the brain is technically inadequate. However, no loss of flow void on T2-weighted images or filling defects on postcontrast images are seen to suggest an occlusion of the dural venous sinuses.

Output: 1.A lesion is evident within the paramedian left superior frontal gyrus, centered on the cortex and/or subarachnoid space. This lesion does not enhance, and by virtue of its signal characteristics, may reflect solid tissue or proteinaceous cystic material. The lesion induces no significant edema in the adjacent parenchyma. No discrete nodular tissue is seen within this lesion, though there is a small focus of susceptibility within it.2.The differential diagnosis for this lesion is broad and would include an infectious cyst as would be seen in neuro-cysticercosis. Although no definite evidence of a scolex is seen, the small focus of susceptibility could conceivably represent a scolex. Lack of edema and enhancement would be compatible with the early vesicular stage the disease. Additional differential considerations would include low-grade primary brain tumor, and much less likely an atypical presentation of a benign developmental cyst. If prior imaging is available, these exams can be up loaded and a comparison to the present study will be made, which may help refine the differential diagnosis.3.MRA imaging of the brain is slightly motion degraded, but no significant arterial abnormalities are suspected. MRV imaging is nondiagnostic for technical reasons. However, on the basis of conventional sequences, no significant abnormalities of the intracranial venous system are suspected.


Instruction: Generate impression based on findings.

Input: Ms. Mallory is a 60-year-old female with biopsy-proven left breast cancer with multiple enlarged ipsilateral axillary lymph nodes. Breast parenchyma is almost entirely fat in both breasts. There is mild background parenchymal enhancement noted bilaterally.LEFT BREAST: In the left breast, there is an irregular enhancing mass in the left lower outer breast measuring approximately 3.1 x 2.7 x 3.3 cm. The mass is associated with peripheral enhancement and central necrosis. Susceptibility artifact from biopsy marker clip is seen abutting the posterior margin of the mass, compatible with biopsy-proven malignancy. Of note, the malignancy does extend to within 1 cm from the skin margin at the infero-lateral margin.No additional abnormal enhancement is identified within the left breast. Specifically, there is no abnormal enhancement identified anterior to the biopsy-proven malignancy, as suggested on the diagnostic mammogram. The focal asymmetry seen on the mammogram likely represents normal fibroglandular tissue.There are at least 4 abnormally enlarged left axillary lymph nodes, the largest of which measures approximately 1.9 x 1.0 cm in the high left axilla. RIGHT BREAST: In the right breast, there is no abnormal enhancement identified . No abnormal axillary lymph nodes are identified in the right axillary region.

Output: (1) Unifocal centrally necrotic left breast malignancy with biopsy marker clip located at the posterior margin. (2) Multiple abnormal left axillary lymph nodes, raising the suspicion for node-positive disease. An US-guided biopsy with clip placement can be performed if clinically warranted. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with bilateral lower extremity weakness. Evaluate for progression of meningioma, edema. Evaluate for sagittal sinus thrombosis. Redemonstrated is evidence of craniotomy at the parietal vertex. Nonspecific dural thickening and a small fluid collection subjacent to the craniotomy are stable.Tumor centered on the posterior interhemispheric falx in the parietal region is approximately unchanged in size relative to the most recent examination. The most accurate measurements are obtained in the sagittal plane where the tumor measures up to 60 mm in length and 24 mm in thickness, with identical measurements obtained on the prior study.Encephalomalacia and ill-defined T2 signal abnormality affecting the bilateral parietal lobes and the left occipital lobe are unchanged. Scattered additional small foci of T2 hyperintensity within the cerebral hemispheres and brainstem are unchanged. No new lesions are detected. No new pathologic enhancement is seen. No evidence of acute intracranial hemorrhage is observed. The ventricles are stable in size and morphology.On dedicated MRV imaging, no detectable superior sagittal sinus flow or opacification is seen in the vicinity of the tumor and prior resection bed. Anterior and posterior the segment, normal sagittal sinus patency is seen. The size of the sinus defect is similar to that noted on the prior examination. The remainder of the visualized intracranial venous structures are patent.

Output: 1.Redemonstration of findings related to prior tumor resection from the parietal vertex.2.Meningioma centered on the parietal interhemispheric falx has not significantly changed in size when compared to the immediate prior examination. Associated encephalomalacia and signal abnormality in the adjacent parenchyma are also unchanged.3.The superior sagittal sinus is absent through the region of tumor and prior resection. Anterior and posterior to this segment, the sagittal sinus demonstrates evidence of normal patency. The size of the absent segment has not changed.


Instruction: Generate impression based on findings.

Input: Ms. Preston is a 60-year-old female with personal history of right breast mastectomy in 2013 for DCIS/LCIS followed by tamoxifen therapy. Family history of breast cancer in paternal cousin and six paternal aunts. Mild parenchymal enhancement is noted in the left breast. Status post right mastectomy with implant based reconstruction.No abnormal enhancement is seen in the left breast or right reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate sudden left neural sensory hearing loss. Signs and symptoms: Left hearing loss. Pre-and post enhanced MRI of the IACs:Examination demonstrates normal size and morphology of bilateral internal auditory canals.There is normal signal intensity and morphology of bilateral neurovascular bundles across the cerebellopontine angles and within the internal auditory canals bilaterally. There is normal morphology and signal intensity of bilateral cerebellopontine angle cisterns. There is also normal signal intensity and morphology of pons. There is no detectable abnormal enhancement of the pons, bilateral neurovascular bundles, internal auditory canals or within the bilateral petrous bones. There is normal signal intensity and anatomical morphology of visualized inner ear structures on this exam. The signal intensity of bilateral mastoid air cells and middle ear cavities are unremarkable. There is no evidence of abnormal enhancement of the cranial nerves on this exam.Negative diffusion weighted images. Axial T2 flair images demonstrate multiple tiny foci of flair hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally in bilateral basal ganglia and questionably within pons which although nonspecific, considering patient's stated age of 69 the findings most likely represent chronic microvascular ischemic changes. Post enhanced images demonstrate no detectable abnormal enhancement the brain parenchyma, leptomeninges, calvarium or the orbits.Minimal mucosal thickening of bilateral ethmoid air cells and unremarkable paranasal sinuses otherwise.

Output: 1.Negative pre-and post enhanced MRI of the IACs.2.Negative diffusion weighted images and findings suggestive of mild chronic small vessel ischemic strokes as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: h/o left parasagital meningioma History: pre op planning The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 11 x 16 mm axial dimension extra-axial mass adjacent to the superior sagittal sinus just behind the right cortical vein and abutting main posterior aspect of the left paracentral lobular.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Extra-axial mass adjacent to the left paracentral lobular is a stable when compared to the prior exam2.examination was performed for stereotactic guidance


Instruction: Generate impression based on findings.

Input: History of breast cancer, low back pain with right leg radiation. Rule out lytic lesion. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L3 on L4 and L4 on L5. Alignment is otherwise maintained. Bone marrow signal is diffusely heterogeneous which is nonspecific but without discrete destructive osseous lesions evident. T1 hyperintense lesion at the right S1 level is compatible with a hemangioma. The conus medullaris is normal in position. No suspicious epidural or leptomeningeal enhancement. There is enhancement associated with facet arthropathy, particularly at the L4-L5 level.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation and height loss as well as a disc bulge with right paracentral protrusion component. There is associated effacement of the right lateral recess. Bilateral facet arthropathy. There is moderate to severe central spinal canal stenosis. Mild to moderate right and mild left neural foraminal narrowing. L4-L5: There is disc desiccation and disc height loss. There is a central dorsal annular fissure. There is advanced bilateral facet arthropathy, ligamentum flavum thickening, and mild disc bulge which contribute to moderate to severe spinal canal stenosis at this level. 5 mm cystic lesion in the right dorsal lateral epidural space which is favored to represent a synovial cyst also contribute to the spinal canal stenosis. There is mild to moderate right and mild left neural foraminal narrowing. L5-S1: There is disc desiccation and disc height loss. There is disc bulge with a small central protrusion component. There is moderate facet arthropathy, particularly on the left. There is no significant spinal canal stenosis. There is mild neural foraminal narrowing, relatively worse on the left.Paraspinous soft tissues are within normal limits.

Output: 1. No evidence of metastatic disease in the lumbar spine.2. Advanced degenerative changes in the lumbar spine at the L3-L4 and L4-L5 level with moderate to severe spinal canal stenoses at these levels. Effacement of the right lateral recess at L3-L4 and mild to moderate right L3-L4 and right L4-L5 neural foraminal stenosis may be contributing to patient's right leg symptoms.3. Advanced facet arthropathy at the L4-L5 level including small synovial cyst which contributes to the above-mentioned moderate to severe spinal canal stenosis at this level. There is also grade 1 anterolisthesis at L3-L4 and L4-L5.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with memory loss. Moderate patchy periventricular and subcortical T2 hyperintensity is seen. There is no evidence of restricted diffusion. No parenchymal edema or mass effect is detected.A 1 cm mildly T2 hyperintense extra-axial nodule is seen along the right olfactory groove. This lesion slightly elevates the right gyrus rectus.No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid is detected. The ventricles and sulci are mildly prominent compatible with parenchymal volume loss.

Output: 1.Moderate chronic small vessel ischemic disease.2.Incidental 1 cm extra-axial mass along the right olfactory groove which most likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: 39-year-old female. Left anterior hip mass. Evaluate etiology. A marker was placed over the patient's palpable abnormality in the left anterior hip. No underlying soft tissue mass or pathologic enhancement on post-contrast sequences is evident. The lack of a discrete mass despite having a palpable abnormality could be explained by a nonencapsulated small lipoma, which could be occult on imaging.Bone marrow signal intensity and the musculature of the left hip are unremarkable. The acetabular labrum is grossly unremarkable.

Output: No discrete soft tissue mass is evident at the site of the patient's palpable abnormality in the left anterior hip. This could be explained by a small nonencapsulated lipoma, which may be occult on imaging.


Instruction: Generate impression based on findings.

Input: 58 years, Female, recent fall, recently diagnosed cancer. Parietal edema on CT. There is extensive FLAIR hyperintensity in the right parietal lobe cortex and subcortical white matter with T1 hyperintensity and susceptibility effect most consistent with laminar necrosis with also possible prior petechial hemorrhage in this region. There is extensive cortical enhancement in this region extending into the right temporal parietal operculum and right temporal occipital region. There is also a punctate focus of mild diffusion hyperintensity, isointense ADC, and T2 hyperintensity involving the left precentral gyrus most compatible with subacute infarct.There are additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with mild chronic small vessel ischemic disease. There is no intracranial mass or mass effect. No significant intracranial mass effect. No midline shift or herniation.Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Imaging findings most consistent with a late subacute, large infarct involving the right parietal lobe. 2. Punctate infarct which is likely subacute involving the left posterior frontal lobe.3. No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Chronic low back pain, difficulty bending over to pick things up. Signs and symptoms: As above. Nonenhanced lumbar MRI:The alignment of vertebral column remains anatomical.There is a well-demarcated focus of T1 and T2 hyperintensity in the vertebral body of L4 measuring approximately 19 mm in size and consistent with a hemangioma. A tiny additional hemangioma is also noted in the body of S2 vertebrae.Examination at T11 -- T12, T12 -- L1, L1 -- L2 levels demonstrate minimal degenerative changes however without spinal stenosis or neural foraminal compromise. Incidental note is made of a small right renal cyst.L3 -- L4 demonstrate moderate disk disease and loss of disk height and mild bilateral facet and ligamentum flavum hypertrophy. Additionally there is a band of T2 hyperintensity and T1 hypointense along the adjacent endplates consistent with Modic signal changes. There is no evidence of spinal stenosis. No significant neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and mild loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. There is mild to moderate right neural foraminal compromise and unremarkable on the left. There is a linear increased T2/T2 stir signal intensity within the annulus of the disk laterally and far laterally on the right consistent with an annular fissure.L5 -- S1 is unremarkable other than mild facet and ligamentum flavum hypertrophy.

Output: 1.Degenerative changes of disks and posterior elements are noted however without evidence of central spinal stenosis at any level.2.Mild neural foraminal compromise as detailed per level above.3.There are multiple skeletal hemangiomas present as mentioned above.4.Right lateral and far lateral annular fissure at L4 -- 5 as detailed above.


Instruction: Generate impression based on findings.

Input: Ms. Lagestee is a 47-year-old female with family history of breast cancer in her mother x2. She has no current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen in both breasts, appearing stable in appearance when compared to prior examination. There is no abnormal enhancement seen in either breast. Scattered subcentimeter cysts are seen bilaterally. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cause of pain in the spine and left arm. Signs and symptoms: History of RCC. Pre and post enhanced thoracic spine MRI:There is normal anatomical alignment of vertebral column. There is normal signal intensity of vertebral column.There is no evidence of any significant degenerative changes of vertebral column.There is no evidence of spinal stenosis or neural foraminal compromise at any level.There is no detectable abnormal enhancement of vertebral column.There is normal signal intensity and caliber of thoracic cord and without detectable abnormal enhancement.

Output: Negative pre-and post enhanced thoracic MRI.


Instruction: Generate impression based on findings.

Input: 74-year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.9 x 4.7 x 4.6 cm.Peripheral Zone: High T1 signal in the peripheral zone bilaterally due to hemorrhage, which limits sensitivity for cancer detection. Within this limitation, there is a single small focus of low T2 signal and restricted diffusion measuring up to 5 mm in the left base, most compatible with prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pathologic lymph nodes by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small focus in the left base peripheral zone, most compatible with prostate cancer. No evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Anisocoria [H57.02], Reason for Study: ^Reason: r/o stroke History: anisocoria 49 years Male (DOB:1/1/1967)Reason: r/o stroke History: anisocoriaPROVIDER/ATTENDING NAME: JOHN F MCCONVILLE Brain MRIPer the request of the neurology service, only diffusion weighted image was obtained.There is no evidence of acute ischemic infarct on the scan.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left Pcom artery is patent and Acom artery is patent.

Output: 1. No evidence of acute ischemic infarction.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: 34-year-old female with strong family history of breast cancer (maternal aunt diagnosed at age 63, maternal aunt diagnosed at age 49, maternal aunt diagnosed at age 35, maternal great aunt diagnosed at age 55). IUD is in place since last year. There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, right more than left.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 37 years Female (DOB:2/22/1978)Reason: In October had evidence of a right PICA fusiform dilatation History: right neck pain, right sided sensory lossPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is extracranial origin of the right posterior inferior cerebellar artery. The right posterior inferior cerebellar artery is tortuous proximally and measures up to 2.5 mm in diameter. It subsequently tapers down to 1 mm in diameter and along the fourth ventricle dilates again to 1.5 mm diameter distal to the caudal loop and at the choroidal point. There is a duplicated component of the right posterior inferior cerebellar artery near the choroidal point.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.The right posterior inferior cerebellar artery is ectatic proximally at the level of the foramen magnum and along the choroidal point. More detailed information the be gleaned from a conventional angiogram if this is clinically needed. Based on this exam there is no convincing evidence for arteriovenous malformation.2.There is no evidence for cerebral infarction or hemorrhage..


Instruction: Generate impression based on findings.

Input: History of adenoid cystic carcinoma of the parotid gland status post surgery. Rule out recurrence. Brain:No abnormal signal is seen on the T2, FLAIR or diffusion weighted images. No abnormal enhancement is identified. There is no evidence mass or edema. There are numerous foci of punctate susceptibility artifact predominantly within the right temporal lobe, brainstem, and cerebellum, which are compatible with tiny microhemorrhages and presumably sequela from prior radiation therapy.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. Stable partial opacification of the right mastoid air cells. The orbits are unremarkable.Neck:Posttreatment changes in the neck including resection of the right parotid gland as well as atrophy of the right submandibular gland. Stable appearance of the tongue with volume loss of the right hemitongue and posterior ptosis of the left tongue base. No enhancing soft tissue mass to indicate a recurrence. No lymphadenopathy. The thyroid, left parotid, and left submandibular glands are unremarkable. Biapical scarring in the lungs. The cervical spine demonstrates mild multilevel degenerative changes without suspicious osseous lesions.

Output: 1. No evidence of metastatic disease in the brain.2. Stable posttreatment changes in the neck related to prior right parotid tumor without evidence of locoregional tumor recurrence.


Instruction: Generate impression based on findings.

Input: Female 51 years old; Reason: Evaluate for possible quad tendon vs patellar tendon rupture. Patient is status post total knee arthroplasty. The quadriceps tendon and patellar tendon appear intact. We see no findings to suggest a patellar fracture. The distal fibers of the vastus lateralis appear normal. There is edema superficial to the distal fibers of the vastus medialis obliquus, however the fibers appear intact. Additional edema is noted throughout the subcutaneous fat. A large joint effusion is present. A collection of fluid signal intensity is noted between the medial head of the gastrocnemius and popliteus muscle measuring approximately 2.5 cm in transverse dimension and extending inferiorly beyond the field of view of this study, perhaps representing an intermuscular hematoma. Additional intermuscular edema is present between the muscles of the upper calf. Given the aforementioned limitations, we seen no muscle tear.

Output: 1. Limited study due to metallic artifact from a total knee prosthesis. Given these limitations, the extensor mechanism appears intact.2. Large joint effusion and soft tissue edema as described above, as well as an elongated fluid collection in the posteromedial knee which may represent an intermuscular hematoma.


Instruction: Generate impression based on findings.

Input: 72-year-old man with history of bladder cancer status post cystectomy, surveillance imaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal. There is mild prominence of the CBD, within normal limits for patient status post cholecystectomy.SPLEEN: The spleen appears normal. An accessory splenule is present.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a 16 x 12 mm cyst arising from the midpole of the left kidney and a subcentimeter left inferior pole renal cyst. The right kidney appears normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post cystectomy and ileal conduit with right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of tumor recurrence or metastatic disease in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: Receptive aphasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few nonspecific scattered foci of T2 hyperintensity in the cerebral white matter, predominantly involving the frontal lobes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2. Few nonspecific scattered foci of T2 hyperintensity in the cerebral white matter, predominantly involving the frontal lobes.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for acute abnormality. Signs and symptoms: Worsening neck pain Enhanced cervical MRI:Precontrast portion of the exam was performed on 6-17-15 and patient was returned and the for post enhanced imaging.Examination demonstrates a well-demarcated round focus of hyperintensity/enhancement in the dorsal right lateral aspect of C5 vertebrae which demonstrated increased T1 and T2 signal intensity on the unenhanced series. Additional foci with similar signal changes on pre and post enhanced images are also present in the left lateral body of T6, vertebral body of T10. There is no evidence of bone marrow edema, fracture or malalignment with the findings. The lesions are highly suggestive of benign skeletal capillary hemangiomas however remote possibility of metastatic disease cannot be entirely excluded. There are no prior exams for comparison.Unremarkable post enhanced images of thoracic and cervical spine otherwise. There is also no detectable abnormal enhancement of the cord or the leptomeninges.There is no detectable abnormal enhancement of perispinal soft tissues.

Output: 1.Post enhanced images demonstrate multiple small foci of hyperintensity/enhancement within the vertebral bodies of C5, T6 and T10 corresponding with regions of T1 and T2 hyperintensity on nonenhanced images which are highly suggestive of multiple skeletal capillary hemangiomas of questionable clinical significance. Remote possibility of metastatic disease cannot be entirely excluded. There is no evidence of associated bone marrow edema, fracture or malalignment with the findings.2.There is no detectable abnormal enhancement of the cord, meninges or the perispinal soft tissues of the cervical or thoracic spine.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with IDC grade 3 with lobular features and DCIS grade 3, and a metastatic right axillary lymph node presents for I-SPY research MRI (#2). There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:A lobulated mass at anterior 12:00 position, which is a known carcinoma, measures 42 x 37 x 39 mm (AP x LR x CC, previously 49 x 48 x 62 mm). Periareolar skin thickening is mildly reduced. Multiple benign masses are unchanged. Anterior lateral aspect of right breast is locally depressed by a pressure dressing from a research biopsy performed yesterday.A proven metastatic right axillary lymph node measures 25 x 17 mm (previously 33 x 23 mm). A marker clip is present within the lymph node. LEFT BREAST:No abnormal enhancement is seen in left breast. Susceptibility artifact from a port is again present in the left medial chest wall.

Output: Reduction in size of the known cancer in the right breast and the metastatic right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Neck pain. Signs and symptoms: Neck pain. Nonenhanced cervical MRI:The alignment of vertebral is anatomical.The signal intensity which column is unremarkable other than subtle changes in the degenerative disease.The signal intensity and caliber of the cervical and upper most visualized thoracic cord is within normal.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 is unremarkable.C4 -- C5 demonstrate mild disk desiccation and minimal uncovertebral hypertrophic changes. Findings results in mild bilateral neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate mild disk desiccation and loss of disk height, mild bilateral uncovertebral hypertrophic changes. Small left lateral shallow disk protrusion is present with resultant very subtle flattening deformity of the cord without detectable signal abnormality. There is moderate (right greater than left) neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate mild disk desiccation and mild facet and ligamentum flavum hypertrophy. No spinal stenosis however mild right neural foramina compromise is suspected.C7 -- T1 demonstrate minimal degenerative changes without spinal stenosis or neural foraminal compromise.

Output: 1.C5 -- C6 demonstrate mild degenerative changes and a left lateral shallow disk protrusion with resultant sulcal flattening deformity of the cord however without central spinal stenosis. Moderate (right greater than left) neural foraminal compromise at this level is also present.2.Mild degenerative changes at other levels however without central spinal stenosis as detailed.3.Normal signal intensity of cervical and upper most visualized thoracic cord


Instruction: Generate impression based on findings.

Input: Reason: s/p acl with anterior knee pain History: pain, cyclops lesion? MENISCI: The lateral meniscus appears intact. The medial meniscus appears.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the lateral aspect of the lateral femoral condyle adjacent to the previously described lateral notch sign/impaction fracture. There is full-thickness articular cartilage degeneration along the medial facet of the patella with articular cartilage blistering and a focal full-thickness articular cartilage cleft.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. The graft appears intact. Note is made foci of decreased signal abnormality along the anterior aspect of the graft consistent with anterior arthrofibrosis. There is also prominent osteophyte formation along the medial aspect of the medial femoral condyle. The PCL appears intact. The LCL and MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Postsurgical changes of ACL graft reconstruction with findings consistent with anterior arthrofibrosis as described above. The graft appears intact.2. Articular cartilage degeneration with full-thickness articular cartilage clefts as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Three months follow-up post tethered cord release. Signs and symptoms: Status post tethered cord release. Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.The signal intensity of vertebral column demonstrate changes from prior surgery and mild degenerative disease.T11 -- T12, T12 -- and one, L1 -- L2 and L3 -- L4 levels are unremarkable.L4 -- L5 demonstrate mild disk disease and facet/ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise. There is a small linear focus of T2/T2 stir hyperintensity in the midline of the annulus of the disk and consistent with an annular fissure.L5 -- S1 demonstrate mild disk disease and without spinal stenosis or neural foraminal compromise. Similar to L4 -- L5 level there is a midline annular fissure. Examination demonstrates post operative changes off laminectomy at L5 level for cord untethering. There are no prior exams for comparison. Sagittal prone images demonstrate forward movement of the cord from T10 to L4 disk level and without evidence of movement from this level inferiorly. Fatty signal intensity of filum terminalis at the L5 -- S1 disk level is noted. The conus is suspected to terminate posteriorly at approximately L4 -- L5 disk level.There is small fluid accumulation in the subcutaneous fat and posterior to the interspinous ligament and surrounding the L5 spinous process suggestive of a postoperative finding. There are no prior exams for comparison. The signal intensity of the adjacent bony structures are unremarkable.

Output: 1.Prone sagittal T2 weighted images demonstrate forward movement of the cord from T10 to L4 level.2.There is termination of the cord at L4 -- L5 level posteriorly. Fatty signal intensity of filum at S1 is noted.3.Postoperative thin layer of fluid collection in the subcutaneous fat extending from L4 through S2 levels as detailed. No prior exam for comparison.4.Midline annular fissure at L4 -- L5 and L5 -- S1 levels. No spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: 59-year-old male with history of prostate cancer. Evaluate for metastatic disease. PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy. No evidence of soft tissue in the prostatectomy bed to suggest disease recurrence.BLADDER: No significant abnormality noted.LYMPH NODES: No suspicious pelvic lymph nodes. There is a small subcentimeter left common iliac lymph node (series 12, image 8).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No findings to suggest disease recurrence in the prostatectomy bed.2.Small subcentimeter left common iliac chain lymph node is nonspecific but may be suspicious given location.


Instruction: Generate impression based on findings.

Input: TSC. There are numerous predominantly subcortical white matter T2 hyperintense lesions, which are compatible with tubers. There are also several subcentimeter subependymal nodules associated with the bilateral lateral ventricles. The ventricles are not particular enlarged. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small left maxillary sinus retention cysts.

Output: Stigmata of tuberous sclerosis complex, with multiple subependymal nodules that do not meet the criteria for subependymal giant cell astrocytoma.


Instruction: Generate impression based on findings.

Input: 30-year-old male presents with back pain. Exam is limited by overlying gas and stool. Vertebral body heights are well-maintained. Degenerative disc disease affects the lower lumbar spine, particularly at L5-S1. The left and right pars interarticularis of the fifth vertebral body are not well visualized, however, there was no corresponding abnormality on the prior MRI. Otherwise, the remaining vertebral bodies appear unremarkable without evidence of a pars defect.

Output: Degenerative disc disease most severe at L5-S1.


Instruction: Generate impression based on findings.

Input: Status post fall. Low back pain radiating to both legs. Lytic lesions are seen throughout the lumbosacral spine, from T12 to the sacrum, correlating with the enhancing lesions seen on the prior MRI study. There is involvement of the anterior and posterior elements. There is involvement of the distal sacrum. There are small pathological fractures at the left pedicle and transverse process of T12, at the inferior endplate of L5 and superior endplate of S1, with minimal displacement of small fracture fragments. There is scoliosis in the lumbar spine, but the alignment of the lumbosacral spine is essentially maintained. There is lesion extending into the right sacroiliac joint. There are lesions involving the iliac bones bilaterally.

Output: Diffuse metastatic disease involving the thoracolumbar junction, throughout the lumbar spine, sacrum, and iliac bones bilaterally. There are small minimally displaced pathological fractures as described.


Instruction: Generate impression based on findings.

Input: There is focal FLAIR/T2 high signal intensity on the right periventricular white matter especially around the right lateral ventricle occipital horn. Possibility of this finding include prominent perivascular space more likely and focal encephalomalacia with some gliotic changes less likely.Hypoplastic vermis especially mid to inferior aspect and expanded 4th ventricle especially posterior aspect were seen indicating Dandy Walker malformation. However, the location of the torcular appears to be normal.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Likely prominent perivascular space on the right periventricular white matter as described above. Otherwise no abnormal signal intensity lesion on this scan.2. Dandy Walker malformation as described above.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a focus of hypodensity within the left frontal lobe as identified on the comparison studies and consistent with chronic infarct. Previously identified small chronic ischemic foci in the right cerebellum on the comparison brain MRI are not readily apparent on today's noncontrast CT technique. There is a new small focus of hypodensity in the anterior limb of the right internal capsule.Redemonstrated is an osteoma extending off the right frontal bone, unchanged. There is no evidence for acute intracranial hemorrhage. No intracranial masses or mass effect are identified. The ventricles are normal in volume and midline without interval dilatation. There is no abnormal extraaxial fluid collection. The mastoid air cells and paranasal sinuses are normal.

Output: 1.Chronic left frontal lobe infarct.2.There is a new small focus of hypodensity in the anterior limb of the right internal capsule representing age indeterminate small vessel disease.3.No acute cranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Severe back pain radiating down right leg Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal anterolisthesis of L3 on L4 and L4 on L5. Alignment is otherwise grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen including multilevel disc desiccation. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with foraminal components. There is no significant spinal canal or right neural foraminal narrowing. There is minimal left neural foraminal narrowing.L3-L4: There is a disc bulge with a small central extrusion. There is also ligamentum flavum thickening and bilateral facet arthropathy at this level contributing to mild spinal canal stenosis. There is mild bilateral, left worse than right, neural foraminal stenosis. L4-L5: Disc bulge with a small central extrusion, facet arthropathy and ligamentum flavum thickening. No significant spinal canal stenosis. There is up to moderate left neural foraminal stenosis and mild right neural foraminal narrowing.L5-S1: Minimal disc bulge without significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis. There is right-sided facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine, relatively worse at the L3-L4 and L4-L5 levels. There is mild spinal canal stenosis at L3-L4. There is moderate left L4-L5 neural foraminal stenosis. Additional details as above.


Instruction: Generate impression based on findings.

Input: Counting of the thoracolumbar spine utilized both the current lumbar spine MRI acquisition as well as the sagittal reconstruction from the previous chest/abdomen/pelvis CT demonstrating that there are 12 ribs, with 4 lumbar-type vertebral bodies and transitional anatomy which includes sacralization of L5.The previously described lesion within the L5 vertebral body, using the counting nomenclature described above, lies within the L4 vertebral body and demonstrates edema with STIR imaging as well as enhancement. This extends to involve not only the anterior elements but also the posterior element elements, notably on the left. This is associated with approximately 25% collapse of the posterior vertebral body. Enhancement also extends to involve the left facet as well as the left paraspinal soft tissues.Edema with enhancement is also noted involving the inferior L3 vertebral body, more prominent on the right, with a small amount of right adjacent soft tissue enhancement.Although a small amount of T2 signal is present within the intervening L3/4 disc, there is no associated enhancement.Marrow throughout the remaining osseous elements demonstrates heterogeneity, without discrete STIR signal abnormality or enhancement.The conus is normal in signal and morphology and terminates at an appropriate level. Please see dictation for CT chest/abdomen/pelvis performed yesterday for full description of abnormal abdominal findings.T12/L1: Asymmetric bulge to the left and bilateral facet hypertrophy. There are no significant stenoses.L1/2: Asymmetric bulge to the right, ligamentum flavum thickening, and facet hypertrophy. There is mild right lateral recess, mild left neural foraminal, and moderate right neural foraminal stenosis.L2/3: Asymmetric bulge to the left and facet hypertrophy. There is mild left neural foraminal stenosis.L3/4: Asymmetric bulge to the left and facet hypertrophy. There is mild left lateral recess, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.L4/5: Diffuse annular disc bulge and bilateral facet hypertrophy. There is moderate bilateral neural foraminal stenosis.L5/S1: Unremarkable

Output: 1.The previously described lesion within the L5 vertebral body, using the counting nomenclature described in the findings section above, lies within the L4 vertebral body and demonstrates edema with STIR imaging as well as enhancement. This extends to involve not only the anterior elements but also the posterior element elements, notably on the left. This is associated with approximately 25% collapse of the posterior vertebral body. Enhancement also extends to involve the left facet as well as the left paraspinal soft tissues.2.Edema with enhancement is also noted involving the inferior L3 vertebral body, more prominent on the right, with a small amount of right adjacent soft tissue enhancement.3.Although a small amount of T2 signal is present within the intervening L3/4 disc, there is no associated enhancement of the disc.4.The constellation of these features is most consistent with metastatic disease.5.Marrow throughout the remaining osseous elements demonstrates heterogeneity, without discrete STIR signal abnormality or enhancement, which may reflect early osseous involvement from metastases.


Instruction: Generate impression based on findings.

Input: Brain abscess. There is a heterogeneous cystic lesion in the left parietal lobe that measures up to approximately 20 mm. There is extensive surrounding vasogenic edema. A previously demonstrated subcentimeter lesion in the left temporal stem is barely discernible due to the lack of intravenous contrast. There is a background of diffuse cerebral white matter T2 hyperintensity. There is unchanged marked prominence of the ventricles, particularly the third and lateral ventricles. There is no significant midline shift or herniation. Skin fiducial markers are present.

Output: 1. Preoperative planning MRI for a left parietal lobe abscess with extensive vasogenic edema. Assessment of the previously demonstrated left temporal stem lesion is otherwise limited due to the lack of intravenous contrast.2. Unchanged ventriculomegaly, which may represent a normal pressure hydrocephalus superimposed upon cerebral volume loss, 3. Unchanged nonspecific background of diffuse cerebral white matter abnormality.


Instruction: Generate impression based on findings.

Input: 57 year old with metastatic kidney cancer. Pretreatment evaluation for progression. Postoperative changes in the right frontal lobe with dural thickening and bony destruction is unchanged from prior CT and probably represents dural metastasis when correlated with the prior MRI. Additional lesion in the greater wing of the right sphenoid appears unchanged.The ventricles and basal cisterns are unchanged in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No interval change of renal cell metastases to the brain.


Instruction: Generate impression based on findings.

Input: Male, 90 years old, with neck pain and tingling in the right hand. Spinal alignment is grossly anatomic. Vertebral body heights are preserved. No evidence of pathologic marrow replacement or marrow edema is seen. Cystic change is demonstrated within the odontoid process along with mild surrounding pannus formation, likely degenerative in nature.The visualized spinal cord demonstrates normal signal intensity throughout. No epidural abnormalities are suspected.The spinal canal is congenitally slender. Additional level specific degenerative findings are superimposed as follows:C2-3: Mild facet hypertrophy. Posterior disc-osteophyte complex formation with a small central component which mildly effaces the ventral thecal sac but causes no significant cord impingement. No significant foraminal narrowing. C3-4: Right greater than left facet hypertrophy. Mild posterior disc-osteophyte complex formation causing mild effacement of the ventral thecal sac. Severe right and mild left foraminal narrowing. C4-5: Right facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C5-6: Right greater than left facet hypertrophy. Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. C6-7: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: Bilateral facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Multilevel disc degeneration and posterior element hypertrophy is seen which nevertheless results in only mild compromise of the spinal canal and no obvious cord impingement.2.Multilevel foraminal narrowing is demonstrated, however, and this is severe on the right at C3-4 and C5-6.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute compression of the thoracic cord or conus, or significant thoracic spinal canal stenosis. There is low T1 and high T2 signal abnormality within the T7 vertebral body extending to the left pedicle, right T8 pedicle and facet, left T10 inferior articulating facet and spinous process, as well as bilateral T11 pedicles facets and spinous process with involvement of the right T11 vertebral body as well. There is also signal abnormality in the bilateral T12 facets and spinous process. Evaluation is limited due to lack of IV contrast. However, these lesions correspond to hypermetabolism on the recent PET, and therefore consistent with metastases. There is expansion of the affected pedicles and facets with epidural tumor invasion causing severe stenoses of the right T7-8, T8-9, and T12-L1 neural foramina, as well as moderate stenoses of the left T7-8, and T9-10, and T10-11 neural foramina. There is severe bilateral stenoses of the T11-12 neural foramina. There is an incompletely imaged mass measuring up to 6.3 CC x 1.8 AP x 5.4 ML cm in the subcutaneous soft tissues superficial to the right paraspinous musculature with hypermetabolic activity on PET, consistent with subcutaneous metastasis. There is desiccation of the intravertebral discs from C6-7 through T10-11 with loss of disc height. There are mild left L2-3 and L3-4 neural foraminal stenoses from disc bulge, facet arthropathy and ligament flava thickening, incompletely imaged. The conus terminates at L1-2. The kidneys are markedly atrophic and contain numerous cysts bilaterally. There is a large cyst in the right posteromedial aspect of the liver without hypermetabolic activity on prior PET.

Output: 1.Numerous thoracic vertebral body and posterior element osseous metastases without evidence of acute fracture, compression of the thoracic cord or conus, or significant thoracic spinal canal stenosis.2.Tumoral expansion of the posterior elements at multiple levels with epidural tumor extension results in moderate to severe neural foraminal stenoses at multiple levels of the thoracic spine, as described in the findings section.3.A large, but incompletely characterized subcutaneous tissue mass in the lower back is consistent with a metastasis.


Instruction: Generate impression based on findings.

Input: Male, 10 years old, history of choroid plexus cyst at birth, with developmental delay and family history of brain tumor. Evaluate for structural abnormalities. Brain parenchymal morphology is within normal limits. No evidence of focal signal abnormality, edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. No evidence of intracranial hemorrhage is seen. No abnormal extra-axial fluid collection or cystic lesion is noted. In particular, there are no findings to suggest choroid plexus cysts. The right lateral ventricle is slightly larger than the left but this is within the limits of anatomic variation. The ventricular system is otherwise unremarkable.

Output: Unremarkable evaluation with no evidence of cord plexus cysts or any other specific structural abnormality.


Instruction: Generate impression based on findings.

Input: 88-year-old female with a left foot ulcer. Evaluate for osteomyelitis. Note is made of extensive subcutaneous edema about the midfoot and forefoot most pronounced along the dorsal aspect of the foot. Some of this fluid signal abnormality/edema becomes confluent along the dorsal aspect of the midfoot, although no organized fluid collection is identified to suggest abscess formation. The bone marrow signal intensity is within normal limits. There is diffuse nonspecific increased signal abnormality within the plantar musculature. There is no definite enhancement on postcontrast sequences. No focal mass lesions are identified. No definite skin ulceration is identified.

Output: Extensive subcutaneous edema about the midfoot/forefoot without evidence of osteomyelitis or abscess formation.


Instruction: Generate impression based on findings.

Input: 62-year-old female. Cholangiocarcinoma, hyperbilirubinemia. Evaluate obstruction of biliary tree. ABDOMEN:LIVER, BILIARY TRACT: Infiltrative soft tissue at Klatskin's point and in the distribution of the central left and right biliary ducts to the tertiary level consistent with infiltrative cholangiocarcinoma. Mild associated upstream intrahepatic biliary ductal dilatation in the periphery of the liver, greater in the left lobe. There is eccentric narrowing of the CBD due to tumor infiltration from Klatskin's point down to the mid CBD, where it is most severely attenuated (series 701, image 97). The intrapancreatic segment of the CBD is normal in caliber and appears unaffected by tumor.Loss of normal flow voids in the intrahepatic and extrahepatic portal vein as well as right and left branches, replaced with intermediate T2 signal intensity consistent with extensive tumor thrombus.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: Confluent lymphadenopathy in the portal hepatis and inferior to the liver, likely local metastases. For reference, there is a node that measures 1.6 x 1.1 cm (series 601, image 307). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large amount of abdominal ascites, suspicious for malignant ascites. OTHER: No significant abnormality noted.

Output: 1. Infiltrative cholangiocarcinoma at Klatskin's point and completely obstructing the central left and right intrahepatic ducts to the tertiary level. Inferior extension of tumor down to the mid-CBD, which is severely attenuated.2. Extensive tumor thrombus in the entire main portal vein and its branches.3. Large amount of abdominal ascites, suspected to be malignant, and local metastatic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. HCV cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Reticular T2 weighted signal intensity compatible with fibrosis.No intrahepatic ductal dilatation or ascites.Ablation defect in segment 2/3.No arterial phase enhancing lesions with washout. No T2 hyperintense or diffusion restricting lesions. Scattered vascular perfusion anomalies.The portal vein, hepatic veins and hepatic artery are patent.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. Note is made of a bifid pancreatic duct with a persistent duct of Santorini.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right lower pole subcentimeter cyst.RETROPERITONEUM, LYMPH NODES: Tortuous thoracic aorta.BOWEL, MESENTERY: No significant abnormality noted. Gastroesophageal varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhosis without a suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is deformity of the posterior horn of the medial meniscus with a defect along the superior surface of the inner half of the horn and body and additional abnormal signal intensity along the undersurface of the posterior horn. A small focus of low signal intensity seen within the medial gutter beneath the body of the medial meniscus. The constellation of findings is suggestive of a flap tear perhaps with displaced meniscal tissue into the medial gutter. The anterior horn is intact.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle but we see no fluid-filled articular cartilage defects. Articular cartilage of the lateral compartment is intact. There is a small focus of full-thickness degeneration of the medial facet of the trochlea with mild superficial fraying of the articular cartilage of the patella. The bone marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial meniscal tear further described above which is suspected to represent a flap tear with displaced meniscal fragment.2. Cartilage abnormalities as detailed above.3. Small joint effusion and Baker's cyst.


Instruction: Generate impression based on findings.

Input: 49-year-old woman with right knee pain and swelling status post ACL reconstruction and medial meniscus repair. MENISCI: The posterior horn of the medial meniscus is small, which may relate to partial meniscectomy, however it is also blunted, indicating tear. The lateral meniscus appears intact. ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal.LIGAMENTS: Components of ACL repair appear intact. The PCL is intact. The MCL and LCL complex appear intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons appear normal.ADDITIONAL

Output: Postsurgical changes of ACL repair. Tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Somnolence [R40.0] / Unspecified convulsions [R56.9], Reason for Study: ^Reason: edema or bleeding? History: somnolence. Redemonstration of posterior raising evaluation surgery for right corpus callosum. At least 3 round to ovoid shaped parenchymal lesion with the surrounding edema are seen. These lesions show restricted diffusion which is unchanged since prior scan. There are central as well as the periportal susceptibility effect of those lesions indicate blood products or hemorrhage.Mild effacement of right lateral ventricle frontal horn is seen.There is no evidence of midline shift or ventriculomegaly.There is no evidence of new acute ischemic or hemorrhagic lesion.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post LASER ablation status of right corpus callosum as described above.2. No significant interval change of MR characteristics of those lesions since prior scan as described above.3. No evidence of new acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: A 58 years old male with history of hypertension, stroke, aortic valve replacement more that 10 years ago, recently diagnosed with myelodysplastic syndrome. A recent echocardiography showed mild left ventricular systolic dysfunction. Referred to cardiac MRI to evaluate ischemia and viability.MEDICATIONS: Atorvastatin, Esomeprazole, Nitrates, Lisinopril, Metoprolol, Warfarin First Pass PerfusionDuring hyperemia, a large perfusion defect is noted in the mid inferior and inferolateral walls. Also small perfusion defects are noted in the mid anteroseptum and anterolateral walls. The inferior and inferolateral wall perfusion defects correspond with the below described myocardial infarction.Viability/ Myocardial ScarThere is a large transmural myocardial infarction involving the entire apex and the mid inferior and inferolateral walls. These territories are not likely to be viable. The rest of the myocardium is free of myocardial infarction and is likely to be viable.Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 212 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 114 ml (normal range 47+/-19), the LV mass index is 79 g/m2, and the LV mass is 173 g. Apical akinesis and mid-to-apical hypokinesis in the inferior and inferolateral walls is noted. No LV apical thrombus is noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size .Aortic ValveA mechanical prosthetic valve is noted in the aortic position. Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is 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 FindingsSternal wires were noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large transmural myocardial infarction which is associated with a perfusion defect and involves the LV apex and the mid inferior and inferolateral walls. This territory is not likely to be viable. 2. In addition to the myocardial infarction, there is a small amount of ischemia present in the mid anteroseptum and anterolateral wall. These segments are likely to be viable. 3. Normal LV size and mild systolic dysfunction (LVEF 46%) with a regional wall motion abnormality as described above.4. Normal RV size and systolic function (RVEF 60%).


Instruction: Generate impression based on findings.

Input: Reason: evaluate for etiology of headache and anosmia History: headaches, anosmia based on smell identification test The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 and demonstrate minor scattered opacities mainly in the right frontal sinus and right ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.MRI of the brain is within normal limits. There are some minor opacities in the ethmoid air cells and right frontal sinus. In theory these could suggest that the patient's symptoms of anosmia and may be related to paranasal sinus inflammation.


Instruction: Generate impression based on findings.

Input: Malignant (primary) neoplasm, unspecified [C80.1] / Human immunodeficiency virus (HIV) disease [B20] / Secondary malignant neoplasm of bone [C79.51] / Disorder of bone, unspecified [M89.9], Reason for Study: ^Reason: cord compression protocol - rule out Cervical MRI:Motion artifacts degraded exam quality.There is normal cervical lordosis. The cranial-cervical junction is normal.Spinal cord signal intensity is normal.There are focal protrusion of discs without creating spinal stenosis at the level of C45 (central to left) and C56 (central to right) level.There is an enhancing mass on the left side paravertebral muscle (21.6mm x 19.8mm) indicating possible lymph node enlargement or muscle mass.Vertebral bodies appears to be within normal limits.Thoracic MRIThere is normal thoracic kyphosis and spine alignment is normal.Spinal cord signal intensity is normal.There is T2 high signal intensity lesion at T10 vertebral body which most likely represent hemangioma. There is irregular shaped enhancing mass lesion on the left side of upper mediastinum which is adjacent to the junction of aortic arch and descending aorta as well as proximal subclavian artery suggesting possible malignant lesion. Dedicated imaging study such as Chest CT scan with enhancement can be considered for further imaging evaluation.No evidence of cord compression.Lumbar MRINormal lumbar lordosis. The spine alignment is anatomic.No evidence of spinal cord compression. The conus medullaris terminates at the level of T12-L1. There is 16.9mm x 18.5mm left adrenal gland nodule. The clinical significant of the lesion can be assessed with dedicated adrenal gland imaging, please consult to abdominal imaging department.There is evidence of soft tissue mass replacing cortical bone on the left side pedicle of the L1 vertebral body with the mass extension toward posterior aspect of the L1 body. The mass appears to be extended toward the left side neuroforamen. There are multifocal vertebral body marrow replacing lesions including L2 vertebral body left side, S1 vertebral body and right side ilium, most likely represent metastatic lesion.This lesion is consistent with metastatic lesion.

Output: 1. No evidence of spinal cord compression.2. Multiple enhancing soft tissue mass lesions including left posterior upper mediastinum, left adrenal gland and left side pedicle with L1 vertebral body indicating possible metastatic lesions.3. Soft tissue masses on the L2, S1 and right side ilium indicating possible metastatic lesions. Comment: considering multiple bony and adrenal metastatic lesions, dedicated imaging studies such as adrenal gland imaging and lumbar spine or pelvic imaging can be considered.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Paresthesias. Assess for disease progression. Compared to the previous examination, the extensive burden of multiple sclerosis lesions on both T1 and T2 sequences has not significantly changed, still most extensive in the frontoparietal periventricular white-matter but also with infratentorial involvement in the cerebellum and brainstem. A few of the lesions are now more conspicuous on FLAIR, such as a cortical lesion that involves the right paracentral lobule, but are stable on T1W imaging. This change in lesional conspicuity is most probably artifactual. There is no definite new brain lesion.The associated severe corpus callosal thinning and the moderate global brain volume loss remain unchanged.Retention cysts and mucosal thickening in the maxillary sinuses are unchanged.

Output: The supratentorial and infratentorial involvement by multiple sclerosis has not significantly changed since the previous examination from December 2015, with extensive burden of T1 and T2 lesions, most pronounced in the frontoparietal white-matter as described above. There is no definite new brain lesion.


Instruction: Generate impression based on findings.

Input: 10-year-old female with ventriculomegaly, optic nerve gliomas, Chiari malformation, experiencing headaches. The patient is status post third ventriculocisternostomy. There is no significant interval change in the diffuse bilateral hypothalamic-optic glioma. A CSF intensity collection in a supra-vermian location, extending in the right paramedian direction, has increased over the interim with compared to the most recent MRI, now measuring up to 20 mm in maximal dimension (previously 7 mm). When compared to the more recent head CT, this is unchanged. This causes mass effect upon the underlying tectum, which previously demonstrated a thickened appearance.T2 hyperintensity is again noted surrounding a prior right transfrontal surgical track, likely related to prior endoscopic third ventriculostomy. As before, no defect is discernable in the floor of the third ventricle and no CSF jet is apparent in the third ventricle. The lateral and third ventricles have slightly increased by approximate 3 mm in maximal width when compared to the most recent MRI, however unchanged when compared to the more recent head CT.There is stable effacement of the aqueduct of Sylvius associated with enlargement of the lateral and third ventricles as well as periventricular T2 hyperintensity that may represent transependymal CSF flow, unchanged in extent. There are stable foci of non-enhancing T2 hyperintensity in the anterior left frontal lobe and cerebellar white matter without interval formation of new hyperintensities. There is no evidence of intracranial hemorrhage or acute infarct. Redemonstrated is mild retroflexion of the dens, platybasia, and extension of the cerebellar tonsils inferior to the level of the foramen magnum with pointed morphology. There is unchanged constriction of CSF flow across the anterior foramen magnum due to the retroflexed dens, although CSF flow is again evident across the posterior foramen magnum and at the level of the circle of tonsils. Previously demonstrated scattered paranasal sinus mucosal thickening has resolved. Mastoid air cells are clear.

Output: 1.A CSF intensity collection in a supra-vermian location, extending in the right paramedian direction, has increased over the interim with compared to the most recent MRI, now measuring up to 20 mm in maximal dimension (previously 7 mm). When compared to the more recent head CT, this is unchanged. This causes mass effect upon the underlying tectum, which previously demonstrated a thickened appearance.2.The lateral and third ventricles have slightly increased by approximate 3 mm in maximal width when compared to the most recent MRI, however unchanged when compared to the more recent head CT.


Instruction: Generate impression based on findings.

Input: Reason: r/o cord compression History: back pain. Acute onset saddle anesthesia and urinary incontinence. Cervical spine:The patient is status post anterior fusion at C5, C6 and C7. The exam is degraded by patient motion artifact.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disk desiccation and some endplate osteophytes as well as a disk bulge at this level. Since the prior exam there has been regression of the spinal stenosis at this level.At C3-4 there is diffuse disk bulge associated with posterior ligamentous hypertrophy and effacement of spinal fluid ventral and posterior to spinal cord creating a moderate degree of spinal stenosis. This is stable compared to the prior exam.At C4-5 there is central disk protrusion associated with effacement of spinal fluid ventral and posterior to spinal cord creating a moderate degree of spinal stenosis. Since the prior exam there has been regression of the spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal. There is some narrowing of the neural foramina due to disk material at this level. Compared to the prior exam there is been some improvement in the spinal stenosis at this level.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. The exam is degraded by patient motion artifact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy present at this level, disk desiccation and a disk bulge. There is narrowing of the neural foramina at this level left worse than right. Compared to prior exam this is stableAt L4-5 there is loss of disk space height, disk desiccation, diffuse disk bulge and bilateral facet and ligamentum flavum hypertrophy associated with mild anterior subluxation of L4 and L5. Overall there is a moderate degree of spinal stenosis at this level. Additionally there is partial effacement of fat within the neural foramina bilaterally with mild encroachment of the exiting nerve roots within the neural foramina. When compared to the previous exam there does not appear to be any significant change.At L3-4 there is loss of disk space height, disk desiccation, diffuse disk bulge and bilateral facet and ligamentum flavum hypertrophy . Overall there is a moderate to severe degree of spinal stenosis at this level. Additionally there is partial effacement of fat within the neural foramina bilaterally with mild encroachment of the exiting nerve roots within the neural foramina. When compared to the previous exam there does not appear to be any significant change.At L2-3 there is loss of disk space height, disk desiccation and disk bulge associated with some facet and ligamentum flavum hypertrophy. Overall there is a mild to moderate degree of spinal stenosis at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.Are multiple large renal cysts present. These were also present on the October exam as well and not substantially different

Output: 1.The exams are degraded by motion artifact which can obscure more subtle abnormalities or more subtle changes.2.There are multilevel degenerative changes present in the cervical spine resulting in multilevel spinal stenosis. Within the cervical spine spinal stenosis at that C2-3, C4-5 and C7-T1 has improved whereas spinal stenosis at see C3-4 remains relatively stable when compared to 7/25/11.3.There are multilevel degenerative changes are present in the lumbar spine resulting in spinal stenosis at L2-3, L3-4 and L4-5 worse at L3-4. This is stable when compared to the prior exam of 10/20/14.


Instruction: Generate impression based on findings.

Input: 48-year-old male patient with known history of metastatic neuroendocrine tumor with liver metastases. ABDOMEN:LIVER, BILIARY TRACT: There are multiple hepatic lesions throughout the liver demonstrating T2 hyperintensity and arterial enhancement. Some of these have increased in size including a reference segment seven lesion which now measures 2.5 x 2.0 cm, previously 2.1 x 1.5 cm (image 20, series 4). Many of these lesions are more discrete on both T2 and arterial weighted imaging. No definite new lesion is identified. There is layering biliary sludge or small stones within the gallbladder. The hepatic vasculature is patent.Stable mild dilatation of the common bile duct measuring 12 mm in diameter. No definite obstructing lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum without pancreatic ductal dilatation.ADRENAL GLANDS: There is a right renal cyst. Additional subcentimeter T2 hyperintense foci too small to characterize, likely also represent cysts.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Slight interval increase in size of multiple hepatic lesions. No new hepatic lesion is identified.2. Stable mild dilatation of the common bile duct.


Instruction: Generate impression based on findings.

Input: 69 year old man with history of Marfan's syndrome, referred for cardiac MRI for interval follow up of aortic dimensions. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 138 ml/m2 (normal range: 74+/-15), the LVEDV is 317 ml (normal range 142+/-34), the LV end systolic volume index is 63 ml/m2 (normal range 25+/-9), the LVESV is 146 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 135 ml/m2 (normal range 82+/-16), the RVEDV is 310 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 190 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is mild-moderate aortic regurgitation. Aortic regurgitation is central due to leaflet malcoaptation. 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. Aortic dimensions are as follows:Sinus of Valsalva: 51 x 55 x 53mmSinotubular junction: 48 x 50mmMid ascending aorta at the level of the main pulmonary artery: 49 x 47mmAscending aorta immediately proximal to the innominate artery: 44 x 44mmDescending thoracic aorta: 30 x 30mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 53%.2. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%.3. Severe aortic root dilation (dimensions described above), increased since last cardiac MRI in 2012. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of right renal pelvis [C65.1], Reason for Study: ^Reason: kidney cancer with new headaches; r/o metastases History: headaches No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Scattered multifocal somewhat patchy FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.There is a focal tissue loss on the left cerebellar hemisphere at the level of middle cerebellar peduncle indicate focal encephalomalacia.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Non specific small vessel ischemic disease.3. Focal tissue loss on the left cerebellar hemisphere likely indicate chronic ischemic infarction.


Instruction: Generate impression based on findings.

Input: There is metallic artifact in the right frontal lobe due to craniotomy / drainage device. Since the previous study the ventricles were decompressed and currently appears within normal size. Again there are a multiloculated CSF signal intensity cystic lesions in the right thalamus and midbrain and its associated mass effect/effacement of the posterior third ventricle that remains identical to prior exam. The pontine high signal intensity on FLAIR and T2 images is unchanged. A drainage tube is seen coming entering the brain from the right frontal lobe and the distal tip is seen in the third ventricle. High T2 and FLAIR signal is seen around the tube, due to gliosis.There is no restricted diffusion. Susceptibility low signal is seen dispersed in the right frontal lobe and midbrain, most likely due to petechial hemorrhage versus calcification.There is no midline shift. Contrast images demonstrates no significant abnormal enhancement.There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Status post craniotomy with drainage system that that demonstrates significant decompression of the ventricular system.2. Again seen are multiple loculated CSF signal cysts in the right thalamus, posterior third ventricle, and the pons, unchanged from the previous study.


Instruction: Generate impression based on findings.

Input: 58-year-old male with recurrent urothelial carcinoma and pelvic abscess. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild intrahepatic biliary dilatation and mild dilatation of the common bile duct is stable. Ill-defined hypodensities in the left lobe of the liver, best seen on image number 30, series number 3 is unchanged.SPLEEN: No significant abnormality notedPANCREAS: Small cystic lesion in the tail of the pancreas is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index left para-aortic node is unchanged, measuring 13 by 8mm image number 63, series number 3. And, more caudal index node is also unchanged, measuring 13 by 12-mm in width. Number 76, series number 3.BOWEL, MESENTERY: Also in the right and left lower quadrants. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy. Previously measured complex fluid collection containing air in drainage catheter and fistulizing into the skin is slightly increased, now measures 7.8 x 5.9 cm image number 121, series number 3. There is tissue defect in the midline pelvis.BLADDER: Ileal pouch is noted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Ill-defined enhancing lesion in the lower midline pelvis measuring 4.9 x 2.8 cm is suspicious for recurrent tumor. MRI may helpful for better characterization of this mass separate from the collection. The mass invades the base of the penis and abuts the pelvic bones.

Output: Interval increase in the size of the complex pelvic fluid collection. Retroperitoneal lymph nodes are stable.Possible pelvic mass, suspicious for recurrent disease. MRI of the pelvis may be helpful for better characterization of this lesion, if clinically indicated.


Instruction: Generate impression based on findings.

Input: Unspecified visual disturbance [368.9], Reason for Study: ^Reason: any infarctions? History: left visual field disturbance There are encephalomalacia on bilateral lingual gyri of occipital lobes associated with scattered susceptibility artifacts indicating hemosiderin deposition suggesting prior hemorrhages.There is also gyriform susceptibility artifacts on the right superior frontal sulcus indicating chronic hemorrhagic lesion.Multiple chronic lacunes on bilateral basal ganglia.Underlying brain shows multifocal scattered high signal intensities on FLAIR images on bilateral periventricular white matter indicating non specific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Chronic ischemic infarction with encephalomalacia on bilateral lingual gyri.2. Non specific small vessel ischemic disease.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Reason: ich History: right side weakness Nonenhanced CT of the brain:Examination demonstrates no evidence of acute intracranial hemorrhage. Diffuse white matter low attenuation of right hemisphere and to a lesser degree of the left hemisphere is similar to what was noted on prior MRI examination and is believed to represent post therapy changes for patient's known tumor. The ventricular system remain within normal range of size and morphology and also with no interval change since prior MRI exam.There is no definite evidence of any cortical abnormality. Small areas of small vessel ischemic changes can be completely obscured by post therapy changes. If clinical concern for stroke persist an MRI is recommended.

Output: Extensive intracranial findings consistent with post therapy changes of patient's known tumor which appears similar to prior MRI examination from 10 -- 19 -- 10. No evidence of hemorrhage, hydrocephalus or midline shift. If concern for stroke persist follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 49-year-old male with left ankle pain. Evaluate for peroneus brevis tear or other ATFL type injury. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. ADDITIONAL

Output: No findings to account for the patient's pain. Specifically, there is no evidence of ligamentous or peroneus tendon injury, as clinically questioned.


Instruction: Generate impression based on findings.

Input: 42 years, Female, laser ablation. Examination is obtained for operative planning and intraoperative navigation. Post gadolinium T1 weighted sequences demonstrate postoperative changes with enhancement/T1 hyperintensity related to ablation of the right amygdala/hippocampus. Changes to prior ablation involving the left medial temporal lobe also noted. No significant hemorrhage, mass effect, or hydrocephalus is appreciated. Multiple burr holes in the bilateral occipital and right temporal calvarium again seen.

Output: Examination for intraoperative navigation for laser ablation