Instruction: Generate impression based on findings.

Input: 48 year old woman with history of hypertrophic cardiomyopathy and subaortic membrane s/ septal myectomy in June 2016, with persistent exertional dyspnea and evidence of residual LVOT gradient on echocardiography, referred for cardiac MRI to quantify gradient and risk stratification. Left VentricleThe left ventricle is severely dilated with hyperdynamic systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 124 ml/m2 (normal range: 65+/-11), the LVEDV is 242 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 77 ml (normal range 31+/-10), the LV mass index is moderately elevated at 108 g/m2 (normal range 67+/-11), and the LV mass is 211 g (normal range 114+/-24). There is asymmetric hypertrophy of the basal anteroseptum (23 mm wall thickness versus 14 mm in the inferolateral wall). There are no regional wall motion abnormalities present. There is late gadolinium enhancement in the inferoseptal region associated with RV insertion point which suggests the presence of an underlying fibrosing, infiltrative process.Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 107 ml/m2 (normal range 69+/-14), the RVEDV is 208 ml (normal range 110+/-24), the RV end systolic volume index is 46 ml/m2 (normal range 22+/-8), and the RVESV is 90 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is flow acceleration through the LVOT/aortic valve, the peak velocity of which is estimated between 2.0-2.5m/s. The regurgitant fraction is consistent with mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is systolic anterior motion of the mitral valve with suggestion of chordal component and at least mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsCholelithiasis. Sternotomy wire artifact. 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. Severely dilated left ventricle with hyperdynamic systolic function (EF 68%).2. The left ventricular mass index is moderately elevated with asymmetric hypertrophy of the basal septum. There is systolic anterior motion of the mitral valve with likely chordal component and evidence of flow acceleration in the LVOT between 2.0 - 2.5m/s and a corresponding gradient of 16-25 mmHg. This constellation of these findings suggests residual obstructive physiology.3. There is late gadolinium enhancement in the inferoseptal region associated with RV insertion point which suggests the presence of an underlying fibrosing, infiltrative inflammatory process.4. The aortic valve is tri-leaflet. The regurgitant fraction is consistent with mild aortic regurgitation.5. Moderate left atrial dilation.


Instruction: Generate impression based on findings.

Input: Female, 53 years old. Eval meniscus, cartilage, s/p knee surgery 1970s. OA MENISCI: The posterior horn of the lateral meniscus is fragmented and loses its normal triangular morphology, compatible with complex tearing. The remainder of the lateral meniscus is extruded and small. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness and near full-thickness cartilage loss involving the lateral femoral condyle measuring approximately 10 mm in mediolateral dimension and 15 mm in AP dimension in the area of the posterior horn of the lateral meniscus. There are additional small foci of high-grade cartilage loss involving the lateral tibial plateau, particularly posteriorly, with slight underlying bone marrow signal abnormality. There is also diffuse cartilage thinning involving the medial femoral condyle and the patellar articular cartilage without focal full-thickness defect identified.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complex tearing of the lateral meniscus as described above.2.High-grade cartilage loss involving the lateral femoral condyle and lateral tibial plateau.


Instruction: Generate impression based on findings.

Input: 9-year-old male with Crohn's disease, history of perianal abscess. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral mildly prominent inguinal lymph nodes are again noted.BOWEL, MESENTERY: There is new wall thickening and enhancement of the sigmoid colon and rectum, consistent with inflammatory changes.BONES, SOFT TISSUES: Continued perianal soft tissue induration. Left-sided soft tissue fluid collection measures 0.9 x 0.3 cm (series 501, image 46), not significantly changed. A small right perianal focus measures 0.9 x 0.5 cm. These regions show increased signal intensity on T2-weighted imaging, decreased signal intensity on T1-weighted imaging, restricted diffusion, and enhancement, consistent with an abscess.OTHER: No significant abnormality noted.

Output: There is new wall thickening and enhancement of the sigmoid colon and rectum, consistent with inflammatory changes. No significant interval change in the appearance of perianal abscess.


Instruction: Generate impression based on findings.

Input: 46 year old female with left-sided headaches. No evidence of intracranial hemorrhage, mass effect, edema, or abnormal enhancement. Ventricles and basal cisterns are within normal limits.Paranasal sinuses, orbits, and osseous structures appear unremarkable.

Output: No abnormality to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with headache. Assess for intracranial mass. Numerous patchy foci of white matter T2 hyperintensity are seen within the cerebral hemispheres without associated restricted diffusion or mass effect. No parenchymal edema is seen. No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is patent and normal in size.

Output: 1. Numerous scattered foci of white matter T2 hyperintensity are seen, a nonspecific finding which can reflect chronic sequelae of microvascular ischemic disease, demyelination, migraine headache, vasculitis or other inflammatory conditions.2. No evidence of any intracranial mass or other definite acute intracranial findings.


Instruction: Generate impression based on findings.

Input: 54 years, Female, metastatic pancreatic cancer to brain, status post SRS. Examination for repeat SRS. Limited post gadolinium 3-D T1 and susceptibility weighted sequences of the brain were obtained per radiation treatment planning protocol.There is a 2 mm enhancing lesion in the left cerebellar hemisphere, series 501 image 46, which is suspicious for metastasis and as seen on recent MRI from 4/26/2016. No associated hemorrhage.Again seen is a small resection cavity involving the left inferior parietal lobule without mass or enhancement to suggest recurrent tumor. There is susceptibility related to chronic blood products in this region. No other suspicious intracranial enhancement is appreciated. A cavernoma with an associated developmental venous anomaly is again seen in the right parietal lobe showing no significant interval change. No evidence of hydrocephalus, intracranial mass effect, midline shift, or herniation.

Output: 1. Examination for repeat radiation treatment planning. Again seen is a 2 mm left cerebellar hemisphere enhancing lesion suspicious for metastasis.2. Evidence of left parietal tumor resection without evidence of recurrence.3. Stable right parietal cavernous malformation.


Instruction: Generate impression based on findings.

Input: Reason: hx of migraine, now with change in HA pattern with new neuro deficits History: above The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 46-year-old female with knee pain. MENISCI: There is an oblique vertical tear of the posterior horn of the medial meniscus. The tear does not appear to extend through the entire width of the meniscus. There is perhaps mild undersurface fraying of the body of the meniscus, but the anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: We see no discrete articular cartilage defects. The bone marrow signal intensity is normal.LIGAMENTS: There is mild edema superficial to the MCL and posterior oblique ligament which may represent a mild sprain, but we see no tear. The PCL appears intact. The ACL appears intact. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Oblique tear of the posterior horn of the medial meniscus.2. Femoral trochlear dysplasia with borderline tibial tubercle to trochlear groove distance.3. Mild edema along the MCL and posterior oblique ligament may represent a mild sprain, but we see no frank tear.


Instruction: Generate impression based on findings.

Input: Female 74 years old with urethral cancer receiving CRT. Evaluate for extent of disease for radiation planing. PELVIS:UTERUS, ADNEXA: Atrophic or surgically absent uterus.BLADDER: A Foley catheter is in place and the urinary bladder is nondistended. Mild trabeculation of the bladder wall is again seen which may reflect chronic bladder outlet obstruction. There is a stable T1 isointense, nonenhancing nodular intraluminal focus along the right lateral aspect of the Foley catheter (series 902, image 306) which is nonspecific and unchanged, this may be related to hemorrhagic material.LYMPH NODES: The reference right inguinal lymph node has decreased in size and is no longer enhancing. Reference measurement is provided below.BOWEL, MESENTERY: Severe sigmoid and descending colonic diverticulosis with thickening of the wall suggesting chronic inflammation. No evidence of acute diverticulitis.BONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine.OTHER: Comparison of the reference enhancing urethral mass is difficult due to changes in areas of intralesional enhancement, with areas of internal nonenhancement likely from treatment-related necrosis. There was previously confluent enhancement but on the current exam the enhancement pattern is more that of concentric circles. The maximal thickness anteriorly measures 7 mm (series 904, image 233), previously the region of maximal thickness was posteriorly and measured 11 mm. Amorphus enhancement extending towards the vaginal cuff has improved. The amount of diffusion restriction associated with the mass has improved.A moderate degree of perineal enhancement is new and nonspecific. Mild cellulitis cannot be excluded and correlation with physical exam is suggested.INDEX LESION MEASUREMENTS (Current exam date/time: 12/8/2016 06:30:00)URETHRAL MASS: 2.8 x 2.6 cm (Image 238, Series 904); 2.8 x 2.6 cm on prior (10/7/2016) (Image 140, Series 9).RIGHT INGUINAL LYMPH NODE: 1.4 x 1.3 cm (Image 238, Series 904); 2.1 x 1.9 cm on prior (10/7/2016) (Image 145, Series 9).

Output: 1.The urethral mass consistent with the patient's known urethral squamous cell carcinoma is stable in size but the enhancement pattern and diffusion restriction have improved indicating treatment response.2.Interval decrease in size and enhancement of metastatic right inguinal lymph node. 3.No new sites of disease.4.A moderate degree of perineal enhancement is new but nonspecific. Mild cellulitis is not excluded and correlation with physical exam is suggested.


Instruction: Generate impression based on findings.

Input: 22 years Female (DOB:8/15/1993)Reason: eval for structural abnormality or MS lesions History: left sided headache, intermittent LUE numbness, nausea and vomiting of unknown etiologyPROVIDER/ATTENDING NAME: BRUCE M BISSONNETTE BRUCE M BISSONNETTE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is abnormal signal present within the medulla and visualized upper cervical spinal cord. There is no diffusion abnormality associated with this. The medulla itself appears expanded at the level of the signal abnormality. There is no significant contrast enhancement associated with this lesion. No hemorrhage is appreciated in association with this lesion on this exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Abnormal infiltrative type lesion encompassing much of the medulla. Differential considerations include low-grade neoplasm such as astrocytoma (i.e. brainstem glioma). An inflammatory condition is less likely but can't be excluded.2.An email was sent to Dr Jacobs at the time of this dictation (not pageable via our system).


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with gait abnormality, with dragging right leg and decreased arm swelling, normal DaTscan and MRI without significant abnormality. Assess for cervical spine abnormality. Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits allowing for mild endplate edema at C4-5 and C6-7. No pathologic marrow enhancement is observed.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Significant loss of disc height is evident at C4-5 and C6-7. Additional level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Mild generalized spinal canal narrowing without cord impingement. Mild to moderate bilateral foraminal narrowing. C4-5: Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Mild generalized spinal canal narrowing without cord impingement. Severe left and moderate right foraminal narrowing.C5-6: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: Multilevel degenerative findings are evident resulting in at most mild spinal canal narrowing with no evidence of cord impingement. However, significant foraminal narrowing is seen, most notably on the left at C4-5.


Instruction: Generate impression based on findings.

Input: 28 years, Female, Reason: pt with a longitudinal vaginal septum; will not tolerate transvaginal sono History: pain with insertion of anything into the vagina. PELVIS: FemaleUTERUS, ADNEXA:Cystic lesion formation along the anterior aspect of the upper vagina, located posterior to the bladder, which measures 0.7 x 0.8 x 2.6 cm (1301/17 and 601/19). No definite communication with either the vagina or urethra is identified.Vagina is normal in appearance. No obstructing septum or fluid collection to suggest an obstructed vaginal cavity is identified.Normal-appearing ovarian follicles.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis is likely physiologic.

Output: 1.No obstructing vaginal septum is identified. However, please note that a nonobstructing collapsed longitudinal septum cannot be excluded on the basis of imaging.2.Cystic lesion formation along anterior aspect of the upper vagina most likely related to Gartner's duct cyst development. Another differential consideration is ectopic ureter, correlation with patient's clinical history recommended; left renal area not well assessed on current study but if patient is known to have a normal left kidney, an ectopic ureter is unlikely and again Gartner's duct cyst favored.


Instruction: Generate impression based on findings.

Input: Male, 19 years old. History of DNET status post resection 06/2015. Followup. There are again postoperative changes of left parietal craniotomy and resection of a mass in the left precentral gyrus. The small resection cavity appears unchanged, with minimal chronic hemosiderin staining and mild T2 hyperintensity at the rim. There is no abnormal parenchymal or leptomeningeal enhancement in the region of the resection cavity or elsewhere. No new lesions are identified. There is no evidence of acute intracranial hemorrhage or acute infarct. The brain parenchyma otherwise appears unremarkable. The midline structures and craniocervical junction are within normal limits. 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. There is mild scattered ethmoid air cell opacification. Otherwise, the orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Expected findings related to resection of a left frontal lobe lesion, without evidence of recurrent tumor or other acute abnormality.


Instruction: Generate impression based on findings.

Input: There is a lobulated T2 hyperintense, nonenhancing lesion involving the deep lobe of the right parotid gland. Lesion measures up to 24 x 10 mm in the long and short axis, respectively, coronal series 301 image 36. There is no significant change in size since earliest available MRI dated 11/13/2015. There appears to be a small septation and possibly low signal posteriorly which may represent dependent debris.There are no abnormal masses or evidence of pathologic enhancement elsewhere in the neck. There are scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. Remainder of the salivary glands are unremarkable.

Output: 1. Nonenhancing cystic lesion involving the deep lobe of the right parotid gland most likely represents a benign cystic lesion such as lymphatic malformation. This lesion is unchanged since 11/13/2015. Additional follow-up or perhaps aspiration can be considered to exclude other etiologies such as necrotic node as clinically indicated.2. No suspicious neck masses or cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with increasing headache and vertigo, evaluate for structural cause. Signs and symptoms: Headache and vertigo. Nonenhanced brain MRI:No diffusion weighted abnormalities.The anatomical morphology and signal intensity to brain parenchyma is within normal on all MRI sequences.Unremarkable surgical cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are unremarkable.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Unremarkable nonenhanced brain MRI.2.Normal signal intensity of paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:4/16/1941)Reason: AVM brain, evaluate for changes, please do on the 3T scanner with CCM protocol for through evaluation. History: AVM brainPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a 17 x 20 mm axial dimension mass adjacent to the right frontal lobe abutting the postcentral gyrus just lateral to the hand motor area. It is associated with adjacent dural thickening. The meningioma is bright signal on FLAIR and T2. It enhances homogeneouslyThere is a second extra-axial mass abutting the right temporal lobe measuring 13 x 26 mm axial dimensions which is associated with the adjacent bony hypertrophy. This meningioma extends into the right transverse sinus. It is associated with a dural tail.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Time resolved MRA demonstrates early opacification of the right transverse sinus and sigmoid sinus with drainage into the jugular vein and condylar vein.There is a meningioma present adjacent to and involving the right transverse sinus which is supplied from right middle meningeal artery branches, right occipital artery , right ascending pharyngeal artery and posterior reticular artery branches. It drains primarily into the sigmoid sinus which subsequently drains out the jugular vein and condylar vein.The right frontal meningioma is associated with enlarged right middle meningeal artery branches.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There are two small meningiomas identified. One of meningioma is located adjacent to the right temporal lobe and extends into the right transverse sinus. It has associated osseous thickening. There is no associated brain edema appreciated. It is supplied by external carotid artery branches and drains primarily into the sigmoid sinus with an arteriovenous fistula appearance. There is no convincing evidence for reversible venous flow based on this exam. It is not clear whether the transverse sinus is completely occluded. The second meningioma is adjacent to the right precentral gyrus and is not associated with early venous shunting.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. These are not unusual in number or distribution.3. No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: 73 year old female with hypertension, chronic kidney disease, and mildly reduced left ventricular function noted on echocardiogram referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is moderately dilated with low normal reduced systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 99 ml/m2 (normal range: 65+/-11), the LVEDV is 199 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 96 ml (normal range 31+/-10), the LV mass index is 14 g/m2 (normal range 67+/-11), and the LV mass is 27 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation times are normal (~950ms). There is no evidence of myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 154 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal pseudobovine 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 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. Moderate left ventricular dilation with low normal systolic function (LVEF 52%) without evidence of underlying myocardial fibrosis inflammation or infiltration.2. Normal right ventricular size and systolic function (RVEF 52%).3. Moderate left atrial dilation.4. Mild dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Persistent headache, awaking the patient from sleep. Associated double vision, nausea and vomiting. The post contrast images are mildly limited by patient motion.BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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.Prominent lymph nodes in the included upper neck are nonspecific in this age group. There is trace mucosal thickening in the ethmoid sinuses, which is also nonspecific.BRAINSTEM/CRANIAL NERVES:There is no brainstem or root entry zone lesion. There is no abnormal contrast enhancement in the brainstem or along the cranial nerve roots. There is no skull base destructive lesion. The cavernous sinuses are symmetric. Carotid arterial flow voids are preserved.

Output: Normal examination. Specifically, there is no brainstem or cranial nerve abnormality.


Instruction: Generate impression based on findings.

Input: Female 75 years old, pain lower thoracic spine at thoracolumbar junction, evaluate for spinal compression deformity at lower thoracic spine or thoracolumbar junction Evaluation of the upper thoracic spine on the lateral view is limited by overlying soft tissue artifact. There are mild compression deformities of L1 and L2 that are comparable to those seen on an MRI examination on 5/6/2015. There are no new compression fractures identified. Degenerative disc disease affects the cervical, thoracic, and lumbar spine. Facet joint osteoarthritis affects the lower lumbar spine. There is approximately 20 degrees of dextroscoliosis of the lumbar spine from the superior endplate of L1 to the inferior endplate of L4, and approximately 15 degrees of levoscoliosis of the thoracolumbar spine from the superior endplate of T9 to the inferior endplate of L1. There is a slight positive coronal balance. There is a positive sagittal balance measuring 6 to 7 mm.

Output: Mild compression deformities of the upper lumbar vertebrae comparable to those seen on prior MRI. Degenerative disc disease of the cervical, thoracic, and lumbar spine and other findings as described above.


Instruction: Generate impression based on findings.

Input: Right thumb pain Tendons: The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: The ulnar collateral ligament and radial collateral ligament are intact.Bones: The bone marrow signal is normal. There is no fracture or contusion. There is no marrow replacing lesions. There is no joint effusion. There is no significant arthrosis.Muscles: There is no tear or atrophy of the visualized musculature.Other: There is an ovoid signal intensity structure identified within the carpal tunnel seen on series 3 image 1 which demonstrates fat signal intensity on all sequences and likely represents a small lipoma.

Output: Normal MRI of the thumb. Specifically, there is no evidence of ulnar collateral ligament injury.


Instruction: Generate impression based on findings.

Input: Clinical question:? Spinal stenosis. Signs and symptoms: Radicular arm and leg pain. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild to moderate degenerative changes resulting in severe right and moderate left neural foraminal compromise and moderate central spinal stenosis.C4-C5 demonstrate moderate degenerative changes resulting in moderate central spinal stenosis and significant bilateral neural foraminal compromise.C5-C6 demonstrate moderate to advanced disc disease and to a lesser degree degenerative/hypertrophic changes of posterior elements. Findings results in moderate central spinal stenosis and significant (right greater than left) neural foraminal compromise.C6-C7 demonstrate moderate to advanced disc disease and loss of disc height with mild hypertrophic changes of posterior elements. There is mild central spinal stenosis and moderate left and mild to moderate right neural foraminal compromise.C7-T1 is unremarkable with the exception of mild degenerative changes.The signal intensity of the cervical and upper most visualized thoracic cord remains within normal.Nonenhanced thoracic MRI:There is normal anatomical alignment of vertebral column.There is normal signal intensity and caliber of thoracic cord.There is no evidence of central spinal stenosis at any level.T1-T2 is unremarkable.T2-T3 is negative for spinal stenosis or neural foraminal compromise. There is however a small) median disc protrusion with resultant mild effacement of ventral subarachnoid space (axial T2 series 12 image 13).T3-T4 is unremarkable.T4-T5 is unremarkable.T5-T6 is unremarkable.T6-T7 is unremarkable.T7-T8 is unremarkable.T8-T9 demonstrate mild left neural foraminal compromise and unremarkable otherwise.T9-T10 demonstrate moderate right and mild left neural foraminal compromise.T10-T11 demonstrate moderate right and mild left neural foraminal compromise.T11-T12 is unremarkable.T12-L1 is unremarkable.Nonenhanced lumbar MRI:T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative disc disease and mild bilateral ligamentum flavum hypertrophy and minimal facet disease. No central spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease and left facet effusion. There is mild grade 1 retrolisthesis. Constellation of changes results in mild central spinal stenosis and moderate right and mild left neural foraminal compromise. Examination also demonstrates a focus of increased T2 signal intensity within the annulus of the disc in the right para median location suggestive of an annular fissure.L3-L4 demonstrate mild degenerative disc disease and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No central spinal stenosis however mild to moderate bilateral (right greater than left) neural foraminal compromise is present.L4-L5 mild disc disease and loss of disc, shallow broad-based bulging disc, moderate to significant bilateral ligamentum flavum hypertrophy, mild facet disease however with evidence of bilateral facet effusion. There is a tiny synovial cyst within the left ligamentum flavum without significant mass effect. Constellation of findings results in moderate central spinal stenosis and significant right and moderate left neural foraminal compromise. Tiny synovial cysts is also noted projecting to the left of the spinous process and posterior to the right articulating facet.L5-S1 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however mild bilateral neural foraminal compromise is present.

Output: 1.Nonenhanced MRI of cervical spine demonstrate degenerative changes throughout the cervical spine involving the discs and posterior longitudinal ligament and to a lesser degree of the posterior elements. Findings results in multilevel central spinal stenosis at C3-C4, C4-C5, C5-C6 and to a lesser degree at C6-C7 levels as well as multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above. The signal intensity of the cord remains within normal.2.Nonenhanced MRI of thoracic spine demonstrate mild to moderate disc disease and mild hypertrophic changes of posterior elements. There is no central spinal stenosis. There are however multilevel mild to moderate neural foraminal compromise as detailed per level above. The signal intensity of the cord remains within normal.3.Nonenhanced MRI of lumbar spine demonstrate moderate central spinal stenosis at L4-L5 and mild spinal stenosis at L2-L3. Multilevel neural foraminal compromise as detailed per level. Multilevel facet effusion and tiny synovial cysts as detailed.


Instruction: Generate impression based on findings.

Input: Low back and right hip pain radiating to groin. Long-term use of prednisone, concern for avascular necrosis versus tendon/ligament damage Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. No evidence of fracture. There is mild reversal of lumbar lordosis. Bone marrow signal is heterogeneous without discrete suspicious osseous lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen including multilevel disc desiccation and loss of height. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge eccentric to the right. Minimal right greater than left neural foraminal narrowing. No significant central canal stenosis.L3-L4: Disc bulge with left paracentral annular fissure and protrusion resulting in effacement of the left lateral recess. There is mild bilateral neural foraminal stenosis. No significant central canal stenosis.L4-L5: Diffuse disc bulge with right foraminal/extraforaminal disc protrusion and small posterior Schmorl's node involving the right inferior L4 endplate. There is moderate right-sided neural foraminal stenosis and minimal left neural foraminal narrowing. No significant spinal canal stenosis.L5-S1: Small central protrusion. No significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Atrophic native kidneys with small cysts noted.

Output: Overall relatively mild multilevel degenerative changes throughout the lumbar spine as detailed above. There is a right foraminal disc protrusion at the L4-L5 level with moderate right neural foraminal stenosis and possible impingement of the exiting right L4 nerve root. No findings to suggest avascular necrosis involving the lumbar vertebral bodies as questioned.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with slight left facial droop, occasional disequilibrium, history of EtOH, evaluate for stroke. No evidence of restricted diffusion is seen. No significant focal lesion, edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles and sulci are minimally prominent but not beyond what is typically seen for age. Bone marrow signal characteristics are unremarkable.

Output: No acute intracranial abnormality or other specific findings which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other disturbances of skin sensation Anesthesia of skinClinical question: Evaluate for structural abnormality, especially at cranio-cervical junctionSigns and Symptoms: Tongue numbness, bilateral arm numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: No abnormal lesions are identified in the brain or cervical spinal cord or the craniocervical junction on this exam to explain the patients arm and tongue numbness.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of RCC, status post right nephrectomy. Had a 7 mm lesion in the left lower pole (indeterminant at outside facility). Surveillance. ABDOMEN:LIVER, BILIARY TRACT: Stable 1 cm T2 hyperintense focus of the hepatic dome, which progressively fills in on venous and delayed postcontrast imaging and is compatible with a hemangioma (coronal series 4 image 22, axial series 11 image 354). The subcentimeter nonenhancing focus of the peripheral hepatic segment 6 is too small to characterize (series 11 image 309).Cholelithiasis. A questionable small enhancing polyp versus enhancing nodular fold within the gallbladder lumen is incompletely characterized (axial series 11 image 319). No intra or extrahepatic biliary ductal dilatation.SPLEEN: Subcentimeter T2 hyperintense foci are too small to characterize.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Normal left adrenal gland. A right adrenal gland is not clearly visualized.KIDNEYS, URETERS: Status post right nephrectomy. The nonenhancing subcentimeter T1 hyperintense focus of the left lower renal pole parenchyma (series 11 image 23) is unchanged. The separate nonenhancing T1 hypointense focus of the left lower renal pole (series 11 image 302) and is best seen in the postcontrast coronal plane (coronal series 13 image 36) is also unchanged. This T1 hypointense focus also does not demonstrate definite T2 signal intensity.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The T2 hyperintense and fat-sensitive hyperintense focus of the L4 vertebral body (coronal series 4 image 21) is unchanged and likely represents a benign osseous hemangioma.OTHER: No significant abnormality noted.

Output: 1. The subcentimeter T1 hyperintense and separate T1 hypointense nonenhancing foci of the left lower renal pole are too small to characterize but unchanged in size and appearance. 2. A questionable small enhancing polyp versus enhancing nodular fold within the gallbladder lumen is incompletely characterized, and a right upper quadrant ultrasound is recommended.3. Small hemangioma of the hepatic dome.


Instruction: Generate impression based on findings.

Input: 82-year-old female patient with cervical mass and cervical bleeding. Preoperative evaluation. PELVIS:UTERUS, ADNEXA: There is a heterogeneously enhancing, intermediate T2 signal mass within the lower cervix measuring approximately 3.5 x 3.3 x 2.8 cm (image 32, series 5 and image 50, series 12). This lesion appears to involve the upper one third of the vagina. The mass abuts the posterior wall of the bladder and anterior wall of the rectum, however, there is no specific evidence of invasion. There is no apparent invasion of the pelvic sidewall. Based on post-contrasting imaging and T2 weighted sequences, there is definite parametrial invasion.A tubular foreign body within the vagina, likely a component of the gel applicator (per technologist removed prior to patient leaving hospital).BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Cervical mass compatible with tumor involving the upper third of the vagina without definite parametrial invasion. 2. No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: Pituitary lesion. Signs and symptoms: Pituitary lesion, compare to prior exam. Pre and post enhanced pituitary MRI:The examination redemonstrates a masslike lesion with T1 hyperintense, T2 hypointense and without enhancement within the sella and with extension into the basal cistern. There is no evidence of interval change in the signal intensity, size or overall appearance of this lesion since prior study. The lesion within the basal cistern demonstrates subtle mass effect on the suprasellar visual complex without interval change since prior exam. Findings as was noted on prior exam likely represent blood products/hemorrhage. This finding was present on head CT examination from 3-9-14 as a focus of low attenuation in the sella and basal cistern.Cavernous sinuses remain within normal limit normal pattern of enhancement.

Output: Redemonstration of a nonenhancing, T1 hyperintense and T2 hypointense masslike lesion within the sella and basal cistern without any appreciable interval change since prior exam. The finding is suspected of representing trauma and demonstrate very subtle stable mass effect on the suprasellar visual complex.


Instruction: Generate impression based on findings.

Input: 60 years Female (DOB:2/14/1956)Reason: back and leg pain History: back and leg painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height, disc desiccation and a small right paramedian broad-based disc protrusion.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild to moderate facet hypertrophy present at this level. There is mild disc desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level. There is mild disc desiccation at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal or exiting nerve roots.2.No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: History of renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from a right renal inferior pole partial nephrectomy. Several interpolar simple cysts are noted and are unchanged.Interval postsurgical changes of the left renal interpolar region with scar tissue extending laterally. Within the scar tissue are small regions of T2 weighted hyperintensity likely reflecting small postsurgical fluid collections. No suspicious residual enhancement in the partial nephrectomy bed.Postcontrast imaging demonstrates differential enhancement of the left kidney with greater enhancement of the inferior pole relative to the superior pole. There is also delayed excretion of contrast by the superior pole. There is mild hydronephrosis as well of the superior pole. RETROPERITONEUM, LYMPH NODES: Nonspecific 5 mm retroperitoneal lymph node posterior to the left renal artery, not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post partial nephrectomy changes of the left kidney interpolar region without specific evidence of residual tumor in the nephrectomy bed.2.Hydronephrosis and relatively delayed and decreased enhancement of the residual left superior pole.These findings were discussed with the ordering physician, Dr. Eggener (1323 at 08/06/2015).


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out CVA. Signs and symptoms: Altered mental status, on possible. Non-infused CT of brain:Images through posterior fossa are unremarkable.Images through the supratentorial space demonstrates advanced small vessel disease of indeterminate age.No definite evidence of cortical stroke is detected. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. No definitive interval change since prior exam. Follow-up with an MRI examination is recommended.

Output: 1.Advanced small vessel disease of indeterminate age.2.No definitive cortical stroke and no hemorrhage.3.Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 36-year-old female with medial right knee pain. MENISCI: The menisci are normal.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the articular cartilage of the patella centrally suggesting early degeneration with superficial fraying of the cartilage along the medial facet of the patella. The remainder of the articular cartilage appears normal.LIGAMENTS: The cruciate and lateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Mild degeneration of the articular cartilage of the patella, but no meniscal tear or other findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cause of headache. Signs and symptoms: Migraines, epistaxis. Nonenhanced brain MRI:Negative diffusion weighted series.There is normal anatomical morphology and development of brain and with normal signal intensity on all MRI sequences.Unremarkable CT cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses appear normal on this nonenhanced exam.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 71 year old male with a history of ventricular tachycardia s/p EP ablation resulting in perforation of LV free wall. Referred for cardiovascular MRI to evaluate for underlying infiltrative or inflammatory disease. Left VentricleThe left ventricle is normal in size and systolic function. There is abnormal septal motion which may be the result of sternotomy. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 130 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 123 g (normal range 164+/-36). There is a small focal region of late gadolinium enhancement in the mid lateral wall, which suggests the presence of a focal underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 60 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a minimal pericardial effusion. There is mild late gadolinium enhancement of the pericardium.Extracardiac FindingsAir seen in the proximal esophagus. Sternotomy. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and systolic function (LVEF 57%). There is a small focal region of late gadolinium enhancement in the mid lateral wall, which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Normal right ventricular size and systolic function (RVEF 52%).3. Minimal pericardial effusion, and late gadolinium enhancement of the pericardium. 4. See extracardiac findings.


Instruction: Generate impression based on findings.

Input: 49 year old who is BRCA 1 positive and has history of fallopian tube ca, presents for breast MRI for screening. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.A Port-A-Cath is present within the medial superior right chest wall.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Intracranial abscess and granulomaClinical question: progression of abscessSigns and Symptoms: previous imaging c/w abscess There is redemonstration of ventriculomegaly. The lateral ventricles at the level of foramen of Monro on coronal imaging measures 7 mm on the current exam and on the prior exam measured the same. The third ventricle measures 21 mm on the current exam and previously measured the same.There is redemonstration of a cystic lesion located in the left parietal lobe measuring approximately 18 x 14 mm axial dimensions which previously measured 18 x 14 mm axial dimensions. There is some associated susceptibility effect. There is associated diffusion restriction within this cystic appearing component. There is a vasogenic pattern of edema surrounding this lesion which was also present on the prior exam. This vasogenic edema appears to have partly regressed when compared to the prior exam.There is redemonstration of periventricular confluent T2 and FLAIR signal hyperintensities.Punctate T2 and FLAIR hyperintense foci are present in the brainstem and unchanged since the prior exam.There are punctate foci of susceptibility in the posterior aspect of the left insular cortex as well as the fourth ventricle which were also present on the prior exam.Previously noted small-enhancing lesions in the right posterior insular cortex and the right inferior parietal lobule are not readily appreciated on this exam most likely due to lack of contrast enhancement on the current exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery is small.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the sphenoid sinus on the right side. The visualized portions of the mastoid air cells demonstrate partial opacification of right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.A hemorrhagic and cystic lesion present in the left parietal lobe has not changed substantially when compared to the prior exam. One possibility is that this represents an abscess. Compared to the prior exam there is less vasogenic edema associated with this lesion.2.Ventriculomegaly is stable and compared to the prior exam.3.Periventricular white matter lesions are stable compared to the prior exam.4.There is a hemorrhagic lesion along the posterior aspect of the left insular cortex.


Instruction: Generate impression based on findings.

Input: Palpable skull defect. There is artifact related to orthodontic hardware obscuring most of the face and distorting the lower aspect of the frontal lobes. Accounting for this, there is no definite skull or scalp abnormality. Also, there is no evidence of mass. A significant part of the brain cannot be assessed on the diffusion-weighted and the susceptibility-weighted imaging because of artifact. The remainder of the brain shows no acute infarct or intracranial hemorrhage. The brain parenchyma and pituitary gland appear 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. Mastoid air cells are clear.

Output: 1.There is no MRI evident skull or scalp abnormality in the right parietal region. Thin section CT through the region may better define the osseous structures if deemed clinically beneficial.2.There is also no significant intracranial abnormality.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 33 seconds.

Output: Successful fluoroscopic guided left hip arthrogram.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of adrenal lesions. ABDOMEN:LIVER, BILIARY TRACT: Bilateral T2 hyperintense lesions likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular left adrenal gland with internal fat density appearing similar to the study from 2014.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: Stable findings of nodular adrenal hyperplasia without suspicious features.


Instruction: Generate impression based on findings.

Input: Evaluate etiology of headache, positional component: history of right mastoidectomy, lumbar drain. MRI: There are postoperative findings related to right mastoid obliteration with fat graft. There is fluid within the remaining pneumatized portions of the right temporal bone. 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. There appears to be mild prominence of the bilateral optic nerve sheath cerebrospinal fluid.MRV: There is constriction of the bilateral transverse sinuses. There is otherwise no evidence of venous sinus thrombosis.

Output: 1. Postoperative findings related to right mastoid obliteration with fat graft. There is fluid within the remaining pneumatized portions of the right temporal bone, which may represent persistent cerebrospinal fluid leakage or effusions. 2. A partially empty sella, mild prominence of the bilateral optic nerve sheath cerebrospinal fluid, and constriction of the bilateral transverse sinuses are suggestive of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Seizures, hearing problems, and developmental delay. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchymal signal appears unremarkable. There is no abnormal intracranial enhancement. The supratentorial ventricles and sulci are mildly prominent diffusely. The cerebellum is unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are small nasopharyngeal retention cysts.Internal Auditory Canals: The bilateral cochleas are small, with deficiency apical and most of the middle turns. The bilateral vestibules also appear to be mildly dysplastic and there appears to be dehiscence of the right superior semicircular canals. There are enlarged bilateral endolymphatic ducts and sacs, left larger than right. The bilateral cranial nerve 7 and 8 complexes appear to be intact. There is no evidence of mass lesions. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. Findings compatible with bilateral incomplete partition type 2, left more pronounced than right.2. Mild diffuse supratentorial cerebral volume deficiency, but no evidence of gross neuronal migration anomalies.


Instruction: Generate impression based on findings.

Input: Male, 34 years old, with neurofibromatosis type I with paraspinal and chest masses. Chronic findings related to prior surgery for tumor debulking at C2-3 and C6-7 are redemonstrated without significant interval change.Residual bilateral foraminal tumors show no significant interval change from the prior exam. At some levels, for example C1-2 bilaterally and C2-3 on the right, some degree of spinal canal encroachment by these tumors does persist. The degree to which they narrow the spinal canal is unchanged and mild.Areas of ill-defined T2 hyperintensity remain evident within the spinal cord at C2-3 and C3-4. More circumscribed T2 hyperintensity is demonstrated within the cord at the C6 and C7 levels. Findings are unchanged and are favored to reflect areas of cystic degeneration and myelomalacia from prior cord compression or injury.The cervical lordosis is reversed similar to prior. Spinal alignment is otherwise unremarkable. Vertebral body height and marrow signal characteristics are within normal limits.Cervical spondylosis remains evident at lower levels, most notably C5-6 where there is a mild spinal canal stenosis.Numerous subcutaneous and paraspinal masses are also redemonstrated without significant interval change.

Output: 1.Redemonstration of prior surgical findings in the cervical spine for tumor debulking.2.The overall size and distribution of residual foraminal neurofibromas is unchanged with stable mild encroachment upon the spinal canal at some levels.


Instruction: Generate impression based on findings.

Input: Right hemifacial spasm, LUE task specific dystonia, rule out lesion, abnormality involving facial nerve. MRI: There are postoperative findings related to left parietal craniotomy with encephalomalacia in the superior portion of the left postcentral gyrus. There is also mild nonspecific scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a retention cyst in the left frontal sinus. MRA: There is vertebrobasilar dolichoectasia and a markedly tortuous right vertebral artery that displaces the right cranial nerve 7 and 8 complex superiorly just medial to the porus acusticus. There is no evidence of significant steno-occlusive lesions or saccular aneurysms.

Output: 1. Postoperative findings related to left parietal craniotomy with encephalomalacia in the superior portion of the left postcentral gyrus, but no evidence of tumor.2. Vertebrobasilar dolichoectasia and a markedly tortuous right vertebral artery that displaces the right cranial nerve 7 and 8 complex superiorly.


Instruction: Generate impression based on findings.

Input: There is a hypoenhancing lesion in the right lobe of the pituitary gland that measures up to 7 mm. The infundibulum is intact. There is no mass effect upon the optic apparatus or cavernous sinuses. The carotid artery flow voids are intact.

Output: Findings compatible with a right pituitary microadenoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old female with bilateral hip arthroplasties now presents with bilateral hip pain. Some residual metal artifact from bilateral hip prostheses remains.There is diffuse fatty atrophy of the muscles in the gluteal region and visualized proximal thigh. However, the hips are grossly normal without evidence of gross inflammation or hardware complication.

Output: Limited/incomplete study as discussed above without gross abnormality identified to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. Vertebral body heights and disc are intact. Normal marrow signal. No abnormal signal within the cord or conus. No significant neural foraminal or spinal canal narrowing. Soft tissue edema is identified in the superficial subcutaneous tissues of posterior midline as well as right suboccipital region. No MRI findings to indicate ligamentous injury. No epidural hematoma or fluid collection. Airspace disease is seen in the right apex.

Output: 1.Soft tissue edema is identified in the superficial subcutaneous tissues of posterior midline as well as right suboccipital region. No MRI findings to indicate ligamentous injury. 2.Airspace disease is seen in the right apex.


Instruction: Generate impression based on findings.

Input: 33-year-old female with endocervical adenocarcinoma. Assess extent of disease. PELVIS:UTERUS, ADNEXA: No significant abnormality noted. Cervix is approximately 2.7 cm in length (sagittal series 701/29).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid, likely physiologic.

Output: No significant abnormality is evident.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with hyperprolactinemia. The pituitary gland is slightly small but still within acceptable limits for size. No definite focal lesions are seen. The pattern of enhancement is within normal limits. The pituitary stalk deviates towards the left but is otherwise unremarkable. No suprasellar lesions are seen.

Output: No definite focal pituitary lesions are identified.


Instruction: Generate impression based on findings.

Input: 60 year-old male status post heart transplant, with altered mental status Examination demonstrates ill-defined hypoattenuation change in the tip of right temporal lobe in associated with a coarse calcification mass. The mass appears wrapping around the greater wing of sphenoid on the right side. It shows no significant change when compared to previous MRI study. Patchy area of low attenuation change is identified in the left frontal lobe with associated prominence of the sulci, consistent with encephalomalacia. There is no new density change in the remainder parenchyma. No evidence of hemorrhage or midline shift is detected. Cortical sulci, ventricular system and all CSF cisterns are symmetric and mild prominent secondary to parenchymal volume loss. Calvarium and skull base is negative for metastatic disease. The visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1. Right temporal tip coarse calcification mass with associated vasogenic edema. Differential diagnosis includes slow growing meningioma, calcified metastatic lesion. The finding is stable when compared to previous MR study.2. Left frontal lobe encephalomalacia. There is no evidence of acute intra-or extra-axial hemorrhage.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of right breast cancer status post mastectomy in 2009 with autologous breast reconstruction. Patient received radiation, chemotherapy, and hormonal therapy. History of left breast reconstruction as well. Family history breast cancer diagnosed in sister at age 36. History of Cowden syndrome. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Postsurgical changes of a right mastectomy with reconstruction.No new or suspicious enhancement is seen in the left breast. Stable enhancing foci and masses in the left breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Evaluate for appendicitis. Right lower quadrant pain in patient who is 2 months pregnant. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Gravid uterus. There is a left adnexal lesion measuring 3.8 x 3.0 cm that is T1 and T2 hyperintense, with fat suppression and contains peripheral nodules, compatible with a dermoid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not definitively visualized. However, there is no fat stranding or other finding to suggest appendicitis. No evidence of bowel obstruction. Trace free pelvic fluid, probably physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Appendix not definitively visualized, but no specific findings to suggest appendicitis.2.Gravid uterus.3.Incidentally noted left dermoid.


Instruction: Generate impression based on findings.

Input: Foci of T2 hyperintensity are present within subcortical white matter involving primarily the frontal lobes, also involving gray matter to some degree. There are also a few foci of T2 hyperintensity within the white matter along radial glial lines. Given differences in technique, these appear unchanged. Lateral ventricular subependymal nodules are again noted (right greater than left). One on the right demonstrates susceptibility from presumed calcification. These findings are unchanged.A 4 mm enhancing nodule is noted near the rightward foramen of Monroe.Susceptibility hypointensity is also noted within the left cerebellar hemisphere, with associated folia prominence of focal volume loss. The susceptibility appears to have increased (again given differences in technique), although the volume loss appears unchanged.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for 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. Incidental note is a prominent developmental venous anomaly arising within the left frontal white matter draining to the inferomedial frontal lobe.

Output: 1.Constellation of MRI findings of tuberous sclerosis including cortical tubers, radial glial lines, and subependymal nodules, including a 4 mm enhancing nodule near the rightward foramen of Monroe.2.Susceptibility hypointensity is also noted within the left cerebellar hemisphere, with associated folia prominence of focal volume loss. The susceptibility appears to have increased (given differences in technique), although the volume loss appears unchanged. This is of uncertain etiology or clinical significance.


Instruction: Generate impression based on findings.

Input: There has been essentially near complete resolution of the previously identified enhancing supratentorial and infratentorial lesions. No new lesions are identified. There are unchanged nonspecific confluent and patchy foci of T2 hypertensity throughout supratentorial white matter. A few punctate foci of susceptibility effect located within areas of previous enhancement are unchanged and are compatible with chronic microhemorrhages. There is no evidence of acute infarct. 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 skull and scalp soft tissues are unremarkable. There is minimal paranasal sinus mucosal thickening.

Output: Near complete resolution of enhancement within the treated metastases. There is no new lesion.


Instruction: Generate impression based on findings.

Input: Female 52 years old Reason: Large left renal mass with venous tumor thrombus. Assess for extent of tumor thrombus History: renal mass with tumor thrombus ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter nonenhancing foci in the liver which are slightly hyperintense on T2 may represent cysts. No suspicious hepatic lesions. Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No discrete nodule in the adrenal glands.KIDNEYS, URETERS: Right kidney enhances homogeneously. No hydronephrosis.There is a large mass in the left kidney measuring at least 7.0 x 7.6 cm. Tumor extends into the perinephric fat with portion of tumor abutting the descending colon. There is a large amount of tumor thrombus extending into the renal vein . The thrombus extends into the IVC up to the level of the caudate. This occludes half of the medial aspect of the IVC between the renal veins and the liver. Inferiorly, there is no extension of tumor in the IVC. The right renal vein is widely patent.RETROPERITONEUM, LYMPH NODES: Few scattered subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of a large left renal mass with extension into the IVC.2.Portions of the tumor is invade the perinephric fat and has significant invasion into the renal sinus.3.No specific evidence of metastatic disease to liver or adrenal glands. No significant retroperitoneal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 72 year old female with known left breast cancer with metastatic left axillary lymph node on neoadjuvant chemotherapy presents to evaluate response. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known index cancer with an associated Hydromark biopsy clip is decreasing in size and intensity of enhancement now measuring 16 x 16 x 14 mm (AP X ML X CC). Previously the mass measured 14 x 11 x 17 mm (on 4/29/15) and 29 x 33 x 27 mm (on 1/29/15). Previously described anterior extension of non mass enhancement is not appreciated on today's imaging.The two reference left axillary lymph nodes are also smaller and demonstrate normal morphology. The biopsied node now measures 12 x 12 mm (including the clip), previously measured 14 x 6 mm on 4/29/2015 and 33 x 24 mm on 1/29/2015. The level 2 node now measures 13 x 6 mm, mostly unchanged from most recent study.No additional suspicious or new enhancement is seen in either breast. No abnormal lymph nodes are identified in the right axillary region.A port-a-cath is noted in the right upper chest wall.

Output: Interval decrease in size of left breast mass and normal sized left axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 23 years Female Reason: Aneurysm coiling, History: 5.5mm right paraclinoid aneurysm extending into the pituitary fossa as well as two aneurysms versus ophthalmic artery infundibulae at the left (2.5mm) right (1.5mm) ophthalmic artery origins OPERATORS: Greg Christoforidis, Brandyn CastroFLUOROSCOPY TIME: 40.8 minutesFrontal: 1331.46 mGyLateral: 1466.52 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery 4) 3-D reconstructions of intracranial left internal carotid artery Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There was reflux into the PCOMAs bilaterally. The PCOMAs are small. There was transient reflux into the distal RVA which is slightly smaller in diameter relative to the LVA. The left PICA origin is extracranial. A posterior meningeal artery originates distal to the PICA.Right vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There was reflux into the PCOMAs bilaterally. The PCOMAs are small. The right PICA is very small. The right PICA origin is extracranial. A posterior meningeal artery originates distal to the PICA. The right AICA is dominant. The anterior spinal artery originates from the RVA.Left internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. The ACOMA is medium sized.There is a 2.5mm left ICA opthalmic artery origin aneurysm present. It is directed superiorly and medially.There is a 1.5 mm right ICA paraclinoid ICA aneurysm present. It is directed inferiorly, posteriorly and medially. It is associated with adjacent bone remodeling.Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula.Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries. The ACOMA is medium sized.There is a 1 mm dilation/blister aneurysm at the right ICA opthalmic artery origin. It is directed superiorly and medially.There is a 5.5 mm left ICA paraclinoid ICA aneurysm present. It is directed inferiorly, posteriorly and medially. It is associated with adjacent bone remodeling.Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula.Intra-aneurysmal arteriogramIntra-aneurysmal arteriogram demonstrates no perforating arteries originating from the aneurysm.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysm using balloon remodeling. The balloon remained across the neck of the aneurysm throughout the procedure. There were no thromboembolic events noted.Final RICA arteriogram :At the end of the procedure there is no opacification of the aneurysm with preservation of the parent vessels and no thromboembolic events.Right common iliac artery: The puncture site is adjacent to the right CFA bifurcation.

Output: 1.Bilateral paraclinoid and ophthalmic origin aneurysms.2.Embolic coil occlusion of a right ICA paraclinoid intracranial aneurysm using MRI compatible (up to 3T) coils.3.Findings were communicated to Drs Awad and Goldenberg at the end of the procedure.


Instruction: Generate impression based on findings.

Input: Unspecified abnormalities of gait and mobility [R26.9], Reason for Study: ^Reason: ? Aqueductal stenosis vs pseudotumor History: ataxia, urinary incontinence Ventricular system appears to be prominent than normal size.There is no evidence of occlusion in CSF pathway.No MR evidence of mass lesion although this examination was performed with very limited imaging sequences.The ventricles, sulci and cisterns are symmetric. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening on the right maxillary sinus.

Output: Prominent ventricular system but symmetric.No evidence of abnormal signal intensity within very limited sequences.


Instruction: Generate impression based on findings.

Input: 56 year old female with a history of bilateral breast cancer s/p right lumpectomy and radiation 12/2013 and left mastectomy in 06/2014. Status post left mastectomy and retropectoral silicone implant placement.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Stable intramammary lymph node is present in the right posterior 9:00 position. No abnormal enhancement is seen in right breast or in the left reconstructed breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 37-year-old female with history of endoscopic repair of CSF leak an encephalocele repair. Rule out subdural hemorrhage. The area of low attenuation in the right frontal lobe is again seen. This could represent vasogenic edema, however, to exclude other etiologies, contrast enhanced CT or MRI should be performed. Previous area of high attenuation in the right frontal lobe is less conspicuous. There is no new additional evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Post-surgical changes with sinus opacity of the sphenoid, right ethmoid, and maxillary sinuses. Right-sided frontal sinuses are also opacified. The mastoid air cells are normally pneumatized.

Output: Area of low attenuation in the right frontal lobe could represent vasogenic edema, though other etiologies should be excluded on MRI or contrast enhanced CT.


Instruction: Generate impression based on findings.

Input: History of right base of tongue squamous cell carcinoma with likelihood of recurrence. There is an infiltrative enhancing mass centered in the right lateral tongue base, which measures up to approximately 25 mm. The tumor also appears to invade a portion of the oral tongue and extends to the glossotonsillar sulcus. Diffuse edema and enhancement in the adjacent right lateral oropharyngeal and retropharyngeal walls is otherwise likely treatment related and the pterygoid musculature appears to be intact. There is no evidence of significant lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is a deficient inferior right internal jugular vein flow void. There is mild multilevel degenerative spondylosis. The imaged portions of the intracranial structures and orbits are unremarkable.

Output: 1. A tumor measuring up to 25 mm centered within the right tongue base likely represent recurrent squamous cell carcinoma in the setting of treatment effects. 2. No evidence of cervical lymph node metastases.


Instruction: Generate impression based on findings.

Input: Reason: eval of lumbo-sacral plexus 2/2 b/l LE weakness History: b/l LE weakness, falls. Metallic artifact from bilateral hip orthopedic hardware limit evaluation.BONE MARROW: No significant abnormality noted. No bony abnormality. SOFT TISSUES: Fatty atrophy of the gluteal musculature. No abnormal mass. JOINTS: Limited evaluation due to metallic artifact. ADDITIONAL

Output: No abnormal mass or bony abnormality identified.


Instruction: Generate impression based on findings.

Input: History of lupus and headaches. Evaluate for any abnormalities. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple punctate foci and confluent areas of T2 signal abnormality in the periventricular and subcortical white matter in the bilateral frontal, parietal, temporal and to a lesser degree the occipital lobes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is minimal opacification of a few right mastoid air cells. The skull and extracranial soft tissues are unremarkable.

Output: 1. Multiple subcortical white matter lesions in the supratentorial white matter, which likely represent CNS involvement of lupus.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disease of spinal cord, unspecifiedClinical question: history of T8-T11 laminectomy for intramedullary lesion done in 1985Signs and Symptoms: c/o right leg numbness and tingling MRI thoracic spine:There is a heterogeneous signal intensity mass at the surgical site along the posterior elements at the T8 and T9 laminectomy sites. It is predominantly bright signal on T2 and heterogeneously bright signal on T1. It appears to enhance following gadolinium administration. It has a cystic appearing component on its superior aspect. It is associated with osseous bridging at the laminectomy site predominantly posterior to this lesion but also anterior to it along the superior and inferior aspects of this lesion.There is distortion of the spinal cord and widening and focal thickening of the spinal cord at the T8 and T9 vertebral body levels where measures up to 18 x 5 mm axial dimensions. There is no abnormal enhancement appreciated within the thoracic spinal cord.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a centimeter-sized focus of marrow replacement along the superior posterior aspect of the L1 vertebral body without associated contrast enhancement which is low signal on T1 and T2 imaging.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is minor disc bulge associated with some disc desiccation at this level. There is a focal signal hyperintensity along the annulus of the disc posteriorly at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy and ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level associated with some loss of disc space height. There is mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is distortion and thickening of the spinal cord at the T8 and T9 vertebral levels. It's possible this is related to post surgical change. Comparison to prior exams and/or follow-up exam would help further evaluate this for possible residual neoplasm.2.There is soft tissue lesion present along the posterior elements at the laminectomy sites which bulges into the spinal canal. One possibility is that this may represent postsurgical growth related to laminectomy and osseous bridging. Even though it does not have a general appearance of a meningioma, meningioma is a common extra-axial mass and thus the possibility cannot be excluded.3.There are some degenerative changes present in the lumbar spine.4.A small L1 vertebral body lesion is of unclear significance.


Instruction: Generate impression based on findings.

Input: Right-sided weakness. History of CVA. Evaluate for ICH. There is a 4.1 x 3.4 cm subtle focal area of abnormal attenuation in the left vertex (image 21/30 on series 4) with a suggestion of surrounding vasogenic edema which may represent a mass which has increased in size when compared to the prior exam from 2006. Further evaluation of this lesion is recommended with a contrast-enhanced CT or MRI. Low attenuation in the periventricular and subcortical white matter is likely due to prior small vessel ischemia. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Possible mass in the left vertex as described above. Further evaluation with a contrast-enhanced CT or MRI is recommended. The ER was notified of these findings at 9:30 a.m. on 9/18/09.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: 72F with h/o CVA with altered mental status History: AMS Redemonstration of restricted diffusion on the left frontal lobe middle and inferior frontal gyri indicating subacute ischemic infarct. The degree of restricted diffusion has been reduced indicating normal evaluation process of acute ischemic infarct. No evidence of hemorrhage transformation.Redemonstration of multifocal chronic ischemic infarct with encephalomalacia involving right frontal lobe, right temporal occipital lobe, left occipital lobe left precuneus. Extensive nonspecific small vessel ischemic lesions, again do not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. 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: Evolving right frontal lobe middle and inferior frontal gyri subacute ischemic infarct without evidence of hemorrhagic transformation.No interval change of multifocal chronic ischemic infarct with encephalomalacia since prior scan.No change of extensive nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 60-year-old male with coronary artery disease, coronary artery bypass graft ('98, redo '03), also with PCI, and angina. Referred for cardiac MRI to assess for any region of new ischemia for possible intervention. Left Ventricle (Resting Condition)The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%. The LVEDV is 206 ml (normal range 142+/-34), the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVESV is 99 ml (normal range 47+/-19) and the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9). The LV mass is 59 g (normal range 164+/-36) and the LV mass index is 26 g/m2 (normal range 85+/-15). There is (1) thinning and akinesis of the basal to mid inferior and inferolateral walls. There is additionally (2) a small focal area of akinesis and myocardial thinning involving the mid anterolateral wall. Myocardial ScarThere is a nontransmural myocardial infarction involving the basal anterior and anterolateral segments. There is a transmural myocardial infarction involving the mid anterolateral segment. There is a transmural myocardial infarct involving the basal inferior and inferolateral segments. There is a nontransmural myocardial infarction involving the mid inferior and inferolateral segments. Dobutamine ResponseDuring low dose dobutamine infusion and peak dose dobutamine infusion, the overall left ventricular systolic function increases in a stepwise fashion. There is a partial increase in contractility noted in the basal to mid inferior and inferolateral walls at low dose dobutamine; however, at peak dose dobutamine, the contractility decreases back down to baseline levels. The small focal area of akinesis involving the mid anterolateral wall does not improve at any stages of dobutamine. The remainder of the myocardium augments appropriately at peak stress. 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 53%. The RVEDV is 148 ml (normal range 142+/-31), RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVESV is 70 ml (normal range 54+/-17), and the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. Right hemidiaphragm is elevated. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The basal to mid inferior and inferolateral segments have evidence of partial ischemia and viability. The remainder of the myocardium is not ischemic. The basal anterior and anterolateral segments have a non-transmural myocardial infarction and are likely viable. The mid anterolateral segment has a transmural myocardial infarction and is not likely viable. 2.Normal left ventricular size with low normal systolic function. LVEF 52%.3.Normal right ventricular size and systolic function. RVEF 53%.4.Elevated right hemidiaphragm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 79 years Male (DOB: 8/13/1936)Reason: cervical cord compression History: myelopathic examPROVIDER NAME: AGNIESZKA A ARDELT AGNIESZKA A ARDELT MRI brain: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 scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.No susceptibility weighted imaging was performed.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is reversal of normal cervical curvature present. There is multilevel loss of disc space height.There are endplate and uncovertebral osteophytes present at multiple levels most prominently at C3-4, C4-5 and C5-6 but also present at C6-7. There appears to be neural foramen encroachment of exiting nerve roots at these levels. Axial imaging is rather limited. There is encroachment of exiting nerve roots due to disc osteophyte complexes bilaterally at C3-4, C4-5, C5-6 and on the left side at C6-7. The right vertebral artery flow-void is not readily identified. There is marked left-sided facet hypertrophy at C3-4.

Output: 1.There is no convincing evidence for acute ischemic cerebral infarction on this exam.2.Periventricular and subcortical white matter lesions of a moderate to marked degree are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 3.Exam is degraded due to artifact resulting from patient motion. This may obscure more subtle abnormalities.4.There are multilevel degenerative changes present cervical spine with the reversal of the normal cervical curvature and encroachment of exiting nerve roots within the neural foramina multiple levels. Please note that details are obscured in part by patient motion.5.Findings suggest slow flow or occlusion of the right vertebral artery