Instruction: Generate impression based on findings.

Input: Female, 76 years old, with GBM, status post RT. A large heterogeneous tumor is redemonstrated occupying the left parietal lobe, left posterior medial temporal lobe and splenium of corpus callosum with extension across midline. Sequelae of prior left parietal approach biopsy are again seen with reduced procedure related enhancement at the burr hole site.Since the prior examination, the heterogeneous, predominantly rim-enhancing lesion has mildly increased in size with measurements increased on the order of 2 to 3 mm depending on where the measurements are made. Much of this mild interval increase in size seems to be due to the development of more and larger internal cystic or necrotic spaces. The entire lesion is associated with strong susceptibility artifact and some of the cystic spaces contain subacute blood product which likely accounts for scattered areas of restricted diffusion. A modest degree of T2 hyperintensity is present within the parenchyma surrounding the lesion and this is slightly increased from the prior exam. The T2 signal now extends into the left occipital lobe, to the left paracentral lobule superiorly, and along the left medial temporal lobe structures. Minimal progressive T2 signal is also seen along the right ventricular atrium. There is moderate regional mass effect with sulcal effacement and effacement of the left ventricular atrium. There is a very slight herniation of the posterior medial left temporal lobe across the tentorial incisure.The ventricular system appears similar to the prior examination in terms of caliber and morphology including areas of tumor related mass effect. Scattered small foci of T2 hyperintensity are evident within the cerebral hemispheres showing no significant change from the prior exam.

Output: Redemonstrated is a large heterogeneously enhancing tumor centered on the left parietal lobe with extension across the splenium of the corpus callosum to the right cerebral hemisphere.Since the prior examination, the tumor shows progressive internal cystic and/or hemorrhagic degeneration. The overall size of the lesion has increased by 2 to 3 mm, and the degree of surrounding T2 hyperintensity has also mildly expanded.Given the recent completion of radiotherapy and the relatively modest degree of lesion expansion, it would be reasonable to entertain the possibility that these changes are treatment related. Continued follow-up will be necessary to exclude the possibility of progressive disease.


Instruction: Generate impression based on findings.

Input: Oscillopsia, eye pain, and headaches. Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.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. There is a persistent left trigeminal artery. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of orbital lesions.2. No evidence of demyelinating lesions, acute intracranial hemorrhage, mass, or cerebral infarction.


Instruction: Generate impression based on findings.

Input: 11-year-old male with right leg wound, evaluate for osteomyelitis Increased T2 edema type signal is noted along the lateral compartment of the right tib-fib with fluid signal tracking along the fascial planes. Induration of the skin is present. This involves the anterior tibialis, flexor digitorum longus and flexor hallucis longus muscles and the peroneal brevis and peroneal longus muscles. Mild edema signal extends anteriorly and along the medial aspect of the tibial diaphysis. Mild cortical irregularity is noted along the anterior aspect of the fibula (series 1001, image 24) with mild marrow enhancement, increased T2, and decreased T1 signal suspicious for osteomyelitis.

Output: Findings suspicious for osteomyelitis of the anterior aspect of the fibula with overlying cellulitis as described above.


Instruction: Generate impression based on findings.

Input: Female, 44 years old. Enthesopathy of the lower limb. The left hamstring origin appears normal, without tendinopathy or tear. The right hamstring origin likewise appears normal. There is minimal edema along the greater trochanters bilaterally, which is not necessarily of any clinical significance. The gluteal tendons appear normal. The musculature appears normal.Small tubular foci of low signal intensity in the left acetabulum presumably reflect prior labral repair. Although lack of intra-articular contrast limits evaluation of the acetabular labrum, we see no fluid-filled tear. Bone marrow signal intensity is otherwise within normal limits.

Output: Surgical changes compatible with prior labral repair. We see no proximal hamstring tendinopathy.


Instruction: Generate impression based on findings.

Input: Lack of contrast limits evaluation of neoplasm.Brain: There is extra-axial T1 hyperintensity along the posterior aspect of the petrous temporal bones favored to represent a small subdural hematoma and new since prior. No significant mass effect.Extra-axial left frontal mass demonstrates decrease in size, measuring approximately 12 mm in diameter in the axial plane, previously 28 mm measured similarly. Mass demonstrates decrease in intrinsic T1 and T2 signal. Surrounding FLAIR hyperintensity/edema has decreased. There is also reexpansion of the frontal horn of the left lateral ventricle related to decreased mass effect. Additional nonspecific scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are not significantly changed.Note small extra-axial lesions can be better assessed with postcontrast imaging. Extra-axial left occipital lesion demonstrates decrease in size, previously approximately 7 mm and infiltrating the adjacent calvarium, now not definitively appreciable. No new intracranial mass or new mass effect. No midline shift or herniation. No hydrocephalus. Low-lying cerebellar tonsils again seen. Diffuse T1 hypointensity of the bone marrow signal is again seen compatible with history of multiple myeloma. Neck:There is an infiltrative appearing mass involving the right maxilla with soft tissue extension laterally into the right buccal space. The mass measures approximately 3.6 x 3.3 x 3.5 cm in the AP, transverse, and craniocaudal dimensions (ax T1 series 18, image 31 and sag T1 series 8 image 14). This region is partially included on the prior brain MRI with questionable minimal if any signal abnormality in this region on prior study. There is increase in opacification of the right maxillary sinus with low T1 and T2 signal suspected to represent direct invasion of the tumor into the right maxillary sinus. Small underlying osseous erosions of the right maxillary sinus wall can be better assessed with CT.Multiple ovoid lesions likely representing lymphadenopathy are present in the neck at levels 1B and 2 bilaterally as well as level 3 on the right. For example a right level 2B lymph node measures 20 x 13. A left level 2A lymph node measures 12 x 12 mm. Airway is patent. Diffuse T1 hypointense marrow signal abnormality is noted in the cervical spine which may related to known leukemia or myeloma. No obvious epidural tumor. Mild multilevel degenerative changes without high-grade spinal canal stenosis.

Output: 1. Compared to MRI dated 6/15/2016, there is interval decrease in size of the previously seen multiple intracranial extra-axial lesions. Residual lesions can be better assessed with post gadolinium imaging.2. New area of extra-axial T1 hyperintensity in the posterior fossa favored to represent small subdural hematomas without associated mass effect. These may conceivably be related to redistribution of blood products associated with the previously seen extra-axial lesions.3. Interval development of a right maxillary mass most consistent with a tumor deposit which appears to infiltrate into the maxillary sinus and extend laterally into the buccal space. 4. Bilateral cervical lymphadenopathy, predominantly on the right.


Instruction: Generate impression based on findings.

Input: Diagnosis: Muscle weakness (generalized)Muscle weakness (generalized)Diagnosis Edits: Clinical question: r/o acute ischemic infarctSigns and Symptoms: right sided weaknessComments: GFR =14 MRI of the brainThere is a focus of diffusion restriction centered along the posterior limb of the left internal capsuleThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Similar lesions are also present along the brainstem.Punctate foci of SWI signal loss are present in the right cerebellum and right thalamus. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The right ICA is smaller compared to the left ICA throughout its course. The right A1 segment is smaller than the right A1 segment. There is a 2.5 mm ACOMA aneurysm present.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:The great vessel origins from the aortic arch and the aortic arch are not included on this exam. There is irregular stenosis at the proximal right ICA associated with decrease in caliber along the cervical right ICA. This suggests a >70% stenosis at the proximal right ICA. The imaging is somewhat degraded by pulsation. On the basis of NASCET criteria there is no significant stenosis at the left carotid bifurcation. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a small acute cerebral infarction centered along the left posterior limb of internal capsule.2.Findings suggest a >70% stenosis at the proximal right ICA. It is not adequately imaged on this exam. Additional investigation with CTA or with ultrasound may be of further benefit.3.There is a 2.5mm ACOMA aneurysm present.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Punctate lesions in the brain stem and thalami are likely related to prior lacunar infarcts.6.Microhemorrhages are present in the right cerebellum and the right thalamus. They are non-specific but could relate to hypertension.


Instruction: Generate impression based on findings.

Input: 45 year old woman with advanced heart failure, referred for evaluation of viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 164 ml/m2 (normal range: 65+/-11), the LVEDV is 260 ml (normal range 109+/-23), the LV end systolic volume index is 127 ml/m2 (normal range 18+/-5), the LVESV is 202 ml (normal range 31+/-10), the LV mass index is 76 g/m2 (normal range 67+/-11), and the LV mass is 121 g (normal range 114+/-24). LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 153 ml/m2 (normal range 69+/-14), the RVEDV is 244 ml (normal range 110+/-24), the RV end systolic volume index is 107 ml/m2 (normal range 22+/-8), and the RVESV is 170 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe 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 small pericardial effusion. Extracardiac FindingsThere are moderate bilateral pleural effusions with lung atelectasis vs infection . In the right lung, there is either a mass or infiltrate and the pleural effusion are complex appearing with evidence of septations. 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 left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 22%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable. Image quality is somewhat limited by patient have difficulty with breath-holds.2. The right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 30%.3. Severe biatrial enlargement4. Severe mitral and tricuspid regurgitation.5. Right lung mass vs infiltrate associated with significant, complex appearing pleural effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:11/24/1944)Reason: 71 y/o male with worsening pain History: neck painPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is hypertrophy of the posterior longitudinal ligament predominantly along the upper cervical spine extending from C2 down to C4.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disc space height, disc desiccation, diffuse disc bulge as well as some endplate uncovertebral osteophytes and some hypertrophy of posterior longitudinal ligament. There is also some hypertrophy of the ligamentum flavum at this level. There is narrowing of the spinal canal and some atrophy of the spinal cord associated with signal change at this level. There is only mild narrowing of the right neural foramen at this level. There is moderate encroachment of the left-sided exiting nerve roots at this level.At C4-5 there is no significant compromise to the spinal canal. There is some disc desiccation and some hypertrophy of the posterior longitudinal ligament. There is a disc bulge at this level with narrowing of the neural foramina bilaterally. There are some encroachment of the left-sided exiting nerve roots within the neural foramen.At C5-6 there is no significant compromise to the spinal canal . There is some loss of disc space height, desiccation and uncovertebral osteophyte formation at this level as well as a disc bulge and narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots.At C6-7 there is loss of disc space height, disc desiccation as well as endplate uncovertebral osteophyte formation and narrowing of the neural foramina bilaterally but worse on the left side compared to the right. There is hypertrophy of the ligamentum flavum at this level and partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a moderate degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine without moderate spinal stenosis at C6-7 as a result of degenerative changes and an neural foramina encroachment of exiting nerve roots predominantly on the left-sided C6-7, C4-5 and C3-4 and bilaterally at C5-6.2.There are some spinal cord myelomalacia present at the C3-4 level where there is narrowing of the spinal canal and spinal stenosis.3.There is hypertrophy of the posterior longitudinal ligament predominantly along the upper cervical spine. This contributes to narrowing of the spinal canal especially at the C3-4 level.


Instruction: Generate impression based on findings.

Input: Reason: R hip pain x 1 yr. Xrays negative. History: see above. ACETABULAR LABRUM: Evaluation of the acetabular labrum is limited due to lack of intra-articular contrast. Although we see no fluid signal intensity entering the labral substance, a thin band of intermediate signal intensity traversing the anterior superior labrum could represent a small tear, but its clinical significance is uncertain. The remainder of the labrum is within normal limits.ARTICULAR CARTILAGE AND BONE: Evaluation of articular cartilage is limited due to lack of intra-articular contrast. There is thinning of the articular cartilage along the posterosuperior aspect of the joint. This suggests minimal osteoarthritis, not unexpected for the patient's age. The bone marrow signal is within normal limits. We see no CAM type deformity or other morphologic features of femoroacetabular impingement. We see no joint effusion.SOFT TISSUES: The muscle and tendons of the hip appear normal. ADDITIONAL

Output: 1.Mild cartilage degeneration affecting the right hip, essentially within normal limits for patient's age.2.Possible small anterior superior labral tear of questionable clinical significance. 3.Left adnexal mass that could conceivably represent a fibroid, but we cannot exclude the possibility of an ovarian neoplasm. Recommend transvaginal sonography for further evaluation. This was relayed by phone to Darnice Dismukes, Dr. Peek's nurse, at the time of dictation.


Instruction: Generate impression based on findings.

Input: Clinical question: Cord compression? Signs and symptoms: PRCA, BLE weakness. Nonenhanced complete spine MRI:Examination demonstrates an expected finding the morning problem.Examination demonstrates no evidence of compromise of spinal canal or any foci of mass effect on the cord.The alignment of vertebral or common remains anatomical.There is a tiny focus of T2 hyperintensity in the vertebral body of T2 which is nonspecific and the signal intensity of the rest of the vertebral column is unremarkable.There is no detectable paraspinal soft tissue abnormality.Moderate degenerative disc disease at L4-L5 and L5-S1 levels as well as C6/C7 is noted.

Output: No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: Follow-up exam. History of prior thoracic fenestration. Thoracic: Vertebral body heights are normal. There is thoracolumbar levocurvature and exaggerated lumbar lordosis. Marrow signal is normal for age. Again seen is evidence of fenestration of the arachnoid cysts with laminoplasty from T2 to T9. Evolution of postsurgical changes is evident with resolution of previously seen edema in the posterior soft tissues with persistent fluid dorsally at the level of the laminoplasties without any mass effect on the thecal sac. No mass effect on the cord is seen to suggest residual or recurrent arachnoid cysts, which were evident on prior myelogram at the T3-T4 level and T7-T8 level.No cord signal abnormality or syrinx is appreciated. The lower thoracic cord and conus with improvement in previously seen clumped appearance of the right-sided nerve roots. No spinal canal or neural foraminal stenosis.There is bibasilar atelectasis Lumbar: There is exaggerated lumbar lordosis with near 90 degree curvature at the lumbosacral junction, more prominent in comparison with prior images from 12/22/2014. Vertebral body heights and alignment are otherwise maintained. Conus is in normal position (L2 level, counting from craniocervical junction previously) without suspicious lesions involving the lumbar spinal canal. No lipoma or appreciable thickening of the filum. Conus and cauda equina nerve roots are rightward positioned favored to be related to the spinal curvature. No significant clumping of the nerve roots is appreciated. No spinal canal or neural foraminal stenosis. Prone images demonstrate no significant motion of the conus and cauda equina nerve roots.

Output: 1.Evolution of postsurgical changes related to fenestration of thoracic arachnoid cysts. No mass effect on the thoracic cord is seen to suggest recurrence of the previously seen cysts. No cord signal abnormality or evidence of syrinx.2. Mild rightward deviation of the distal spinal cord and cauda equina nerve roots is again noted which is favored to be related to thoracolumbar levocurvature. 3. When compared to MRI spine study from 12/22/2014, the thoracolumbar levocurvature and exaggerated lumbar lordosis including near 90 degree curvature at the lumbosacral junction appears to have progressed. Would suggest correlation with radiographs.4. Prone images demonstrate no significant ventral motion of the conus in the prone images, finding which was present on 12/22/2014. Although the conus is not low-lying and there is no obvious thickening or lipoma of the filum, tethering cannot be entirely excluded by imaging and would suggest correlation with clinical findings.


Instruction: Generate impression based on findings.

Input: 69-year-old male with history of right kidney mass. Please assess left kidney function. The posterior abdominal radionuclide angiogram demonstrates heterogeneous flow into the right renal fossa, correlating with known right renal mass from prior outside MRI. There is prompt perfusion of the left kidney. Sequential renal images show the left kidney to be of normal size and morphology. There is prompt uptake but delayed excretion of the radiopharmaceutical by the left kidney. There are no abnormalities of the left ureter or bladder.Following administration of the diuretic, there was prompt washout of collecting system radiotracer into the bladder without evidence of current obstruction. However, some cortical activity persisted after diuretic administration for the remainder of the study. The T1/2 washout from the left collecting system was 19 minutes.

Output: 1.Normal perfusion and uptake but delayed excretion by the left kidney. Clearance of radiotracer from collecting system with persistent cortical activity after diuretic administration suggests medical renal disease without obstruction.2.Lack of right renal function with heterogeneous perfusion into right renal fossa on angiographic phase, compatible with known mass in this location.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell carcinoma follow up after treatment. There is no significant change in size of the enhancing lesion in the left precuneus, which measures up to 5 mm, previously also 5 mm. Likewise, the associated mild confluent surrounding T2 hyperintensity is not significantly changed. The enhancing right inferior temporal gyrus lesion has also decreased in size, which measures up to 3 mm, previously also 3 mm. There is no evidence of intracranial hemorrhage or 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 orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid in the mastoid air cells and retention cyst formation in the maxillary sinuses.

Output: No significant interval change in size of the left parietal and right temporal lobe metastases.


Instruction: Generate impression based on findings.

Input: Compared to 2/11/2013 there is unchanged appearance of the minimal enhancing tissue within the medial right cavernous sinus. Enhancing tissue along the floor of the sella on the left, which is in continuity with the left pituitary stalk and likely representing residual pituitary gland, also shows no appreciable change. Left cavernous sinus is unremarkable.As demonstrated previously, there is retraction of the optic chiasm inferiorly related to postsurgical change, however this is unchanged. Left cavernous sinus is unremarkable. Limited visualization of the remainder of the brain demonstrates no intracranial mass or mass effect.

Output: Examination of the sella including minimal enhancing tissue within the medial right cavernous sinus remains unchanged since 2/11/2013. No new or enlarging lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42-year-old male with shoulder pain. ROTATOR CUFF: There is thickening and increased signal abnormality indicating moderate to severe tendinosis of the supraspinatus tendon. There is increased fluid signal abnormality consistent with a undersurface fraying of the supraspinatus tendon. The supraspinatus muscle belly appears within normal limits. The infraspinatus muscle and tendon appear intact. The teres minor tendon appears intact. There is mild fatty atrophy of the teres minor muscle belly. There is increased signal abnormality within the subscapularis tendon likely representing tendinosis. There is linear increased fluid signal intensity within the superior fibers of the subscapularis tendon consistent with interstitial tearing. The subscapularis muscle belly appears within normal limits.SUPRASPINATUS OUTLET: Degenerative changes affect the acromioclavicular joint which results in impression along the superior fibers of the supraspinatus muscle. There is a small amount of fluid within the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although this examination was not protocoled for evaluation of the glenoid labrum, there is irregularity and heterogeneity of the glenoid labrum, consistent with degenerative tearing.BICEPS TENDON: The intra-articular portion of the long head of the biceps tendon is poorly visualized which may reflect chronic tendon rupture. ADDITIONAL

Output: 1. Findings suggestive of tendinosis and undersurface fraying of the supraspinatus tendon and interstitial tearing of the subscapularis tendon, without evidence of a near full-thickness or full-thickness rotator cuff tear.2. Findings suggestive of complete rupture of the intra-articular portion of the tendon of the long head of the biceps.3. Mild fatty atrophy of the teres minor and posterior deltoid musculature, suggestive of denervation atrophy in the distribution of the axillary nerve.


Instruction: Generate impression based on findings.

Input: 52-year-old with a strong family history of breast cancer. The patient has a family history of breast cancer in two sisters and a maternal cousin. Minimal parenchymal enhancement is noted bilaterally. Scattered fibroglandular elements are present. Stable enhancing right retroareolar foci. No suspicious enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual mammography is also due this month. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Left knee pain after injury MENISCI: There is complex tearing of the medial meniscus which involves the posterior horn, body, and anterior horn. Lobulated parameniscal cyst is identified within the medial gutter. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a comminuted fracture of the lateral tibial plateau with extension into the lateral tibial spine although there is no significant displacement or depression. Extensive marrow edema is seen along the fracture lines.There is mild diffuse tricompartmental thinning of the articular cartilage which is worst in the medial compartment. Otherwise there is no fluid-filled full-thickness defect appreciated.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Mild amount of prepatellar edema is present. Otherwise the extensor mechanism is intact.ADDITIONAL

Output: 1. Comminuted fracture of the lateral tibial plateau without significant displacement or depression. 2. Complex tearing of the medial meniscus.


Instruction: Generate impression based on findings.

Input: 22-year-old man with a history of anterior calcaneal fracture by prior MRI. Evaluate healing.IMAGE ACQUISITIONS: Unenhanced CT of the right ankle with multiplanar reformatting. There is mild diffuse demineralization, consistent with disuse osteopenia. No definite fracture is apparent by CT imaging. No sclerotic lesions are present within the calcaneus, and there is no evidence of cortical thickening or periosteal reaction to suggest an underlying lesion. No displaced fracture.Incidental note is made of a well corticated os trigonum. The remainder of the visualized osseous structures are unremarkable. The joint spaces are well preserved, with no evidence of dislocation or degenerative change.There is mild indistinctness in the fat planes surrounding the peroneal tendons, which is consistent with the reactive tenosynovitis seen on the prior MRI study. No additional focal soft tissue abnormalities are appreciated.

Output: Findings consistent with disuse osteopenia, however, otherwise, no acute abnormalities are appreciated by CT exam. Please see the prior MRI study for further details.


Instruction: Generate impression based on findings.

Input: Renal mass and altered mental status. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild cerebral white matter T2 hyperintensity. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small defect in the left lamina papyracea, with protrusion of orbital fat. There is a right lens implant.

Output: No evidence of intracranial metastases. Mild cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute intracranial hemorrhage or acute infarct. There are scattered small foci of T2 hyperintensity within the supratentorial white matter, including the right temporal pole, the right parietal white matter, and along the right frontal horn. 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 midline structures and craniocervical junction are within normal limits. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Scattered supratentorial white matter lesions are non-specific although may represent early chronic small vessel ischemic disease, thus a follow-up MRI may be beneficial.


Instruction: Generate impression based on findings.

Input: Reason: evaluation of exatension of liver mass History: known HCC ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The ablation cavity has decreased in size since the prior MRI. There is increased tumor superior to the ablation cavity, within segments 5 and 8. A reference segment 5 lesion measures 3.3 x 2.2 cm, similar to the recent CT but increased since the prior MR where it measured 2.1 x 1.1 cm. This lesion extends into the anterior branch of the right portal vein as well as multiple smaller branches which are dilated. This extends peripherally within segment 8 and a geographic distribution with increased T2 signal, enhancement and restriction on diffusion-weighted images. The main portal vein is patent. Nonspecific gallbladder wall thickening is again noted.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the pancreatic head measures 1.9 x 1.2 cm (601/16), previously 1.7 x 1.1 cm and likely communicates with the main pancreatic duct. This lesion is has a complex appearance with internal septations.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild edema in the right chest wall and subcutaneous tissues. Moderate degenerative changes of the spine. Scoliosis.OTHER: 6 mm left lower lobe lung nodule is better evaluated on recent CT.

Output: 1.Status post hepatic ablation with tumor superior to the ablation cavity, increased from the prior MRI but similar to recent CT.2.Tumor thrombus within the anterior branch of the right portal vein.3.Cystic lesion within the pancreatic head likely represents a complex sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: Female, 52 years old. Left anterior knee pain going up and down stairs. MENISCI: There is abnormal signal within the anterior horn of the lateral meniscus extending toward the root, compatible with a vertical tear with both vertical and horizontal components. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is near full thickness cartilage loss involving the lateral patellar facet more focal area of cartilage loss at the apex, with mild underlying marrow signal abnormality in the patella as well as a small focus of marrow signal abnormality along the lateral femoral trochlea. Tibiofemoral articular cartilage is intact.LIGAMENTS: Cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complex tear of the anterior horn of the lateral meniscus.2.Patellar cartilage loss with mild associated marrow signal abnormality in the patella and lateral femoral trochlea.3.Moderate to large joint effusion.


Instruction: Generate impression based on findings.

Input: 38 years Male (DOB:8/14/1977)Reason: Etiology of bilateral LE/thigh pain History: b/l thigh painPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI 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 T1 hyperintense focus associated with the fat suppression on the inversion recovery imaging measuring 23 mm superior-inferior dimension and 6 mm AP dimension 17 mm with which narrows the ventral aspect of the thecal sac. It appears to originate from the dura and is extra medullary.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small central disc protrusion present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a broad-based central disc protrusion at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Findings are compatible with a lipoma behind the L3 and L4 vertebral bodies which mildly narrows the ventral aspect of the thecal sac. It is not associated with any significant stenosis, however. 2.There are mild degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 17 years, Female, right frontal intraventricular mass, status post ETV, tumor biopsy, and placement of EVD. Postoperative CT reveals potential increased size of intraventricular mass. Compared to MRI brain from 11/8/2015, interval postsurgical changes of biopsy of enhancing mass involving the right lateral ventricle with interval development of hemorrhage within the tumor. Blood products are also noted layering within the bilateral lateral ventricles, third ventricle, and the suprasellar cistern as seen on recent CT. Again seen are two left transfrontal ventriculostomy catheters coursing through the bilateral frontal horns and terminating near the foramen of Monro bilaterally. The right lateral ventricle remains dilated with the septum pellucidum deviated to the left. There is mild edema and hemorrhage along the ventriculostomy catheters, particularly the more anterior/right frontal horn one. No evidence of acute infarct. No hemorrhage elsewhere in the brain. Evidence of endoscopic third ventriculostomy, patency of which can be better assessed with a high-resolution 3-D T2 and phase contrast/CSF flow sequence. No midline shift or herniation. Trace mucosal thickening involving the paranasal sinuses.

Output: 1. Compared to prior MRI from 11/8/2015 interval postsurgical changes of biopsy of enhancing intraventricular mass with development of intratumoral hemorrhage. Increased local mass effect associated with the hemorrhage results in leftward deviation of the septum pellucidum. Blood products are also noted within the lateral and third ventricles as well as the suprasellar cistern.2. Two EVD catheters are in place coursing through the bilateral frontal horns. The right lateral ventricle remains dilated as seen on CT from 11/9/2015, while the left lateral ventricle is decompressed. Third ventriculostomy has been performed, patency of which can be better assessed with a high-resolution 3D T2 and phase contrast/CSF flow sequences.


Instruction: Generate impression based on findings.

Input: Myositis Left: The musculature of the thigh is normal in signal intensity and caliber. There is no abnormal enhancement following gadolinium administration. The marrow signal of the femur is normal.Right: The musculature of the thigh is normal in signal intensity and caliber. There is no abnormal enhancement following gadolinium administration. The marrow signal of the femur is normal.

Output: Normal appearance of the thigh musculature.


Instruction: Generate impression based on findings.

Input: THORACIC: There is a thin syrinx in the thoracic spine measuring up to 2 x 1 mm extending from T6-T12 vertebral bodies (on axial images). There is no other cord signal or caliber abnormality. There is normal alignment of the thoracic spine. The osseous marrow signal is benign. There are scattered high T1 signal foci in the vertebral bodies likely representing hemangiomas. There is no sniffing disk herniation or spinal stenosis in the thoracic spine.LUMBAR: There are the usual compliment of 5 lumbar type non-rib bearing vertebral bodies and the last well formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. The osseous marrow signal is benign. There are scattered hemangiomas/fatty marrow deposition. There is no osseous marrow edema. The conus terminates at L1, within normal limits. There is no fatty filum/lipoma or dysraphism.L1-2: No disk herniation or spinal stenosis.L2-3: Minimal disk bulge with no spinal stenosis.L3-4: Mild disk desiccation and loss of disk height, left paracentral annular fissure, and mild disk bulge. No spinal stenosis.L4-5: Disk desiccation, moderate loss of disk height, right paracentral annular fissure and protrusion superimposed on diffuse disk bulge and facet arthropathy with disk material abutting the right subarticular zone. No significant spinal stenosis.L5-S1: Diffuse disk bulge, central annular fissure, facet arthropathy. No spinal stenosis.

Output: 1.Thin 2 x 1 mm thoracic cord syrinx extending from the T6-T12 vertebral body levels.2.No tethered cord, fatty filum/lipoma or dysraphism.


Instruction: Generate impression based on findings.

Input: History of distal pancreatic mass, evaluate for change. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is redemonstration of a peripherally enhancing, T1 and T2 heterogeneously hypointense lesion in the pancreatic tail measuring 2.6 x 2.2 cm (series 1001, image 354) previously 3.3 x 2.2 cm. Calcifications within this lesion are better seen on prior CT. There is no evidence of communication of the lesion with the pancreatic duct. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts are unchanged.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: Peripherally enhancing pancreatic tail lesion with calcifications, of indeterminate etiology, stable since 2011.


Instruction: Generate impression based on findings.

Input: Vertigo, history of stem cell transplantation. There are multifocal restricted diffusion lesions involving bilateral periventricular white matter, thickening of interventricular septum, inferior aspect of caudate nucleus head, pineal gland and mainly bilateral cerebellar white matter as well as right superior, bilateral middle and right inferior cerebellar peduncles. On Gad enhancement, those lesions show nodular and patchy enhancement on periventricular lesions, and mainly patchy enhancement on cerebellar lesions. Gradient echo images show susceptibility artifacts for right cerebellar lesion indicating possible central hemorrhagic conversion.Considering the patient's history of stem cell transplantation, these lesions could represent post transplant lymphoproliferative disease, infiltrative tumours such as CNS lymphoma, lympho-infiltrative vasculitis with possible associated with acute ischemic infarctions and hemorrhagic transformation especially right cerebellar lesion. However, the possibilities of infectious origin cannot be excluded.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Internal Auditory Canal MRIAgain bilateral cerebellar white matter lesions and bilateral middle cerebellar peduncle lesions were seen.However, the inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted.

Output: Multifocal supra and infratentorial nodular and patchy enhancing lesions as described above. Diagnostic possibilities include PTLD, CNS lymphoma, lympho- infiltrative vasculitis with acute ischemic infarctions and hemorrhagic conversion on the right cerebellar lesion as described above.Discussed with Dr. Kline at the time of this dictation.


Instruction: Generate impression based on findings.

Input: structural cause for dizziness and numbness. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.In particular, thin section bilateral internal auditory canal images show no evidence of abnormal enhancement of evidence of mas.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial mass or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Male, 50 years old, with epilepsy, pre laser fiber placement. Bilateral parietal approach depth electrodes are in place coursing along the medial temporal lobes. A small left temporal craniotomy was also performed through which a subdural electrode grid has been placed along the surface of the brain. No evidence of significant parenchymal edema or mass effect is seen within the limitations of artifact induced by electrodes. No pathologic intracranial enhancement is observed. The ventricles are normal in size and morphology.

Output: Preprocedural imaging demonstrates bilateral parietal approach depth electrodes coursing along the medial temporal lobes, as well as a subdural electrode grid along the left temporal lobe.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:10/18/1980)Reason: brain metastasis, concern for spinal metastasis History: brain metastasis, concern for spinal metastasis PROVIDER/ATTENDING NAME: KWANG JIN CHOI KWANG JIN CHOI MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.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 appears to extend down to the L4-5 disc space level. There appears to be a spina bifida defect present.No abnormal enhancing lesions are appreciated in the lumbar spine.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.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There appears to be a cystic type lesion anterior lateral to the first sacral segment. This is not clearly defined on this exam.

Output: 1.This a limited examination due to the patient's inability to cooperate fully with the exam. Findings suggest tethered cord with a spina bifida defect. If clinically appropriate additional lumbar spine imaging may be of further benefit complete evaluation and confirm this finding.2.There appears to be a cystic type lesion anterior lateral to the first sacral segment. This is not clearly defined on this exam due to motion artifact. Possibility of metastatic disease cannot be excluded. Please correlate with prior imaging studies. There is a CT of the abdomen from 5/4/2016. Please refer to that exam for further comments.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease status post ileocecectomy. Presents with diarrhea an abdominal pain. 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: The oral contrast adequately distends the small bowel and has reached the level of the sigmoid colon.The small bowel fold pattern is unremarkable.There are postsurgical changes in the right lower quadrant compatible with the stated history of an ileocecectomy.Approximately 10 cm of the neoterminal ileum demonstrates striated circumferential wall thickening with mild T2 hyperintensity, restricted diffusion, contrast enhancement, and minimal surrounding fat haziness/induration and mesenteric fluid compatible with active inflammation. The lumen is persistently moderately narrowed with mild upstream dilatation of the small bowel up to 2.7 cm suggesting underlying fibro-stenotic disease as well. More proximally there are portions of the small bowel which appear collapsed which demonstrate normal caliber on later imaging. No additional site of active inflammation or fibro-stenotic disease of the small bowel is noted. There is an 8.5 cm segment of transverse colon which demonstrates fixed luminal narrowing and mild restricted diffusion with delayed contrast enhancement and surrounding mesenteric haziness suggesting a fibro-stenotic stricture with superimposed active inflammation. There is mild prestenotic/upstream dilatation of the transverse colon up to 5.2 cm. No discrete sinus tract or fistula formation.No significant free fluid or loculated fluid collection.BONES, SOFT TISSUES: Note is made of a butterfly lower thoracic vertebra, a normal variant. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of active small bowel inflammation superimposed on fibro-stenotic disease involving approximately 10 cm of the neoterminal ileum and 8.5 cm of the transverse colon with mild upstream/pre-stenotic dilatation. 2.No sinus tract or fistula formation. No drainable fluid collection.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is increased signal separating the anterior fibers of the distal supraspinatus from the greater tuberosity, indicating an insertional tear. This is best appreciated on the sagittal T2 oblique series. The tear measures approximately 1 cm in the AP dimension and although it appears to involve the majority of the thickness of the tendon, there is no retraction and it may not extend through the articular or bursal surface fibers. There is a small focus of abnormal marrow signal within the underlying greater tuberosity. There is mild tendinosis of the remaining supraspinatus tendon with mild associated fatty infiltration of the muscle distally. The infraspinatus and teres minor tendons demonstrate no evidence of focal tearing or muscle atrophy. Evaluation of the subscapularis is limited by internal rotation however there is no evidence of focal tear or muscle atrophy.SUPRASPINATUS OUTLET: The acromioclavicular articulation is normal. There is a trace amount of fluid within the subacromial/subdeltoid bursa which is of questionable significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild osteoarthritis and thinning of the articular cartilage of the glenohumeral joint. There is branching intermediate signal within the superior labrum representing tearing. There is deformity of the anterior labrum which is also likely secondary to tearing.BICEPS TENDON: Evaluation of the long head tendon of the biceps is limited given patient positioning however there is no discrete abnormality identified.

Output: Non-retracted and possibly concealed insertional tear of the anterior distal fibers of the supraspinatus. The remaining rotator cuff tendons are intact and additional findings are described above.


Instruction: Generate impression based on findings.

Input: Other amnesia [R41.3], Reason for Study: ^Reason: eval for structural lesions/ atrophy History: severe memory decline No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with chronic daily headaches. Signs and symptoms: Chronic daily headaches, left-sided frontal headache with nausea and sonophobia no focal exam findings. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.There is normal anatomical development of brain parenchyma and the normal adult pattern of myelination.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for patient's stated age. The signal intensity of brain parenchyma also remains within normal on all MRI sequences.Negative post enhanced images or any abnormal enhancement brain parenchyma, leptomeninges or of the calvarium.Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: Unremarkable pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: New ataxia, right sided weakness and dementia, and history of alcohol use. Brain MRI: There is a subcentimeter area of restricted diffusion and high T2 signal in the posterior limb of the left internal capsule. There are also subcentimeter defects without restricted diffusion in the bilateral basal ganglia, thalami, and corona radiata. In addition, there is patchy high T2 hyperintensity in the cerebral white matter. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, which may represent a chronic microhemorrhage. There is no evidence of acute intracranial hemorrhage. There is diffuse cerebral volume loss. There is no midline shift or herniation. There is no evidence of intracranial mass lesions. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Brain MRA: There is a focal high-grade stenosis of the P1 segment of the left posterior cerebral artery. There is also mild stenosis of the right posterior cerebral artery. The anterior circulation appears to be intact. There is no evidence of saccular aneurysm, within the limits of MRA.Neck MRA: There is mild to moderate stenosis at the left carotid bifurcation, with an apparent focal outpouching in the proximal left internal carotid artery. There is also an apparent focal stenosis of the origin of the right vertebral artery. The left vertebral artery appears to be occluded near the origin and continues distally in the form of a deep cervical artery collateral. There is no evidence of significant steno-occlusive lesions in the right common and internal carotid arteries. There is a focal outpouching along the left lateral aspect of the aorta.

Output: 1. Recent infarct in the posterior limb of the left internal capsule with associated early Wallerian degeneration and a focal high-grade stenosis of the left posterior cerebral artery.2. Chronic lacunar infarcts in the bilateral basal ganglia, thalami, and corona radiata, and chronic small vessel ischemic disease in the cerebral white matter.3. Mild to moderate stenosis at the left carotid bifurcation, with an apparent focal outpouching in the proximal left internal carotid artery, which is likely atherosclerotic in nature. A CTA may be useful for further characterization.4. The left vertebral artery appears to be occluded near the origin and continues distally in the form of deep cervical collateral artery. 5. Apparent focal stenosis of the origin of the right vertebral artery.6. A focal outpouching along the left lateral aspect of the aorta may represent an ulcerating plaque or pseudoaneurysm. A CTA may be useful for further characterization.Discussed with MENDELSON, SCOTT at 10:20 AM on 1/7/15.


Instruction: Generate impression based on findings.

Input: Ileocolonic Crohn's and left sided abdominal pain. 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: There is mild wall thickening and increased enhancement of the distal ileum connecting to the cecum and proximal cecum. These findings are suggestive of mild active Crohn's disease.There is also increased enhancement and wall thickening of the rectosigmoid colon. There is a left perirectal abscess measuring 2 x 1.6 cm on image #20, series #17 with fluid fluid levels.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. MR findings compatible with active inflammation of rectosigmoid colon and terminal ileum and cecum. Small left perirectal abscess.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right DBS, now planning for left DBS. There are postoperative findings related to right deep brain stimulator insertion. The electrode passes through the right lateral ventricle and region of the right globus pallidus and terminates in the region of the superior margin of the right cerebral peduncle. There is mild diffuse cerebral volume loss. There is a punctate focus of susceptibility effect adjacent to the left superior frontal sulcus, which is nonspecific. There is no midline shift or herniation. The major intracranial vessels are unremarkable.

Output: Preoperative planning MRI demonstrates a right deep brain stimulator in position.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is restricted diffusion involving the bilateral posterior putamina and likely restricted diffusion involving the bilateral upper caudate bodies compatible with hypoxic ischemic injury. Along the superior thalami there may be bilateral punctate areas of restricted diffusion as well. The cerebral cortex is relatively preserved and there is no evidence of edema in the brain parenchyma. There is a tiny burr hole within the right frontal bone and what appears to be a thin tract within the underlying brain parenchyma on T2/FLAIR images which could reflect prior instrumentation. A focus of restricted diffusion in this location adjacent to the burr hole mitral reflect postoperative artifact. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. There is mucosal thickening and fluid involving the bilateral maxillary sinuses and fluid in the sphenoid and ethmoid sinuses. There is also fluid in the bilateral mastoid air cells. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI C-Spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. There is no evidence of STIR signal abnormality within the cervical spine bone marrow or ligaments. The cervical spinal cord has normal signal characteristics and overall morphology. There is no significant compromise to the spinal canal or neural foramina.

Output: MRI Brain:1.Restricted diffusion within the bilateral basal ganglia, compatible with hypoxic ischemia. 2.Relative preservation of the cortical parenchyma without significant general edema.3.Mild signal changes within the right frontal lobe, consistent with prior instrumentation.MRI C-Spine:No cord signal abnormalities or imaging evidence of trauma involving the cervical spine osseous or ligamentous structures.


Instruction: Generate impression based on findings.

Input: 72-year-old female with soft palate cancer. CT of the soft tissues of the neck:Images through the skull base and including cavernous sinuses are unremarkable. Mastoid air cells and paranasal sinuses are within normal limits. A mass with possible small area of necrosis is noted along the posterior lateral aspect of the soft palate on the left. The mass measures approximately 26.5 mm in AP axis and 14.6-mm in transverse axis measured on axial image 33. On coronal reformatted image 33 the tumor measures 28.6-mm in cranial cephalad axis and 16-mm in transverse axis. There is no definitive evidence of a pathologic lymph node in the neck. Increased vascularity immediately posterior to the mass in the left is noted (axial image 37 and 39).The vasculature of the neck is unremarkable. No evidence of osseous or cartilaginous erosion. Limited images of the apices of the lungs and mediastinum are negative however please review the dictated report of CT of chest which visualizes both these regions would better advantage. Extensive degenerative changes of the cervical spine is noted.CT of brain with infusion:Examination demonstrates a mass in the right anterior cranial fossa which is believed to be extra-axial in location the mass measures 18-mm in AP axis and 26.6-mm in transverse axis. The mass abuts the inner table of the skull a days the right frontal bone. There is a small amount of vasogenic edema surrounding the mass. There is uniform enhancement of the mass. The finding is believed to represent a meningioma the possibility of metastatic disease is considered significantly less likely however it cannot be entirely ruled out. Follow-up with an MRI is recommended. Minimal findings of a small vessel disease is noted. No evidence of any additional area of abnormal enhancement is detected. Calvarium is intact.50 CC of Omnipaque 350 was utilized for a bulbous studies.

Output: 1.Left-sided soft palate tumor with no associated pathologic adenopathy as detailed.2.Left frontal meningioma with associated area of vasogenic edema in the right anterior cranial fossa. Follow-up with an MRI is recommended.3.Minimal small vessel disease.


Instruction: Generate impression based on findings.

Input: HCV Cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with hypertrophy left hepatic lobe. No focal lesion, or vascular abnormality.The patient is status post cholecystectomy. The common duct measures up to 10 mm and tapers smoothly at the ampulla, similar to prior. This is not unexpected in a postcholecystectomy state and given the patient's age. No filling defect or discrete lesion.SPLEEN: The spleen is normal in size measuring 9.1 cm in craniocaudal dimension without a focal lesion.PANCREAS: No significant abnormality noted. Probable punctate pancreatic head side-branch IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Partial duplication of the right and left renal collecting systems.RETROPERITONEUM, LYMPH NODES: Prominent porta hepatis lymph nodes are again seen likely related to hepatitis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology without focal lesion.


Instruction: Generate impression based on findings.

Input: 19-year-old male with newly diagnosed germinoma presenting with headaches, nausea, and vomiting. Evaluate for hydrocephalus. Postoperative changes status post right frontal craniotomy are again evident, with interval decrease in pneumocephalus and extra-axial fluid. No acute intracranial hemorrhage is evident. Again seen is diffuse decreased attenuation in the subcortical and periventricular white matter in the frontal lobes bilaterally which appear grossly unchanged. Hyperdense masses are again seen in the suprasellar and pineal regions, correlating with lesions seen on recent MRI. The suprasellar mass appears more prominent compared to the prior exam, which may be in part due to slice thickness and partial volume averaging. Hypodensity in the right periependymal region adjacent to the frontal horn of the right lateral ventricle is again seen, causing mass effect upon the ventricle at this level. The ventricles remain midline, with interval increase in volume of the lateral ventricles. The third and fourth ventricles demonstrate normal morphology and volume.Postoperative changes status post right frontal craniotomy, with the remaining calvaria stable in appearance. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Interval increased volume of the lateral ventricles.2. Increased prominence of suprasellar mass, which may in part be due to slice thickness and partial volume averaging. Stable appearance of pineal mass. 3. Postoperative changes status post right frontal craniotomy, with no acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: A 72 year old male with LV systolic dysfunction while on doxorubicin for diffuse large B cell lymphoma, referred to cardiac MRI to re-evaluate the LV function. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 123 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 47 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). There is global hypokinesis regional variation. There is interventricular septal wall motion abnormality which may be conductional in origin.There is stable, focal, mid-myocardial, non-transmural late gadolinium enhancement which involves the basal inferior wall. This finding is atypical for prior myocardial infarction. This is in the region of wall motion abnormality and may be secondary to prior inflammation or chemotoxicity. Similar findings were noted in the previous cardiac MRI of 12/26/2013. There is no suggestion of cardiac amyloidosis. No thrombus was noted.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 51%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 120 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 59 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA port catheter occupies the left anterior chest wall with the catheter ending at the superior cavoatrial junction.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 45%. There is global hypokinesis with regional variation. There is interventricular septal wall motion abnormality which may be conductional in origin. 2. There is stable, focal, mid-myocardial, non-transmural late gadolinium enhancement which involves the basal inferior wall. This finding is atypical for prior myocardial infarction. This is in the region of wall motion abnormality and may be secondary to prior inflammation or chemotoxicity. Similar findings were noted in the previous cardiac MRI of 12/26/2013. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: staging exam History: high grade prostate cancer recently diagnosed PELVIS:PROSTATE:Prostate Size: 4.7 x 3.5 x 3.7 cmPeripheral Zone: Scattered low T2 signal throughout the peripheral zone may reflect chronic prostatitis and lowers the sensitivity for prostate MRI.There is a lesion of the left apex measuring 1.1 x 0.7 cm which is dark on T2/ADC and demonstrates early enhancement, suspicious for prostatic adenocarcinoma.There is a large lesion in the right base which is dark on T2/ADC and suspected to represent a BPH nodule. Another small lesion in midline mid gland (704/464) is also dark on T2/ADC without early enhancement, indeterminate.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspicious lesion in the left apex and indeterminate lesion in the central mid gland. No evidence of extracapsular extension.2.No pelvic lymphadenopathy.3.Low T2 signal throughout the peripheral zone may reflect chronic prostatitis and limits the sensitivity of prostate MRI.


Instruction: Generate impression based on findings.

Input: History of poorly differentiated adenocarcinoma presumed from the lung, with symptomatic spinal cord compression near the T1, T2, and T3 levels due to pathological fracture and cord compression. There are postoperative findings related to upper thoracic laminectomy. There is a pathological fracture of the T1 vertebral body with near complete loss of height and retropulsion of bone and tumor posterior into the spinal canal measuring 7 mm in width, which results in spinal cord compression and edema. There is also approximately 9 mm of anterior subluxation of the cervical vertebral column. The rest of the thoracic spinal column alignment is intact. There is a bulky soft tissue tumor arising from the left T1 posterior elements that projects into the paraspinal soft tissues, where there is extensive edema. There is obliteration of the bilateral T1-2 neural foramina. There is also a mass situated alongside the right T11-12 level measures up to approximately 4 cm mainly projects into the paraspinal soft tissues, where there is extensive edema, but may also have slight extension into the adjacent neural foramen. There is a focus of T2 hyperintensity in the right posterior elements of the T2 vertebra. The previously demonstrated pulmonary nodules are better depicted on the prior chest CT.

Output: 1. Pathological fracture of the T1 vertebral body with near complete loss of height and retropulsion of bone and tumor posterior into the spinal canal resulting in spinal cord compression and edema, as well as approximately 9 mm of anterior subluxation of the cervical vertebral column. Bulky soft tissue tumor arising from the left T1 posterior elements otherwise projects into the paraspinal soft tissues. 2. A metastasis situated alongside the right T11-12 level measures up to approximately 4 cm mainly projects into the paraspinal soft tissues, but may also have slight extension into the adjacent neural foramen.3. A focus of T2 hyperintensity in the right posterior elements of the T2 vertebra may represent an additional site of metastatic disease. Discussed with Dr. Ramos at 10 AM on 2/21/16.


Instruction: Generate impression based on findings.

Input: Directed second look ultrasound of the right breast in patient with newly diagnosed right breast ILC at the 10 o'clock position. Staging MRI demonstrated two satellite lesions anterior to the index mass as well as a mildly atypical appearing subpectoral lymph node in the right axilla and an indeterminate focus of enhancement in the central aspect of the right breast. A targeted ultrasound of the right breast and right axilla was performed for the areas identified on the MRI. A 2.9-cm along right axillary lymph node is noted in the central inferior right axilla. The margins are slightly lobulated. The cortex measures 3 mm in thickness. There is hilar flow. This does not have morphologic features that are suspicious enough change the standard surgical approach to staging the axilla. The suspicious subpectoral lymph node seen on MRI could not be identified. The index mass is again identified at the 10 o'clock position approximate 7 cm from the nipple. Immediately adjacent to the lateral edge of the mass is a 4 x 2 mm hypoechoic nodule. This is either a focal protrusion from the index mass or an adjacent satellite. This is labeled number one.A satellite lesion is identified approximately the 5 mm anterior to the index mass corresponding to one of the two satellite lesions seen on MRI. This is labeled number two. This measures approximately 8 x 3 x 3 mm. There is apical blood flow on color Doppler imaging.A second satellite lesion measuring 8 x 3 x 8 mm and demonstrating apical blood flow is identified just anterior to lesion labeled number two. This is labeled number 3. The two satellite lesions together measure approximately 2 cm and therefore the more anterior lesion is approximately two half centimeters away from the index mass.No sonographic correlate was identified in the expected location of the additional MRI detected focus in the central medial right breast.

Output: 1. The two satellite lesions anterior to the mass that were suspected on MRI are seen on ultrasound. Measurements as documented above. A third satellite or focal projection was identified immediately adjacent to the lateral edge of the mass.2. The indeterminate subpectoral lymph node in the right axilla could not be identified. There were no lymph nodes with sonographic features that would alter the standard surgical approach to staging the axilla.3. No sonographic correlate corresponding to the additional central medial enhancing focus could be identified. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 31-year-old female status post brain biopsy. There is no evidence of intracranial hemorrhage, mass or edema. Redemonstrated is a heterogeneous mass which is centered about the right medial temporal lobe. The lesion exerts mass effect on the right cerebral peduncle, unchanged. The majority of the mass demonstrates hypoattenuation with occasional calcification, similar in appearance to the previous CT examination dated 4/11/2012. Centrally within the mass is a single punctate focus of hypointensity which most likely represents a focus of air.Associated expected postoperative changes include a right frontal burr hole with overlying surgical sutures a small focus of pneumocephalus is adjacent to the burr hole tract, also within the anterior right frontal subdural space.No abnormal extra-axial collections are identified. No midline shift. No additional basal cistern effacement.The ventricles are normal in size and configuration.The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable appearance of the right medial temporal lobe lesion with pneumocephalus and right frontal burr hole compatible with postbiopsy change. No definitive evidence of hemorrhage.


Instruction: Generate impression based on findings.

Input: 53 years Male (DOB:8/21/1962)Reason: lower back pain with radiation into R leg; B/L hip pain with radiation into anterior thigh; ? of radiculopathy History: see abovePROVIDER/ATTENDING NAME: TAO XIE TAO XIE 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 are 5 nonrib-bearing vertebrae present. The lowest nonrib-bearing vertebrae is a transitional vertebra which is labeled L5 for the purpose of this exam. The left renal vein is identified at the T12-L1 level.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is bilateral facet hypertrophy present associated with disc desiccation and mild loss of disc space height. The facet hypertrophy is worse on the right when compared to the left side There is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge and mild facet and ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is some disc desiccation and mild loss of disc space height at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Please note that there is a transitional vertebra present. For the purpose of this exam it is labeled as L5.2.There are degenerative changes present in the lumbar spine which are worse at L4-5. The degeneration at this level is mainly in the form of facet disease which is worse on the right side versus the left. There is no compromise to lumbar spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with multiple sclerosis and bowel incontinence. Assess for new MS lesion. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal signal abnormality or pathologic enhancement is detected. No epidural abnormalities are seen.The intervertebral discs are preserved. No significant disc bulging or herniation is seen. The spinal canal and neural foramina are patent.

Output: No evidence of demyelinating disease or any other specific thoracic spine abnormality.


Instruction: Generate impression based on findings.

Input: Pt with gait/balance issues; ? Possible parkinsonism, PSP The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several punctate subcortical white matter lesions present which are right on T2 and FLAIR MRI and not associated with diffusion restriction or contrast enhancement nor susceptibility effect.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 mild mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No abnormal mass lesions are appreciated intracranially that would explain the patient's symptoms.2.There are several subcortical white matter punctate-sized lesions which are probably of little clinical significance and not unusual in this age group


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: eval stroke History: R face/arm/leg weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. There is small retention cyst on the right maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: H/o lung cancer. Evaluate for brain metastasis. The previously described left occipital cortical nodule (image# 18-19 of series# 3151) is considered occipital gyrus. The current infused exam shows a 4-mm nodule left adjacent to the posterior sagittal sinus in the left occipital lobe, which corresponds to the lesion identified on the initial MRI dated 12/4/08. The surrounding edema/encephalomalacia is seen. No additional lesion is identified. The small vessel ischemic disease and right parietal encephalomalacia are again identified. No intracranial hemorrhage, mass effect, midline shift or abnormal extraaxial fluid collection is identified. The ventricles are normal in volume. The calvarium is intact.

Output: Essentially stable head CT with a left occipital metastatic lesion. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 54 year old presenting for evaluation of atypical chest pain MEDICATIONS: no cardiac medications First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 27 g/m2, and the LV mass is 53 g. There are no regional wall motion abnormalities present. 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 68%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 136 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 43 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 68%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Leg numbness/tingling. Difficulty voiding after injury. Rule out cauda equina syndrome. Evaluate for disc bulge. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is also within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the upper L2 level. There is mild fibrofatty infiltration of the distal filum terminale measuring up to 2 mm at the S2 level.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disc desiccation and disc bulge eccentric to the right as well as a disc extrusion measuring approximately 8 x 11 x 10 mm which effaces the right lateral recess. There is also mild stenosis involving the right lateral aspect of the central spinal canal, which is otherwise patent.. There is suspected impingement of the right S1 nerve root. There is also contact of the right S2 nerve root. There is also mild to moderate bilateral, right greater than left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Right L5-S1 disc extrusion with associated impingement of the right S1 nerve root in the lateral recess. There is also contact of the right S2 nerve root. There is also mild to moderate bilateral, right greater than left, L5-S1 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 79 years Male (DOB:1/26/1937)Reason: r/o Infarct History: DysphagiaPROVIDER/ATTENDING NAME: MICAH T PROCHASKA MICAH T PROCHASKA Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The exam is degraded due to motion artifact. Overall the patient's spinal cord appear small and atrophicAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this levelAt 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. There is a small central disc protrusion present at this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a left paramedian disc protrusion present at this level without significant compromiseAt 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.MRI of the brainNo diffusion weighted abnormalities are appreciated. Exam is degraded due to motion artifact.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No 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. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The left middle meningeal artery is fairly prominent and larger compared to the right middle meningeal artery.Findings suggest a 1.5 mm right middle cerebral artery bifurcation aneurysm which is directed superiorly.There is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right posterior communicating artery is medium-sized whereas the left posterior communicating artery is very small. The anterior communicating artery is small The left vertebral artery is slightly larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.The patient's spinal cord is small and atrophic.2.The left middle meningeal artery is large. There is a nonspecific finding but could relate to vascular lesion which supplies or represent a variant of normal. Please correlate with patient's clinical symptoms3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.The exams are degraded by motion artifact which will obscure more subtle abnormalities.5.There is no evidence for acute ischemic cerebral infarction


Instruction: Generate impression based on findings.

Input: Female, 15 years old, history of hemoglobin sickle cell disease, new stroke on CT, evaluate for pathology. Diffusion weighted images are unremarkable. No evidence of parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or abnormal extra-axial fluid is detected. Brain morphology and volume are within normal limits. Ventricles are normal in size and morphology. Bone marrow signal characteristics of the calvarium are homogeneously reduced which is a common finding in HgbSS disease.MRA imaging of the head is slightly degraded by motion artifact but diagnostic information is nevertheless obtained. Robust flow related signal is seen throughout the anterior and posterior circulation. No evidence of significant vascular stenosis or occlusion is seen. Mild vascular prominence along the right P1 segment is felt to be due to vascular tortuosity and/or the presence of vascular infundibula. The appearance of this segment is unchanged.

Output: 1. No evidence of acute ischemia.2. No evidence of parenchymal edema or other significant parenchymal signal abnormality.3. Stable appearance of the intracranial MRA with no evidence to suggest high-grade vascular stenosis or occlusion.


Instruction: Generate impression based on findings.

Input: A 64 year old male with history of chronic lymphoid leukemia, now admitted due to syncope and found ventricular tachycardia on the electrocardiogram. During the current hospitalization the patient was catheterized and a stent was implanted in the left anterior coronary artery in a borderline lesion. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 98 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 96 ml (normal range 47+/-19), the LV mass index is 47 g/m2 (normal range 85+/-15), and the LV mass is 90 g (normal range 164+/-36). There mild hypokinesis of the basal infero- lateral and lateral walls, and of the apical anterior and inferior walls. Severe hypokinesis is demonstrated by the apical lateral wall. There is abnormal epicardial enhancement of the apical one-half of the lateral wall. The basal lateral and infero- lateral walls demonstrate patchy enhancement in a predominantly mid-myocardial distribution, sparing the subendocardium and atypical for infarct. No septal enhancement is noted. The differential diagnosis includes myocarditis, which may be active in the presence of wall motion abnormality. In the setting of prior chemotherapy exposure, myocardial chemotoxicity should also be considered. This was discussed with the clinical service in the ICU.No intracardiac thrombus.Left AtriumThe left atrium is upper limits normal size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 153 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17). No aneurysm or fatty infiltration in the myocardium. Right AtriumThe right atrium is upper limits of normal size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mitral regurgitation, not quantified, with thickening of the free margin of the anterior leaflet.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation, not quantified.AortaThere is a left sided aortic arch. The aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a focal T2 hyperintense abnormality in a lower thoracic vertebral body, right of midline, that is incompletely characterized. Further evaluation with dedicated spin echo imaging of the spine may be performed to better characterize.

Output: 1. The left ventricle is normal in size with mild systolic dysfunction, the LVEF is 49%. Wall motion abnormalities are noted in regions of enhancement, involving the lateral and inferolateral walls. The appearance is atypical of infarct, with considerations including myocarditis and myocardial chemotoxicity. 2. The right ventricle is normal in size with normal systolic function, the RVEF is 52%. No aneurysm or fatty infiltration in the myocardium. There are no MRI findings to suggest arrhythmogenic right ventricle cardiomyopathy. 3. There is a focal T2 hyperintense abnormality in a lower thoracic vertebral body, right of midline, that is incompletely characterized. Further evaluation with dedicated spin echo imaging of the spine may be performed to better characterize.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right 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, 15 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: 43 seconds.

Output: Successful fluoroscopically guided injection of intra-articular gadolinium for right MRI hip arthrogram.


Instruction: Generate impression based on findings.

Input: Status post trauma, no neurologic activity. Normal gray-white matter differentiation. There are no changes to suggest diffuse axonal injury however MRI would be more sensitive in detecting changes of DAI. No coup or contra-coup lesion demonstrated.There is no evidence of acute intracranial hemorrhage, mass, midline shift or edema. No intra or extra-axial collection. There is a 5 mm thick left scalp hematoma overlying the left parietal-temporal region.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. No fracture or diastases demonstrated.Mucosal thickening is seen in maxillary antrum with a fluid level on the right and in the sphenoid sinuses. Nonspecific soft tissue opacification seen in the right ethmoid cells. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: *Normal unenhanced brain CT.*No acute intracranial abnormality. However MRI would be more sensitive in detecting changes of DAI.