Instruction: Generate impression based on findings.

Input: 65 year old woman referred for cardiac MRI imaging prior to atrial fibrillation ablation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 151 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 72 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 86 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a patchy pattern of late gadolinium enhancement involving the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The LGE does involve the subendocardium so prior myocardial infarction can not be excluded. Left AtriumThe left atrium is severely dilated. The LA volume is 243 ml. There is no obvious left atrial appendage thrombus.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 192 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 91 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. The right atrium volume is 169 ml. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. There is a very large right-sided pulmonary vein with a small right inferior pulmonary vein branching off nearly at the ostium. Dimensions as below:RUPV: 33mm x 25mmRLPV: 13mm x 9mmLUPV: 19mm x 16mmLLPV: 24mm x 20mmPulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%. There is a patchy pattern of late gadolinium enhancement involving the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The LGE does involve the subendocardium so prior myocardial infarction can not be excluded. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%.3. The left atrium is severely dilated. The LA volume is 243 ml. There is no obvious left atrial appendage thrombus. Moderate right atrial dilation.4. All four pulmonary veins drain normally into the left atrium. Dimensions as above.5. The main pulmonary artery is mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 65 years old Reason: restaging liver disease - poorly differentiated carcinoma, behaving like neuroendocrine. no treatment since Feb 2014 (RT) last chemo 2/2013-4/2013 ABDOMEN:LIVER, BILIARY TRACT: Confluent large hepatic mass in the region of the hilum consistent with the patient's history of cholangiocarcinoma. This has increased in size compared to prior study. It measures approximately 8.2 x 6.5 cm ( series 16, image 118), previously 6.3 x 5.2 cm.Two peripherally enhancing reference lesions, which may represent necrotic components are stable/mildly increased compared to prior study.The hepatic dome lesion measures 3.1 x 1.9 cm (series 16, image 109), previously 3.0 x 2.3 cm.The segment 4 lesion measures 3.1 x 2.7 cm (series 16, image 119), previously 3.1 x 2.9 cm.The mass invades the hepatic veins and there is hepatic vein occlusion. The hepatic arteries and portal veins are patent. No biliary dilatation.Diffuse hepatic steatosis. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Increase in size in large confluent hepatic mass, consistent with patient's known poorly differentiated carcinoma.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with history of breast cancer, now multiple lung nodules, concern for brain metastases. Extensive patchy periventricular T2 hyperintensity is seen. A chronic infarct is suspected within the left cerebellar hemisphere. No evidence of restricted diffusion is detected.No findings are seen to suggest parenchymal edema or mass effect. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.No evidence of significant intracranial hemorrhage is detected. There are a few scattered punctate foci of susceptibility, for example within the bilateral thalami, which may reflect chronic microhemorrhage. No abnormal fluid collections are seen. The ventricles are normal in size and morphology.

Output: 1.Evidence of advanced chronic microvascular disease and at least one small chronic infarct in the left cerebellum.2.No findings to suggest intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: 55-year-old female with stage IV uveal melanoma status post hepatic embolization/radiofrequency ablation ABDOMEN:LIVER, BILIARY TRACT: Numerous T2 hyperintense liver lesions are noted scattered throughout the left and right lobe of the liver. Segment 5 lesion measuring 2.3 x 1.3 cm is not significantly changed and compatible with a hemangioma demonstrating peripheral discontinuous nodular progressive enhancement (series 1303, image 192). Multiple additional irregularly enhancing lesions scattered throughout the liver compatible with metastases are increased in size since the prior exam. Interval increase in caudate lesion compatible with recurrence within or near the prior ablation cavity. There is a segment 8 lesion measuring 13 x 12 mm, previously 8 x 7 mm (series 1305, image 300).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent porta hepatis lymph nodes measuring up to 12 mm (series 1201, image 28).BOWEL, MESENTERY: Postsurgical sequelae involving abdominal wall.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval increase in size of liver lesions as detailed above. 2.Recurrence of disease within prior caudate ablation cavity.


Instruction: Generate impression based on findings.

Input: Redemonstration of mixed solid and cystic enhancing mass originating from the midbrain involving the tectum and projecting to the superior vermian cistern. Drainage catheter within the dominant tumoral cyst is unchanged in position. The enhancing portion of the mass similar to prior exam measuring 3.4 x 2.9 cm in axial dimension and 3.3 cm in craniocaudal dimension. The cystic component has increased in size.There is effacement of the quadrigeminal plate cistern and inferior displacement of the fourth ventricle, unchanged from prior. There is superior extension of the mass into the right thalamus. This is some susceptibility associated with the mass perhaps related to blood products.Right frontal approach ventriculostomy catheter with tip terminating in the anterior horn of the right lateral ventricle is unchanged. Ventricular system is mildly dilated but unchanged from prior examination. There is evidence of right frontal craniotomy with some susceptibility changes and a linear tract in the occipital lobe likely postprocedural. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1. Stable size of the solid enhancing component of the mass with interval increase in size of the cystic component.2. Stable mildly dilated ventricular system with right frontal ventriculostomy catheter.


Instruction: Generate impression based on findings.

Input: 61-year-old female with a history of lower extremity weakness and numbness with upgoing babinski for several months, history of ALL. Possible lumbosacral nerve root enhancement on prior MRI at Mayo. Please eval for evidence of nerve root infiltration or other structural abnormality to explain her symptoms. There continues to be no suspicious nodular enhancement involving the cauda equina nerve roots. There is increased enhancement involving an isolated right-sided linear structure possibly representing the right L5 nerve root, less likely radicular vein. There is also suggestion of some left-sided cauda equina nerve roots which are enhancing less so compared to the previous exam. These findings are nonspecific but may represent an inflammatory process. The conus medullaris shows normal signal. Alignment is notable for unchanged minimal retrolisthesis of L1 relative to L2 which is associated with desiccation and mild disc height loss. The other intervertebral discs are preserved in height. The vertebral bodies are preserved in height. There is no significant neuroforaminal or spinal canal stenosis. The bone marrow signal is preserved. There are changes of presumed bone marrow biopsies in the posterior iliac bones.

Output: 1.Previously seen minimal contrast enhancement of the cauda equina nerve roots appears decreased on the left compared to the prior exam. There is however increased enhancement involving an isolated right-sided linear structure, possibly representing the right L5 nerve root or less likely radicular vein. These findings are nonspecific especially given history of lumbar punctures and chemotherapy for leukemia. Possibility of an ongoing inflammatory process affecting the cauda equina nerve roots remains, but would correlate with clinical findings and CSF analyses. There is however no clear nodular leptomeningeal enhancement to suggest leukemic infiltration by imaging. 2.Minimal degenerative changes in the lumbar spine without significant spinal canal foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Evaluate lymph nodes in neck prior to scheduling surgery for lesion removal on right ear: mass to right ear in patient with history of angiosarcoma. There an exophytic nodule along the inferior right auricle that measures up to 15 mm. The tumor appears to be confined to the auricle, without evidence of invasion of the underlying temporal bone. There is no evidence of significant cervical lymphadenopathy. The salivary glands, thyroid, and upper aerodigestive tract are unremarkable. There are bilateral retropharyngeal internal carotid arteries. There appears to be a small defect in the inferior right orbit, with herniation of orbital fat. There is a right maxillary sinus retention cyst. There is patchy white matter T2 hyperintensity in the pons and bilateral cerebral hemispheres, which may represent chronic small vessel ischemic disease.

Output: Right auricle tumor. No evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is abnormal signal intensity within the posterior horn of the lateral meniscus concerning for complex tear. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Mild articular cartilage thinning is seen within the lateral compartment with a partial-thickness defects seen along the posterior weightbearing surface. The articular cartilage of the medial and patellofemoral compartments appears relatively intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings concerning for complex tear of the posterior horn of the lateral meniscus.2. Increased signal intensity within the gastrocnemius which may represent a mild muscle strain.


Instruction: Generate impression based on findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0] / Arteriovenous malformation, site unspecified [Q27.30], Reason for Study: ^Reason: 3T Scanner, please evaluate for brain AVMs History: HHT Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on this scan.There is focal linear and slightly nodular enhancement on the right frontal lobe pre central gyrus and middle frontal gyrus junction area (series 1101, image 24/32, series 1201, 24/31). Considering the patient's history of HHT, this could represent a very small arteriovenous shunt. Follow up MR examination needs to be considered.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. 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.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate enlarged left PCA which is communicating with the left ICA branch likely representing inferolateral trunk.The right Pcom artery is patent and the Acom artery is also patent.There is no evidence of intracranial arterial aneurysm or significant luminal stenosis.

Output: 1. Focal enhancing lesion on the right frontal lobe as described above which may indicate tiny arteriovenous shunt. Follow up MRI with and without contrast enhancement can be considered.2. No intracranial arterial aneurysm. No intracranial arterial luminal stenosis. No evidence of intracranial arterio-venous malformation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other convulsionsClinical question: Please evaluate for seizure focus or ischemic lesionSigns and Symptoms: Transient dysarthria and episodic anxiety after new onset GTC seizure 1 wk ago The CSF spaces are appropriate for the patient's stated age with no midline shift. Metallic artifact is present along the scalp.The temporal horn of the right lateral ventricle is slightly larger than the temporal horn of the left lateral ventricle. No signal abnormalities appreciated within the hippocampus. The right hippocampal head appears smaller than the left temporal headNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The right hippocampal head is asymmetrically smaller than its left-sided counterpart. This is a nonspecific finding which may be of little clinical significance.


Instruction: Generate impression based on findings.

Input: Female 40 years old Reason: right knee medial meniscus tear History: right knee pain. MENISCI: There is mild attenuation and blunting of the posterior horn and body of the medial meniscus that may reflect prior partial meniscectomy or alternatively chronic attritional tearing but we see no discrete tear involving the medial meniscus. The anterior horn of the medial meniscus and the lateral meniscus appear normal. ARTICULAR CARTILAGE AND BONE: There is edema within the medial femoral condyle particularly along its weight-bearing aspect and extending laterally. Within the edema is a curvilinear focus of low signal intensity in the subchondral bone, the etiology of which is uncertain and could be degenerative, represent a small focus of osteonecrosis or perhaps a subchondral fracture. It appears to be associated with at least one small cyst. There is mild heterogeneity of the signal of the overlying cartilage which may represent degeneration although the possibility of neo-cartilage related to prior microfracture is also considered. There is a small full-thickness cartilage defect just above the free edge of the anterior horn of the medial meniscus.Moderate osteoarthritis affects the patellofemoral joint with multi-focal cartilage defects of varying thickness.There is also a focus of abnormal subchondral signal in the anterior aspect of the lateral femoral condyle with mild heterogeneity and thinning of the overlying cartilage suggesting degeneration. There is minimal subchondral edema-like signal more posteriorly in the lateral femoral condyle just above the free edge of the posterior horn of the lateral meniscus with the overlying articular cartilage appearing intact. Tricompartmental osteophytes are noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Slight attenuation of the posterior horn and body of the medial meniscus may reflect prior partial meniscectomy or perhaps chronic attritional tearing but we see no discrete meniscal tear.2. Osteoarthritic changes as described above, most severely affecting the patellofemoral joint.3. Subchondral focus of curvilinear low signal intensity in the weight-bearing portion of the medial femoral condyle associated with marrow edema which may be degenerative in etiology or reflect focal osteonecrosis or perhaps a subchondral fracture. The possibility of prior microfracture at this site is also considered.4. Small joint effusion and mild synovitis.


Instruction: Generate impression based on findings.

Input: New onset headaches, left leg intermittent weakness, and intermittent left leg weakness, blurry vision . There is high T2 signal along the posterior mid cerebellar folia bilaterally. There is no evidence of mass or acute infarct. There is trace encephalomalacia in the left more than right posterior parieto-occipital regions, with punctate foci of susceptibility effect. There is also a punctate focus of susceptibility effect in the posterior left insula subcortical white matter. The rest of the supratentorial brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Abnormality along the posterior mid cerebellar folia bilaterally, as well as trace encephalomalacia in the left more than right posterior parieto-occipital regions may represent prior watershed infarctions or sequale of posterior reversible encephalopathy syndrome. Otherwise, no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: Slurred speech [R47.81] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: AMS, h/o CVA History: AMS Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.Focal encephalomalacia on the left thalamus and external capsule indicate chronic ischemic infarction.Scattered high FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale suggest mild non specific small vessel ischemic disease. 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 mastoid air cells are clear. Retention cyst on the left maxillary sinus.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. Bilateral PCAs are fetal origin.Right distal vertebral artery is hypoplastic, otherwise vertebrobasilar system appears to be normal.There is no intracranial arterial aneurysm or significant luminal stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic ischemic infarction involving left thalamus and external capsule with underlying non specific small vessel disease. 3. No evidence of significant luminal stenosis on bilateral CCAs, ICAs and vertebrobasilar system. 4. No evidence of intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: Hoarseness, enlarging gland and history of thyroid cyst. RIGHT LOBE MEASUREMENTS: 5.9 x 2.1 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.5 x 2.0 x 1.3 CmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Stable tiny hypoechoic nodule with a hyperechoic focus measuring 7 x 4 x 6 mm in the equator of the left lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small lymph nodes measuring up to 1.5 cm in diameterOTHER: No significant abnormality noted.

Output: Stable exam. Tiny hypoechoic nodule in left lobe unchanged.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is an oblique tear through the body of the lateral meniscus, extending to the tibial surface with adjacent parameniscal cysts. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There are bone contusions in the medial femoral condyle, tibial plateau and to a lesser degree the lateral femoral condyle. There is mild fissuring of the articular cartilage of the lateral femoral condyle, otherwise the articular cartilage is intact.LIGAMENTS: The anterior cruciate ligament is chronically torn. The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Chronic tear of the ACL.2.Oblique tear through the body of the lateral meniscus. 3.Bone contusions in the distal femur and proximal tibia.


Instruction: Generate impression based on findings.

Input: 50 year-old female with pancreatic cancer on chemotherapy (gemcitabine). Additional history reveals patient is status post Whipple and radiation treatment. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions with compressive atelectasis. Mild emphysema. No lung nodules identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right-sided Port-A-Cath tip is in the SVC. No evidence of osseous metastatic disease. Bilateral thyroid nodules.ABDOMEN:LIVER, BILIARY TRACT: The liver is diffusely low-attenuation, due to fatty infiltration. In the posterior inferior right lobe of the liver the hypervascular lesion is grossly stable in size, measuring 2.4 x 1.9 cm (image 94/11 of series 4). This avid enhancement is unusual for a adenocarcinoma metastasis to the liver; however, enhancement on this study may appear exaggerated given the degree of fatty infiltration. The adjacent lesion in the lateral aspect of the liver is also grossly stable in size, currently measuring 1.1 x 0.8 cm (image 96/211 of series 4). This hypodense lesion in the left lobe liver near the falciform ligament is unchanged and had characteristics of a simple cyst on the patient's recent MRI. Attenuation differences within the liver elsewhere are likely due to transient differences due to phase of enhancement.There is a subcapsular fluid collection anterior to the right lobe of the liver. This measures 4.0 x 1.9 cm (image 68/211 series number 4).Extensive postsurgical changes are identified in the porta hepatis. There is fluid attenuation throughout the porta hepatis which may be postsurgical in etiology. Extrahepatic portal vein occlusion noted. Numerous varices are identified throughout the abdomen.SPLEEN: Stable mild splenomegaly. The splenic vein appears to drain inferiorly into the inferior mesenteric vein and there are splenic vein collaterals.PANCREAS: Patient status post Whipple with pancreatic head removal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The azygos and hemiazygos systems are dilated due to collateral blood flow.BOWEL, MESENTERY: Multiple collateral vessels are identified in the lack of flow through the portal vein. Diffuse ascites. There is diffuse infiltration of the mesentery as well as multiple soft tissue nodules which may be due to ascites. BONES, SOFT TISSUES: No significant abnormality noted. The osseous abnormalities identified on the patient's recent MRI are not seen on this exam.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The well-defined lesion identified medially to the right of the rectum measures 2.0 x 1.4 cm (image 29/211). This has peripheral calcification. Diffuse ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Gross stability of the two enhancing lesions in the right lobe of the liver. While the hypervascularity of these lesions is unusual for pancreatic adenocarcinoma, enhancement may be exaggerated given the degree of fatty infiltration throughout the remainder of the liver. Both should be followed to confirm stability.2. Multiple collateral vessels and ascites likely secondary to portal vein occlusion.


Instruction: Generate impression based on findings.

Input: 24 year old female with a history of pulmonary valve atresia status post transannular patch and pulmonary valve replacement (bioprosthetic Carpentier-Edwards 29mm) presenting for evaluation of chamber size and function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 132 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 55 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced RV systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 46 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). RVOT has evidence of presumed prior patch repair. Right AtriumThe right atrium is moderately enlarged. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. The aortic valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve is consistent with a bioprosthetic valve replacement. There is mild pulmonic regurgitation present; however, correlation with echo suggested if this does not fit clinical impression given presence of significant artifact created by bioprosthetic valve. Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. No evidence of aortic aneurysm or dissection. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery and its main branches are normal in size without significant aneurysm or stenosis. Main PA - 25x28mmLPA - 24x20mmRPA - 15x17mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 59%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size with mildly reduced RV systolic function (RVEF 49%) with evidence of likely RVOT patch repair.3. Bioprosthetic valve noted in pulmonary position with mild pulmonic valve regurgitation; however, if this finding does not fit clinical impression than correlation with echo suggested given presence of significant artifact related to presence of bioprosthetic valve.4. No significant pulmonary artery aneurysm or stenosis. 5. Moderate right atrial dilation.6. Moderate tricuspid regurgitation.7. Mild aortic regurgitation. Compared to previous study, the LV volumes are larger (both ESV and EDV) with similar ejection fraction (these changes may be related to aging), RV volumes are slightly lower with improvement in right ventricular ejection fraction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Metastatic right breast cancer. This is a limited examination, only sagittal T1 and STIR sequences were obtained to assess for cord compression. It is further limited by patient motion and inability to cooperate.Sagittal alignment is notable for cervical straightening as well as minimal anterior subluxation of L4 relative to L5. Vertebral body heights and alignment are otherwise maintained. Multilevel shallow ventral indentations of the thecal sac are caused by disc-osteophyte complexes in the cervical and thoracic regions which is most pronounced at C3-C4 where it is mild-to-moderate. There is no severe/significant spinal canal stenosis. The spinal cord grossly shows no abnormal signal.There is T2 signal in T8-T9 disc while there is desiccation involving the other thoracic discs. There is T2-hyperintense, T1-hypointense signal in the marrow subjacent to the T8-T9 endplates and also extending into the left T8-T9 neural foramen. Subtle endplate irregularity was evident at this level on prior chest CT from 10/27/2015. There is mild L5-S1 neural foraminal stenosis bilaterally. There is facet arthropathy at L4-L5 with mild joint distention.

Output: 1.Examination is limited to sequences per cord compression protocol. No evidence of cord compression. No evidence of pathologic compression fractures or epidural tumor within the limits of the study. Note this examination is not adequate for detecting small metastatic lesions in the spine.2.Disc and endplate marrow signal changes at T8-T9 are favored to be on a degenerative basis with degenerative changes and associated mild irregularity also evident on prior chest CT from 10/27/2015. Discitis-osteomyelitis however cannot be entirely excluded.3.Mild to moderate spinal canal stenosis is noted in the cervical spine on a degenerative basis.Dr. Monther Qandeel discussed the above findings with the care team over the phone on 3/5/2016 at about 10:00 AM. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post prostatectomy. Rising PSA. Radical prostatectomy 6/27/2012 Gleason's score of 4+3. No extraprostatic extension and negative margins. PELVIS:PROSTATE: The patient is status post radical prostatectomy. There is no MR evidence of residual or recurrent tumor in the prostatectomy bed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: 9 mm T1 weighted hypointense and T2 weighted hypointense lesion in the right iliac bone adjacent to the right sacroiliac joint is partially imaged (series 601/28). There is no corresponding mobility on the lumbar spine MRI from 6/22/2013 CT dated 6/22/2013 or bone scan dated 9/12/2013.OTHER: No significant abnormality noted.

Output: 1. No specific evidence of residual or recurrent tumor in the prostatectomy bed.2. Hypointense right iliac bone 9 mm lesion is not seen on prior imaging. Further evaluation with a bone scan is recommended for further evaluation to exclude metastatic disease.


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0] / Paresthesia of skin [R20.2] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: evaluate for stroke History: R radial nerve sensorimotor distribution, R lower face Vc vs cervical branch, ?LUE tingling Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Scattered FLAIR high signal intensity lesions on by lateral hemisphere indicating nonspecific small vessel ischemic disease in this age.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. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.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.C-spine MRIThe cranial-cervical junction is normal. The spine alignment is anatomic but it lost normal cervical lordosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. Degenerative changes are as follows;C1-C2: No evidence of neuroforaminal stenosis, no spinal stenosis.C2-C3: No evidence of neuroforaminal stenosis, no spinal stenosis.C3-C4: No evidence of neuroforaminal stenosis, no spinal stenosis.C4-C5: No evidence of neuroforaminal stenosis, no spinal stenosis.C5-C6: Focal central bulging of disc which abuts thecal sac. No evidence of neuroforaminal stenosis, no spinal stenosis.C6-C7: No evidence of neuroforaminal stenosis, no spinal stenosis. There is a relatively well circumscribed lesion within the right neuroforamen which shows CSF signal intensity without demonstrating evidence of mass effect (size=5.3mm). This lesion is most likely representing perineural cyst. The same character but slightly smaller (size=3.5mm)lesion is seen on the left side neuroforamen.C7-T1: No evidence of neuroforaminal stenosis, no spinal stenosis. Again, there are perineural cysts, one on the right side (3.5mm) and another on the left side (6.3mm).

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Normal brain MRA.4. Focal central bulging of disc at the level of C5-6 which abuts thecal sac.5. Multiple perineural cysts at the level of C67 and C7T1, otherwise unremarkable C-spine MRI.


Instruction: Generate impression based on findings.

Input: 63-year-old male with knee pain. MENISCI: There is increased signal abnormality which extends to the tibial and femoral articular surface with associated deformity of the posterior horn of the medial meniscus consistent with a complex but predominantly radial tear. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage degeneration along the medial facet of the patella. There is focal full-thickness articular cartilage degeneration along the lateral facet of the patella with bone marrow edema type signal abnormality in the surrounding area, likely degenerative in etiology. There is superficial fraying of the articular cartilage of the femoral trochlea. There is near full thickness articular cartilage degeneration along the posterior aspect of the medial femoral condyle above the posterior horn of the medial meniscus.LIGAMENTS: There is increased signal abnormality about the MCL suggestive of a MCL sprain. The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above.2. Articular cartilage degeneration as described above.3. Findings suggestive of a partially ruptured Baker's cyst.


Instruction: Generate impression based on findings.

Input: 2 yo female with seizure, abnormal EEG. There is no restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is a focus of susceptibility suspected within the right cerebellar hemisphere. Brain parenchyma appears otherwise unremarkable for age. The hippocampi are grossly symmetric and similar in intensity. The myelination pattern appears normal for age. 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.No intracranial mass or structural lesion to suggest seizure focus is identified. If there is continued suspicion for a structural etiology, dedicated MRI with epilepsy protocol may be obtained.2.Focus of susceptibility effect within the right cerebellum favored to represent a punctate chronic microhemorrhage.


Instruction: Generate impression based on findings.

Input: 58-year-old male with weakness and mass on inspection and palpation of the right arm. Likely right biceps tendon rupture. LIGAMENTS: No significant abnormality noted.TENDONS: There is complete rupture of the biceps tendon just distal to the myotendinous junction. There is at least 12 cm of retraction. There is a large amount of fluid signal abnormality surrounding the proximal tendon remnant. ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. There is a small amount of fluid within the elbow joint without evidence of large effusion. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Complete rupture with retraction of the biceps tendon as described above.


Instruction: Generate impression based on findings.

Input: 79 year old male referred for cardiovascular MRI to evaluate for cardiac amyloidosis. Left VentricleThe left ventricle is normal in size with moderate to severe concentric hypertrophy and mildly reduced systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 127 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 98 g/m2 (normal range 85+/-15), and the LV mass is 188 g (normal range 164+/-36). The basal segments of the ventricle are more hypokinetic than the apical segments. The myocardium and LV cavity blood pool appear to null at near the same inversion time consistent with abnormal "gadolinium kinetics." There is diffuse nearly transmural late gadolinium enhancement which is most pronounced in the basal inferolateral wall and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. Taken together these findings are consistent with the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small to moderate pericardial effusion.Extracardiac FindingsBilateral pleural effusions are note (R>L). 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. Moderate to severe left ventricular hypertrophy with mildly reduced systolic function (LVEF 41%). There is evidence of abnormal "gadolinium kinetics" and diffuse late gadolinium enhancement in a pattern strongly suggestive of cardiac amyloidosis.2. Normal RV size with moderately reduced systolic function (RVEF 39%).3. Biatrial dilation.4. Small to moderate pericardial effusion.5. Bilateral pleural effusions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 14-year-old female with low back pain x 6 months plus sciatica. Evaluate for sclerosis/healing of bilateral spondylolyses. Lumbar spine:There is minimal straightening of the lumbar spine which may be secondary to positioning for examination. Attenuation and morphology of the vertebral bodies and intervertebral disk spaces is within normal limits. The pre-and paravertebral soft tissues are within normal limits. L1-2: within normal limits without central or neuroforaminal narrowing.L2-3: within normal limits without central or neuroforaminal narrowing.L3-4: within normal limits without central or neuroforaminal narrowing.L4-5: within normal limits without central or neuroforaminal narrowing.L5-S1: within normal limits without central or neuroforaminal narrowing. There is a mild amount of sclerosis at the L5-S1 bilateral pars defect without evidence of fusion. No evidence of spondylo-listhesis.Limited abdominal imaging is within normal limits.

Output: 1. Spondylolysis of L5. Mild bilateral sclerosis involving the inferior L5 facet compatible with pars defect without evidence of fusion.2. No evidence of spondylo-listhesis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: 24 hr post L MCA strokeSigns and Symptoms: stroke MRI of the brainThere is a focus of diffusion restriction present involving left inferior frontal gyrus, left insular cortex and left middle frontal gyrus with some extension into the lateral aspect of the left precentral gyrus and a small component in the left inferior parietal lobule supramarginal gyrus. There are associated FLAIR and T2 signal changes. There is a focus of susceptibility effect present along the left inferior frontal gyrus anteriorly. This focus of susceptibility measures 18 x 9 mm axial dimensions on the T2 axial images.A small focus of encephalomalacia is present along the right occipital lobe the lower portion of the cuneus and region measuring approximately 15 x 20 mm in sagittal dimensions.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 demonstrate mucosal thickening in the right maxillary sinus associated with a small right maxillary sinus. There is depression of the floor of the right orbit and the medial deviation of the medial wall of the right orbit. The visualized portions of the mastoid air cells are clear. MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is fetal origin of the posterior cerebral arteries bilaterally associated with small P1 segments. The A1 segments are similar in size. The anterior communicating artery appears small. The left vertebral artery is slightly larger than the right vertebral artery. There is thickening of the walls of the right vertebral artery along its proximal intracranial segment and distal extracranial segment without significant stenosis.

Output: 1.Subacute infarction in the left middle cerebral artery territory as detailed above associated with the a small area of hemorrhagic conversion.2.Small focus of encephalomalacia is present along the right occipital lobe. Most likely this is related to remote cerebral infarction. Please note that there is fetal origin of the posterior cerebral arteries.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Findings suggest an old right orbital blowout fracture.


Instruction: Generate impression based on findings.

Input: Reason: RCT? History: pain ROTATOR CUFF: Note is made of a full-thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 13 mm in AP dimension. There is approximately 1 cm of retraction of the proximal tendon fragment. There is mild fatty atrophy of the supraspinatus along the myotendinous junction. There is thickening and intermediate signal intensity of the infraspinatus indicating tendinosis. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. The infraspinous muscle appears intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa confirming a full-thickness tear. Mild to moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. The glenohumeral joint alignment is anatomic. There is heterogeneity of the anterior and inferior glenoid labrum which may reflect degeneration and degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is a small amount of fluid within the tendon sheath which may reflect fluid extending from the glenohumeral joint.ADDITIONAL

Output: 1. Full-thickness rotator cuff tear with retraction as described above. Rotator cuff tendinosis.2. Osteoarthritis of the shoulder. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with dizziness. Evaluate for cord lesion. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow signal abnormality or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No pathologic intramedullary or leptomeningeal enhancement is evident. No epidural abnormalities are suspected.The intervertebral discs are preserved. No significant disc herniation is seen. The spinal canal and neural foramina are patent.

Output: No findings are seen to account for the patient's dizziness.


Instruction: Generate impression based on findings.

Input: 53-year-old female with worsening pain. Right shoulder met, recent RT. Again seen is a lytic lesion of the humeral head and neck most compatible with metastatic disease as seen on recent MRI study. Since the prior right shoulder radiograph on 2/22/2016 there is a new comminuted fracture involving the surgical neck of the humerus and greater tuberosity which appears slightly impacted. Right chest port catheter tip overlying the right atrium.

Output: Metastatic lesion in the humeral head and neck with new comminuted and slightly impacted fracture of the surgical neck of the humerus and greater tuberosity. Findings were discussed with Dr. Lauren Das by phone on 4/27/2016 at 10:00 AM.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses.

Output: 1.Negative MRI of the brain including gadolinium enhancement.2.Negative MRI of the brain including gadolinium enhancement.3.Specifically, there are no MRI abnormalities of the brain or spine to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Aphasia. There is a cluster of punctate foci of restricted diffusion and high T2 signal involving the left inferior frontal gyrus, Heschl gyrus, and superior temporal gyrus. There are otherwise scattered punctate foci of cerebral white matter T2 hyperintensity without restricted diffusion, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. The brainstem and cerebellum appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are bilateral maxillary sinus retention cysts.

Output: Punctate acute posterior left peri-Sylvian sulcus infarcts, without evidence of hemorrhagic transformation.


Instruction: Generate impression based on findings.

Input: 35-year-old male with liver lesion. Evaluate lesion seen on liver on CT. ABDOMEN:LIVER, BILIARY TRACT: Large lesion of the caudate lobe measuring 5.9 x 6.8 cm (series 3 image 46) demonstrates discontiguous nodular peripheral enhancement that fills in on venous and delayed phases following blood pole is consistent with a benign hemangioma. Additional predominantly subcentimeter T2 hyperintense foci also demonstrate peripheral enhancement that fills in on delayed series compatible with small hemangiomas. Small lesion in hepatic segment 4B may also represent a small hemangioma (series 5 image 223).SPLEEN: No significant abnormality noted.PANCREAS: Normal T1 bright signal intensity on the precontrast series. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Benign hemangioma of the caudate lobe. Scattered small additional hepatic lesions also likely represent small hemangiomas.


Instruction: Generate impression based on findings.

Input: 50 year-old female with history of multiple sclerosis presenting with paresthesias. Brain:Again seen are multiple white matter T2 hyperintensities in a primarily subcortical distribution in the supratentorial brain and pons. Patient motion on both today's scan and the prior examination mildly limits comparison, but within this limitation no definite new lesions are identified and the existing lesions are not significantly changed. Only the largest lesion which is located in the left occipital lobe is associated with decreased T1 signal. No significant cerebral volume loss.In the skull base there appears to be anomalous vessel arising from the mildly ectatic junction of the cavernous and petrous right internal carotid connecting to the basilar artery, traversing the dorsum sellae. This is just above the level of the trigeminal nerve. The slightly focally ectatic cavernous carotid mildly remodels the dorsum sella on the right side. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:The cervical spinal cord is normal in caliber and contour throughout. No evidence of myelomalacia. No evidence of demyelinating disease. The vertebral body and intervertebral disc heights are maintained. There is minimal multilevel decreased intervertebral disc signal compatible with early desiccation. There is straightening of the lower cervical lordosis which may be positional or degenerative in etiology. No bone marrow signal abnormalities.There are very minimal disc osteophyte complexes at C3-4, C5-6, and C6-7 without significant neural foraminal or spinal canal stenosis. Thoracic spine:Again seen are patchy poorly defined areas of increased T2 signal within the proximal thoracic spinal cord. This is most notable in the ventral cord at the lower T1 level as well as in the right lateral cord at the T3 and T4 levels. A more focally defined plaque of increased T2 signal within the central to posterior spinal cord at the T9-10 level measures 3 x 3 x 12 mm, previously 3 x 3 x 11 mm. There is mild volume loss associated with the T9-10 lesion. These findings are not significantly changed from prior and no new lesions are identified.The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities. There are small right paracentral disc protrusions at T5-6 and T6-7. There is mild spinal canal stenosis with flattening of the anterolateral cord T6-7. No significant neural foraminal stenosis.

Output: 1. Stable findings of multiple sclerosis in the brain with multiple demyelinating lesions in the supratentorial brain and pons. Accounting for differences in techniques, these lesions are not significantly changed and no new lesions are identified. Overall, trace T1 and mild T2 burden of disease, including infratentorial lesions.2. Stable findings of demyelinating disease with patchy areas of abnormal T2 signal in the proximal thoracic cord as well as a more defined focal plaque at T9-10. No new lesions are identified.3. Anomalous vessel in the skull base likely representing a persistent trigeminal artery with associated ectasia of the right cavernous carotid artery, and associated remodeling of the dorsum sella which is a common finding. This can be further evaluated with MR angiography.4. No evidence of demyelinating disease in the cervical spine.


Instruction: Generate impression based on findings.

Input: Ms. Bray is a 46-year-old female presenting from outside hospital with two suspicious lesions identified in the left breast. These were biopsied and final pathology revealed atypia, but no malignancy. She presents today for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, limiting the evaluation of MRI.In the left breast, far posterior depth, there is a lobulated T2 hyperintense lesion identified with associated enhancement. This lesion measures approximately 2.1 x 1.8 x 1.5 cm. Susceptibility artifact from biopsy marker clip is seen at the posterior aspect of this lesion, compatible with one of the biopsied lesions at outside hospital (labeled on outside images as left breast 2:00 location, approximately 7 cm from the nipple).In addition, in the left breast, mid depth, there is an additional lobulated T2 hyperintense lesion identified with associated enhancement. This lesion is slightly harder to measure due to its irregular margins, but approximately measures 2.8 x 1.4 x 1.6 cm. Susceptibility artifact from biopsy marker clip is seen at the lateral aspect of this lesion, compatible with the second of the biopsied lesions at outside hospital (labeled on other images as left breast 2:00 location, approximately 3 cm from the nipple). The two biopsy marker clips are separated by approximately 7 cm in the AP dimension. Of note, these two lesions were re-biopsied on the same day as the MRI, and the new biopsy marker Hydromark clips are separated by approximately 6 cm in the AP dimension on the ML view. Although there is significant background parenchymal enhancement identified in both breasts, there is no additional abnormal enhancement identified. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Two enhancing lesions with T2 hyperintense signal (suggestive of mucin content) in the left breast, corresponding to the biopsied lesions at outside hospital. Repeat US guided biopsies of these two lesions was performed on same day as MR. Awaiting final pathology. (2) No additional MR evidence of malignancy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 20 year old woman with Marfan's syndrome, referred for interval imaging of the thoracic aorta. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 124 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 39 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 63 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 44 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet and opens widely. There is trace aortic regurgitation (regurgitant fraction 2%).Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root dimensions as follows:SOV: 38mm x 36mm x 34mmSTJ: 29mm x 30mmAscending aorta: 25mm x 25mmMid aortic arch: 18mm x 18mmDescending thoracic aorta: 16mm x 16mmPulmonary 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 normal in size with normal systolic function. The overall LV ejection fraction is 69%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%. 3. Normal thoracic aorta size, dimensions as above. 4. Compared to prior cardiac MRI on 12/12/13, there is no significant change. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for TFCC injury or other ligamentous injury, presents with DRUJ instability. LIGAMENTS: No significant abnormality is noted. In particular, the scapholunate and triquetrolunate ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is intact. There is slightly increased signal intensity within the TFCC possibly representing a sprain, however no fluid-filled tear is seen.TENDONS: The flexor and extensor tendons of the wrist are intact and of normal signal characteristics.BONES: A 4-mm bone fragment is displaced approximately 3 mm from the lateral articular surface of the radius.ADDITIONAL

Output: 1. 4-mm bone fragment from the lateral articular surface of the radius.2. Intact TFCC and carpal ligaments, as above.


Instruction: Generate impression based on findings.

Input: Causes of dysautonomia: syncope, weakness, and gastroparesis. Many of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct, although the exam is partly limited by patient motion and no contrast could be administered.The images for this exam now reside on accession #15401187 to accurately reflect the procedure that was performed. Accession# 15396040 will be billed.


Instruction: Generate impression based on findings.

Input: Male, 17 years old. NF2 complaining of chest pain and tachycardiaVIEWS: Chest PA/lateral (two views) 07/21/2016, 1352 hrs. A VP shunt courses over the left hemithorax.Cardiothymic silhouette is normal.No focal airspace opacity. No pleural effusions or pneumothorax.A round opacity overlying the right apex corresponds with a paraspinal mass seen on recent spine MRI from 05/18/2016.

Output: No focal airspace opacity. Right upper thoracic paraspinal mass.


Instruction: Generate impression based on findings.

Input: Melanoma, evaluate for recurrence Within the posteromedial soft tissues of the knee is an area of ill-defined streak-like high T2, low T1 signal intensity presumably in the region of the patient's prior lesion. These changes are best appreciated on series 701 images 6 through 12. Following contrast administration, there is faint contrast enhancement at this area is thought to represent an area of prominent vascularity and scarring as opposed to a true recurrence. There is otherwise no evidence of abnormal enhancement within the surrounding soft tissues of the knee or calf and no discrete nodule or mass.The signal intensity of the calf musculature is normal. The marrow intensity of the tibia and fibula are normal.

Output: Ill-defined enhancement in the posteromedial subcutaneous tissues of the knee presumably representing post surgical scarring and prominent vascularity. There is otherwise no evidence of discrete enhancing nodule or mass within the right lower leg.


Instruction: Generate impression based on findings.

Input: 6-year-old with history of a right temporal cyst. Interval follow-up exam. There is a juxtaventricular cystic lesion that measures up to 15 mm in the right temporal lobe immediately superior to the hippocampus. There is persistent adjacent mild high T2 signal, but no associated enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is partial opacification of the left sphenoid and maxillary sinuses.

Output: Stable appearance of the cystic lesion in the right temporal lobe, which likely represents a form of benign post-injury, such as a porencephalic cyst, although no direct communication with the ventricular system is discernible, versus a development cyst, such as an ependymal or neuroglial cyst. A low-grade neoplasm is less likely.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Other alteration of consciousness [780.09] / Abnormal involuntary movements(781.0) [781.0], Reason for Study: ^Reason: headaches, jerking movements suggestive of seizures, seizure focus? History: jerking arms and legs, spacing out Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There are multiple small retention cysts on bilateral maxillary sinuses.Pituitary gland MRIThe pituitary gland is normal in size, morphology, signal intensity and enhancement. There is no hypo-enhancement or signal abnormality suggestive of neoplasm. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable.

Output: Normal Brain MRI and normal pituitary gland MRI


Instruction: Generate impression based on findings.

Input: 43-year-old male with congenital hepatic fibrosis. Recent ultrasound completed at OSH indicated to large hepatic masses. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Multifocal lesions in both hepatic lobes that demonstrate increased T1 signal intensity (axial series 13 images 38, 54, 58, 74, 98, 114, 134, 154, 164), decreased T2 signal intensity, and contrast enhancement. No washout or arterial hyperenhancement is identified. The largest lesion in the left hepatic lobe measures 8.7 x 7.7 cm. These lesions are favored to represent regenerative nodules and are stable in appearance since the 2008 MRI exam.Cystic dilatation of intrahepatic bile ducts, which are massively dilated at the hepatic dome. No extrahepatic biliary ductal dilatation.There is cavernous transformation of the portal vein and large gastric and splenic varices. A splenorenal shunt is noted, and there is dilatation of the left renal vein. Mild dilatation of the common hepatic duct is also noted.SPLEEN: Splenomegaly measuring 20 cm in craniocaudal length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multifocal small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Bilobar hepatic lesions with T1 hyperintensity, T2 hypointensity, and contrast enhancement are compatible with regenerative nodules. These lesions are unchanged in appearance since the 2008 MRI exam. No evidence for malignancy.2.Extensive cystic dilatation of the intrahepatic bile ducts, which are markedly dilated at the hepatic dome. Also unchanged.3.Stigmata of portal hypertension including splenomegaly, gastric/splenic varices, and a splenorenal shunt.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:3/26/1964)Reason: Evaluate for worsening headaches that are bifrontal and radiate to back of head with associated nausea and vomiting. Please compare to previous study that is uploaded to PACS, possible Dandy-walker malformation. PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS 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. There is a perivascular space present in the right basal ganglia is probably of significance.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is an arachnoid cyst present located just above the cerebellar vermis which measures approximately 14 x 19 mm sagittal dimensions. The cerebellar vermis appears to be displaced and deformed but not hypoplastic. The cerebellar tonsils extend approximately 3 mm below the level of foramen magnumThe visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is small arachnoid cyst present posterior fossa. 2.Low-lying cerebellar tonsils.3.Several periventricular and subcortical punctate lesions at this age are frequently seen, likely of little clinical significance and are nonspecific. There is no evidence for Dandy-Walker malformation4.Some minor opacities in the paranasal sinuses are likely inflammatory in nature.


Instruction: Generate impression based on findings.

Input: Pituitary macroadenoma complicated by subarachnoid hemorrhage after transphenoidal surgery: worsened right arm weakness, new rigidity. There are postoperative findings related to transphenoidal surgery. There is a heterogenous sellar and suprasellar mass that measures up to 35 mm, previously 45 mm, with areas of T1 hyperintensity and susceptibility effect, compatible with recent hemorrhage. There is also hemorrhage within the left suprasellar and basal cisterns, bilateral Sylvian fissures, posterior temporal convexities, upper cerebellar sulci, and within the occipital horns of the bilateral lateral ventricles. In addition, hemorrhage is also present within the sinonasal cavities. There is scattered cerebral white matter T2 hyperintensity, which is nonspecific. There is no evidence of acute infarction. There is no midline shift or herniation. The ventricles appear to be more prominent diffusely. The major cerebral flow voids appear to be grossly intact. There is fluid within the bilateral mastoid air cells. The orbits are grossly unremarkable.

Output: Interval evolution of recent hemorrhage within the pituitary macroadenoma, which has overall decreased in size, with persistent subarachnoid and intraventricular extension, as well as developing hydrocephalus. Hemorrhage is also present within the sinonasal cavities.


Instruction: Generate impression based on findings.

Input: Diplopia. MG versus TED No appreciable orbital proptosis by imaging or enlargement of the extraocular muscles to suggest thyroid associated ophthalmopathy. Bilateral orbits appear within normal limits without evidence of mass or abnormal enhancement. Bilateral globes are intact. No abnormal signal within the optic nerves. There is artifact related to dental hardware which particularly degrades the diffusion and susceptibility weighted sequences. Within this limitation, there is no evidence of acute ischemia or acute hemorrhage. No intracranial mass or mass effect. There are multiple scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, similar to prior study, and compatible with mild chronic small vessel ischemic changes. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. No abnormal parenchymal or meningeal enhancement.Partially imaged is a circumscribed, lobulated, enhancing mass involving the left medial aspect of the parotid gland measuring approximately 2.2 x 2.9 cm in the transverse and craniocaudal dimensions, previously approximately 1.3 x 2.1 cm, measured similarly on 9/11/2010.

Output: 1. Bilateral orbits appear within normal limits. No imaging findings to suggest thyroid associated orbitopathy. 2. Mild chronic small vessel ischemic changes are again seen. Brain parenchyma appears otherwise within normal limits.3. Partially imaged is a lobulated, enhancing mass involving the medial aspect of the left parotid gland measuring approximately 2.2 x 2.9 cm in the transverse and craniocaudal dimensions. Finding is suspicious for neoplasm. Consider dedicated neck imaging and ENT consultation.Dr. Ali discussed with Dr. Qayum at 1550 hrs on 3/24/2015.


Instruction: Generate impression based on findings.

Input: dementia No evidence of acute ischemic or hemorrhagic lesion on this scan.Comparing to prior scan, there is a new high signal foci on the right pre central gyrus white matter on FLAIR images. However, the lesion does not show restricted diffusion or susceptibility artifacts, thus, this lesion is likely to represent age indeterminate non specific small vessel ischemic lesion.The vertebrobasilar system appears to be slightly enlarged and tortuous indicating atherosclerotic changes.Previously identified right side medulla mass like lesion is not shown on this scan, most likely related to thick slice of today's scan.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: No evidence of acute ischemic or hemorrhagic lesion on this scan.A new focal high signal lesion on the right frontal lobe pre central gyrus white matter without evidence of restricted diffusion indicate non specific small vessel ischemic lesion.


Instruction: Generate impression based on findings.

Input: 25 years, Female, history of cranial radiation, baseline exam. History of leukemia. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter which are nonspecific but compatible with posttreatment change. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. Ventricles are within limits. No extra-axial collections. No abnormal parenchymal or meningeal enhancement. There is heterogeneous low T1 marrow signal including the clivus and visualized upper cervical spine which are nonspecific but compatible with history of leukemia. There is near complete opacification of the left sphenoid sinus extending into the left posterior ethmoid sinus. Paranasal sinuses are otherwise clear. Remainder of the visualized extracranial soft tissues are unremarkable.

Output: Several T2/FLAIR hyperintense foci scattered in the periventricular and subcortical white matter which while nonspecific are compatible with posttreatment change. No intracranial mass or abnormal enhancement to suggest neoplasm.


Instruction: Generate impression based on findings.

Input: 57-year-old male with worsening chronic right knee pain. No known trauma. Evaluate for osteoarthritis with weightbearing radiographs. Three weightbearing views of the right knee demonstrate mild medial and lateral joint space narrowing. There are tiny osteophytes in the patellofemoral compartment. No evidence of acute fracture or malalignment. There is fullness in the calf consistent with the patient's known lipoma which is better characterized on prior MRI from 7/1/2015.

Output: Mild osteoarthritis of the right knee.


Instruction: Generate impression based on findings.

Input: 79-year-old male with liver hypoattenuation seen on CT abdomen. LIVER: The liver measures 13.4 cm in length. Normal echogenicity of the hepatic parenchyma. No suspicious lesions, including the left hepatic lobe. The main portal vein demonstrates normal hepatopedal flow and velocity measuring 16.8 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 3.8 mm in diameter. The gallbladder is normally distended and shows no intraluminal stones or wall thickening.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 8.8 cmRIGHT KIDNEY: The right kidney measures 9.1 cm, and the left kidney measures 9.2 cm in length. No hydronephrosis. OTHER: No significant abnormalities noted.

Output: No suspicious hepatic lesions, particularly in the left hepatic lobe.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of upper lobe, right bronchus or lung Encounter for antineoplastic chemotherapy Disseminated malignant neoplasm, unspecified Secondary malignant neoplasm of brain Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm Encounter for examination for normal comparison and control in clinical research programClinical question: mets lung cancer, brain mets. Liver and adrenal mets; s/p 6 cycles of chemo, pls c/w previous study and evaluate treatment response. Please provide bi-dimensional measurements to all lesions per RECIST 1.1Signs and Symptoms: brain mets, s/p RT There is redemonstration of multiple foci of susceptibility effect where there were previously enhancing lesions on the 4/22/2015 exam. On the postcontrast T1 weighted images enhancing lesions are identified. A lesion on the surface of the left superior frontal gyrus currently measures 8 x 6 mm and previously measured 6 x 8 mm axial dimensions. The lesion along the right parietal lobe inferior parietal lobule adjacent to the occipital lobe measures 11x8 axial dimensions and on the October exam measured 13x 10 mm. On the April exam it measured 20 x 23 mm. A 3 mm enhancing nodule is present in the splenium of the corpus callosum at its junction with the septum pellucidum. This lesion previously measured similar size. Lesions which currently do not enhance but are associated with susceptibility effect include a left cerebellar lesion as well as the right temporal lobe lesion, right hippocampal lesion, right occipital lobe lesion, left precentral gyrus lesion.There continues to be T2 and FLAIR signal abnormality surrounding the above described lesions which appears stable when compared to the prior exams.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening along the left maxillary sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities in the right mastoid air cells. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.

Output: 1.Multiple lesions scattered throughout the brain are compatible with hemorrhagic metastases. There is mild regression of some of the enhancing lesions compared to the October exam. 2.Associated FLAIR signal abnormalities are stable.


Instruction: Generate impression based on findings.

Input: History of chronic pancreatitis and IPMN status post distal pancreatectomy and splenectomy. Evaluate for recurrence. 11/25/2009 Pathology demonstrated side-branch IPMN and chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size measuring 17 cm in craniocaudal dimension. No focal suspicious lesion. No vascular abnormality.Lobular dilatation of the common bile duct is not significantly changed in caliber or morphology without a filling defect, stricture or mass lesion. Minimal central intrahepatic ductal dilatation, unchanged.Normally distended gallbladder.SPLEEN: Status post splenectomy.PANCREAS: Postsurgical changes from distal pancreatectomy. The main pancreatic duct is mildly irregularly prominent up to 4 mm, slightly improved from prior. There is mild side branch ectasia and several punctate subcentimeter T2 hyperintensities in the parenchyma without definitive communication with the main pancreatic duct.No suspicious postcontrast enhancement. The pancreatic parenchyma has diminished intrinsic T1-weighted signal intensity but demonstrates homogeneous postcontrast enhancement. No specific findings of acute pancreatitis.ADRENAL GLANDS: Stable small left lipid rich adrenal adenoma.KIDNEYS, URETERS: At least partially duplicated collecting system on the right. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large perineural cyst/Tarlov cysts in the partially imaged sacrum, unchanged dating back to 2013.OTHER: No significant abnormality noted.

Output: 1. Interval mild decrease in residual pancreatic ductal irregular dilatation without a focal lesion evident, likely stigmata of chronic pancreatitis.2. Stable punctate cystic pancreatic parenchymal foci without definitive communication with the main pancreatic duct may represent small side branch IPMNs vs other tiny cystic lesions. No suspicious imaging characteristics.


Instruction: Generate impression based on findings.

Input: 43-year-old male status post right shoulder injury now with decreased range of motion and pain, clinical concern for rotator cuff tear. ROTATOR CUFF: There is minimal intermediate signal in the distal fibers of the supraspinatus tendon and perhaps minimal undersurface tearing. We see no discrete tear. Similarly, there is mild irregularity of the undersurface fibers of the infraspinatus tendon, but we see no discrete tearing. The tendons of teres minor and subscapularis are intact. The musculature of the rotator cuff is intact.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. The distal end of the clavicle is enlarged, perhaps reflecting old trauma, with impression upon the superior fibers of supraspinatus. GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is intact. As seen on the prior radiograph, there is a Bankart fracture of the anterior-inferior glenoid. We estimate the fracture fragment to be approximately 1.5 cm in greatest dimension and approximately 6 mm in width. It is difficult to assess the degree of glenoid bone loss on this study, but we estimate the loss to be between 10 and 15%.There is a moderate-sized joint effusion. There is a 2 cm crescentic bone/cartilaginous fragment is in the joint, representing a displaced fracture fragment from the posterior aspect of the humeral head, with edema of the underlying humeral head. There is an additional 6 mm focus of indeterminate signal in the posterior aspect of the glenohumeral joint, likely representing a bone or cartilage fragment.There is a bucket-handle type tear of the superior labrum, which extends into both the anterior and posterior labrum. The cartilage of the anterior aspect of the glenohumeral joint appears thinned with full-thickness cartilage loss along the inferior aspect of the glenoid.BICEPS TENDON: The tendon of the long head of the biceps appears thin at its anchor, and may represent extension of the SLAP tear. The remaining biceps tendon appears intact. Fluid within the bicipital sheath likely represents extension from the glenohumeral joint effusion.

Output: 1.Findings compatible with prior anterior shoulder dislocation, with associated Bankart fracture and a displaced osteochondral fragment from the posterior lateral aspect of the humeral head into the glenohumeral joint.2.Labral tearing with a equivocal extension into the biceps anchor as described above.3.Moderate osteoarthritis of the acromioclavicular joint.4.Cartilage loss along the inferior glenoid.5.Minimal tendinosis and perhaps minimal undersurface fraying of the rotator cuff.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with left buttock and back pain, and left lower extremity paresthesias. Alignment is anatomic. Vertebral body heights are preserved. Degenerative endplate irregularity is seen at L5-S1. No worrisome marrow replacement is detected.The visualized distal spinal cord, conus and cauda equina are within normal limits.Mild loss of disc T2 signal affects the lower lumbar levels. The L5-S1 disc demonstrates moderate loss of height. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild laterally bulging disc. No spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild laterally bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Bulging disc. No significant spinal canal. Moderate left and mild right foraminal narrowing. A large quantity of intraperitoneal fluid is partially visualized in the pelvis. In addition, the right kidney is somewhat larger than the left and demonstrates mild heterogeneous signal characteristics, though this could be related to imaging artifact.

Output: 1. Multilevel degenerative disc disease is seen. At L5-S1, there is moderate loss of disc height, and although no significant spinal canal stenosis is seen, the left neural foramen is moderately narrowed.2. Incidental note is made of significant intraperitoneal pelvic fluid. The right kidney is also somewhat larger than the left with possible heterogeneous signal characteristics suggesting edema, though this could be artifactual. Dedicated abdominal imaging is suggested to better assess these findings. Findings were communicated to Dr. Schipper via email on 10/24/15 at 3:35 PM, and to Dr. Landy, orthopedic surgery resident on call, via phone on 10/24/15 at 3:45 PM.


Instruction: Generate impression based on findings.

Input: Clinical question: Tuberous sclerosis. Now with headaches. Assess for etiology. Signs and symptoms: As above. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates postoperative changes left paramedian posterior parietal craniotomy without change since prior exam. The underlying parenchyma demonstrate no detectable signal abnormality or parenchymal/leptomeningeal enhancement similar to prior study.Few punctate foci of nonspecific FLAIR hyperintensity without detectable enhancement in the subcortical white matter of bilateral cerebral hemispheres in a nearly identical to prior exam from 2012.Unremarkable cerebral cortex and cortical sulci, ventricular system and CSF spaces as well as brain myelination otherwise and without evidence of abnormal enhancement.The signal voids of major intracranial arterial branches are identified. The signal void of intracranial venous sinuses are within normal with normal pattern of enhancement.Calvarium is otherwise unremarkable.Images through the orbits and including axial fat sat post enhanced series are unremarkable.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Negative diffusion-weighted images.2.Stable chronic postoperative changes of the left posterior parietal paramedian craniotomy.3.Stable few punctate foci of FLAIR hyperintensity in bilateral cerebral hemispheres without enhancement since prior exam.4.Unremarkable intracranial contents otherwise and without evidence of abnormal enhancement.5.Unremarkable calvarium otherwise.6.Well-pneumatized paranasal sinuses and mastoid air cells/middle ear cavities.


Instruction: Generate impression based on findings.

Input: Reason: cervical neuroma History: RUE pain. Additional history per chart patient has left upper extremity paralysis secondary to brachial plexus injury status post MVA, HIV, EBV related lymphoproliferative disorder. Also history of brachial plexus exploration and nerve transfer. Again seen is a previously biopsied, enhancing intradural extramedullary lesion along the anterolateral left aspect of the spinal cord extending from the C5 through C7 levels which measures approximately 4 mm in the AP dimension in the sagittal plane and craniocaudally up to 4.4 cm. Compared to 7/17/2012, there is no significant change. Component of the lesion partially tracks along the ventral intradural nerve root at C6 as before. There is mild associated mass effect on the left aspect of the cord. No abnormal signal within the cervical cord or intramedullary mass is evident. The cervical vertebral bodies are appropriate in height. There is unchanged including mild reversal of cervical lordosis. Bone marrow signal is benign.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small central disc protrusion similar to prior. No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing as before. C6-7: No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing as before. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Multiple nodules in the parotid glands are again seen including decrease in size of the dominant left parotid lesion which which measures approximately 15 x 11 mm previously 19 x 15 mm, measured in the long and short axis. Mild cervical lymphadenopathy is also again seen but not well evaluated.

Output: 1. Mild degenerative changes in the cervical spine are not significant changed in the interval. There is fairly mild right C5-C6 and C6-C7 neural foraminal stenosis. Otherwise no significant spinal canal or neural foraminal stenosis. No cord signal abnormality.2. No appreciable change in enhancing intradural-extramedullary lesion along the left ventral aspect of the cord from C4 to C7 with mild local mass effect on the left aspect of the cord. This lesion has not significantly changed in size dating back to 7/17/2012 and compatible with prior biopsy which was benign.3. Multiple parotid nodules which may represent intraparotid lymph nodes or lymphoepithelial lesions are not significantly changed aside from the dominant partially necrotic lesion on the left which demonstrates decrease in size. Mild cervical lymphadenopathy is also again noted but incompletely evaluated.


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:6/9/1984)Reason: Cerebral Aneurysms (Opthalmic artery, PCA), Pregnant History: AsymptomaticPROVIDER/ATTENDING NAME: MAHMOUD A. ISMAIL MAHMOUD A. ISMAIL MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. Left posterior communicating artery is larger than the right posterior communicating artery. The anterior communicating artery is small.Proximal enlargement of the left ophthalmic artery. There is an infundibulum at the origin of the right posterior communicating artery is seen on the prior examThe current exam was performed at 1.5 Tesla MRI unit with a lower matrix size. As a result special resolution is lower than that of the prior exam from 9/16/2014An abnormal appearance to the sphenoid bone. Please refer to CT of the head from 9/16/2014 for further comments.

Output: 1.Please note that this study was performed on a 1.5 Tesla magnet with the lower spatial resolution which degrades comparison. Patient has what appears to be a large infundibulum along the right posterior communicating artery origin and focal aneurysmal dilation at the origin of the left ophthalmic artery which is unchanged since prior exam. There is no evidence for interval change.


Instruction: Generate impression based on findings.

Input: Reason: Recurrent abdominal pain, nausea, h/o abdominal hernia, suggestive of partial SBO. Exclude small intestinal strictures, inflammation, and adhesive disease History: Recurrent abdominal pain, nausea, h/o abdominal hernia, suggestive of partial SBO. Exclude small intestinal strictures, inflammation, and adhesive disease ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic right lower pole cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or dilatation. No evidence of active inflammation. The terminal ileum appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a large ventral hernia arising from the lower pelvis measuring approximately 14.9 x 7.4 cm in transverse dimension with a 8.3 cm neck. This hernia contains loops of small bowel without evidence of obstruction.OTHER: No significant abnormality noted.

Output: 1.Large ventral hernia containing small bowel loops without evidence of obstruction.2.No evidence of active bowel inflammation or obstruction.


Instruction: Generate impression based on findings.

Input: 28 year-old female with history of Crohn's colitis complaining of abdominal pain and vomiting. Rule out Crohn's flare, rule out obstruction. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple lymph nodes scattered throughout the mesentery, likely reactive.BOWEL, MESENTERY: Long segment thickening extending from the neoterminal ileum measuring approximately 7 cm may reflect chronic/resolving Crohn's disease. No bowel obstruction as clinically questioned.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse, patchy low-attenuation areas likely represents any infiltration secondary to previous inflammatory disease. No bowel obstruction as clinically questioned.BONES, SOFT TISSUES: Enhancing focus within the perirectal soft tissue extends superiorly to the levator ani terminating at the intersphincteric level may represent an abscess/fistula which appears grossly unchanged when compared to the previous MRI, 5/2005. This area of enhancement measures 9 x 27 mm, (image 141, series 3).OTHER: No significant abnormality noted

Output: 1. Long segment bowel wall thickening of the neoterminal ileum measuring approximately 7 cm may reflect chronic/resolving Crohn's disease, appears to have increased in comparison with prior study. 2. No bowel obstruction as clinically questioned.3. Enhancing focus within the perirectal soft tissue represents an abscess/fistula which appears grossly stable when compared to prior MRI, 5/2005.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine. The osseous marrow signal is within normal limits. The vertebral body heights and are preserved. There is mild loss of normal T2 signal in all cervical disks. The cervical cord caliber and signal are within normal limits.C2-3: No disk/endplate degenerative change or spinal stenosis.C3-4: No disk/endplate degenerative change or spinal stenosis.C4-5: No disk/endplate degenerative change or spinal stenosis.C5-6: No disk/endplate degenerative change or spinal stenosis.C6-7: No disk/endplate degenerative change or spinal stenosis.C7-T1: No disk/endplate degenerative change or spinal stenosis.The imaged upper thoracic spine shows no disk herniation, or spinal stenosis. The flow-voids in the cervical spine are intact.

Output: No spinal stenosis or cord signal abnormality.