Instruction: Generate impression based on findings.

Input: Previous MRI with possible left sided arteriovenous malformation: seizures. MRI: There is a subcentimeter curvilinear area of T2 hyperintensity, enhancement, and susceptibility effect in the posterior limb of left internal capsule. Otherwise, there is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions, arteriovenous malformations, or aneurysm.

Output: 1. A lesion in the posterior left internal capsule likely represents a small developmental venous anomaly.2. No evidence of arteriovenous malformation, within the limits of MRA.


Instruction: Generate impression based on findings.

Input: 49-year-old man with history of pain and joint line tenderness. MENISCI: The lateral meniscus appears normal. There is complex/"parrot beak" tear of the posterior horn of the medial meniscus with both horizontal and vertical components extending to both femoral and tibial articular surfaces (series 601, images 20-22) with blunting of the meniscus near its root (series 801, image 19).ARTICULAR CARTILAGE AND BONE: There is focal articular cartilage fissuring over the lateral patellar facet (axial series, image 25) with a small amount of subchondral reactive bone marrow change. No additional significant osseous abnormality is noted.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. The popliteus muscle and tendon are intact.EXTENSOR MECHANISM: The patella and extensor mechanism are intact.ADDITIONAL

Output: 1.Complex tear of the posterior horn of the medial meniscus.2.Focal chondral fissuring with underlying reactive marrow change involving the lateral facet of the patella.3.Moderate joint effusion and subcutaneous soft tissue edema.


Instruction: Generate impression based on findings.

Input: 14 years Female (DOB:12/2/2001)Reason: Please evaluate for abnormal abnormality and abnormal structure History: Headache, Post ConcussionPROVIDER/ATTENDING NAME: CAROL J. MACMILLAN CAROL J. MACMILLAN The CSF spaces are appropriate for the patient's stated age with no midline shift. There is artifact limiting from the patient's teeth which obscures visualization of the orbits distorts visualization inferior aspects of the frontal lobes and anterior aspects of the temporal lobes most routine imaging. There is substantial distortion of diffusion-weighted imaging and the susceptibility weightedNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Examination is degraded due to metal artifact which can obscure some abnormalities especially at the inferior aspects of the frontal lobes and anterior aspects of the temporal lobes. To the extent of visualization there is no abnormal mass lesion appreciated intracranially.


Instruction: Generate impression based on findings.

Input: Toxoplasmosis, unspecified [B58.9], Reason for Study: ^Reason: r/o PRES History: somnolence Brain MRIThere are multiple nodular enhancing lesions seen on bilateral cerebellar hemisphere, right mesial temporal lobe and left occipital lobe. Some appear to be either new or not as conspicuous as today on prior scan but others are unchanged since prior scan. The clinical significance of those new or more conspicuous lesions may need clinical correlation.Patchy and confluent T2/FLAIR high signal intensity lesions on periventricular white mater are again seen, unchanged since prior scan. There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Opacifications on paranasal sinuses and bilateral mastoid are seen, unchanged since prior scan.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation especially MIP reconstruction images show multifocal luminal irregularities on bilateral MCAs, however, those findings are more likely related to motion artifacts or TOF technique related issues. Source images of TOF review show no evidence of significant luminal narrowing. There is no convincing evidence of luminal irregularities either especially on intracranial arterial system.There is no evidence of intracranial arterial aneurysm.

Output: 1. Nodular enhancing lesions seen on right mesial temporal lobe, left occipital lobe and bilateral cerebellar hemisphere. Some lesions are new or more conspicuous than prior and other enhancing lesions are unchanged since prior scan. Clinical correlation is recommended about the disease progression.2. Unchanged confluent/patchy T2/FLAIR high signal intensity lesions on periventricular white mater since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.4. No evidence of intracranial arterial luminal narrowing or irregularity. If clinically indicated regarding intracranial arterial abnormality. CTA can be considered for more precise anatomical evaluation.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82] / Unspecified abnormalities of gait and mobility [R26.9], Reason for Study: ^Reason: r/o infection, structural lesion History: altered mental status, headaches No evidence of acute ischemic or hemorrhagic lesion.Patchy scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and pons are nonspecific, these are likely small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Nonspecific small vessel ischemic disease as described above.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (7/20/16), ultrasound images of both breasts (7/20/16), breast MRI (8/2/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (7/20/16):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). Architectural distortions are present at upper outer quadrant in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF BOTH BREASTS (7/20/16):In the left breast at 12:30 position, there is a spiculated hypoechoic mass measuring 16 x 13 mm. This mass corresponds to the architectural distortions on the mammogram. Hypo-/anechoic mass likely cysts are detected at 12:00, 3:00, and 6:00 position in the left breast. No abnormal findings are detected in the right breast or right axilla, except for a cyst in the right retroareolar region.Per outside report, the pathology of the left breast mass is malignant.BREAST MRI (8/2/16):Breast MRI was performed with a protocol outlined in the outside report. An enhancing mass is present at 12:30 position in the left breast, measuring 16 x 21 x 14 mm (AP x LR x CC) in the left breast, corresponding to sonographic and mammographic abnormality. A few small cysts are seen in the left breast.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Unifocal malignant mass in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Cleary is a 52-year-old female with known multicentric invasive lobular carcinoma in the right breast and recent MRI demonstrating mass/nonmass enhancement in the left breast, presenting for further diagnostic workup of the left breast. An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No specific correlate to the enhancing foci on the MRI is identified. LEFT BREAST ULTRASOUND

Output: Segmentally distributed band of complex and clustered cysts in the left breast, corresponding to the non-mass enhancement identified on recent MRI. Ultrasound-guided biopsy with clip placement of two sites, including an anterior and posterior site, can be performed if clinically warranted. Results and recommendations were discussed with the patient as well as Dr. Bao. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Bacteremia [R78.81], Reason for Study: ^Reason: AMS Significant motion artifacts degraded exam quality.T2 high signal intensity lesions within the left sigmoid sinus and jugular bulb suggest unchanged persistent thrombosis without evidence of venous congestive encephalopathy.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no definitive mass, mass effect, edema, midline shift, intra or extra-axial fluid collection.There is no evidence of acute ischemic lesion.The midline structures and cranial-cervical junction are normal. There is right maxillary sinus retention cyst.Bilateral mastoid air cells are opacified, unchanged.

Output: Limited exam.No evidence of acute ischemic stroke.Persistent left sigmoid and jugular bulb thrombosis is suggested.Ventricular system appears to be normal.Comment: If clinically indicated, considering prior MR scan was also poor quality due to patient's motion artifacts, post enhanced scan with either deep sedation or general anesthesia should be considered for more precise MR evaluation.


Instruction: Generate impression based on findings.

Input: history of meningioma with prior resection. Follow up imaging. No evidence of acute ischemic or hemorrhagic lesion on this scan.Redemonstration of prior midline parieto-occipital craniotomy with minimal gliotic changes of right parietal lobe superior lobule. No change of minimal thickening and enhancement along the posterior falx especially on the right side does not show any significant difference comparing to prior examination. The flow void of the adjacent superior sagittal sinus seems to be preserved.No significant fluid collections. No new foci of signal abnormality are seen. Mild periatrial FLAIR high signal intensities as well as a linear focus of the left frontal lobe are unchanged and nonspecific. There is no new enhancing lesions. The ventricles are stable and normal in size.Fluid collections on the left maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.3. Post operative changes, no unusual finding. No evidence of recurrence of tumor.


Instruction: Generate impression based on findings.

Input: Diagnosis: Kidney transplant status End stage renal disease Other symptoms and signs involving the musculoskeletal systemDiagnosis Edits: ||Clinical question: Leg weakness, neuro consult recommendations. No contrast as is s/p kidney transplantSigns and Symptoms: as above Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation present. There appears to be hypertrophy of the ligamentum flavum extending from C1 down to the C4-5 disc space level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a diffuse disc bulge present associated with hypertrophy of the ligamentum flavum. There is flattening of the spinal cord associated with T2 signal hyperintensity within the spinal cord at this level. Overall there is severe spinal stenosis at this level.At C4-5 there is a diffuse disc bulge present associated with some ligamentous hypertrophy. There is effacement of spinal fluid ventral and posterior the spinal cord and mild flattening of the spinal cord. Overall there is moderate spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Exam is compromised by patient motion.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. Exam is compromised by patient motion.

Output: 1.There are degenerative changes present in the cervical spine with severe spinal stenosis at C3-4 and moderate spinal stenosis at C4-5. There is associated cord signal change at C3-4 and flattening the spinal cord.2.Exam is compromised by patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Abdominal painEXAMINATION: MR Abdomen/MRCP without and with IV contrast date ABDOMEN:LIVER, BILIARY TRACT: The hepatic ducts, cystic duct, and common bile duct are normal in course and caliber.PANCREAS: The pancreatic duct is not visualized on this exam.Significant interval decrease in size of the retroperitoneal fluid collection, consistent with a pancreatic pseudocyst, status post drainage. Cystogastric communication device in place along the posterior wall of the stomach adjacent to the fluid collection. Patency of the device cannot be assessed on this exam. The main residual collection now measures approximately 3.8 x 2.4 x 3.5 cm (series 401, image 16; series 301, image 17). An additional small component of fluid collection lying lateral to the left kidney measures approximately 3.5 x 1.5 cm (series 501, image 24), and appears to communicate with the previously described collection.The pancreatic tail is not well visualized, but the remainder of the pancreas enhances normally.SPLEEN: Decreased local mass effect on the splenic vessels. The splenic vein is now patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant mass-effect by the residual collection on the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant decrease in size of a pancreatic pseudocyst status post drainage device placement. Patency of the drain cannot be assessed on this exam.2.The pancreatic duct is not visualized on this exam.3.Decreased mass effect on the splenic vasculature. The splenic vein is now patent.


Instruction: Generate impression based on findings.

Input: 67-year-old male with C6 spinal ependymoma, status post resection and radiation therapy. Weakness and paresthesias. Evaluate for progression. Again seen are postsurgical changes in the cervical spine from C4 to C6 related to myelotomy and resection of intramedullary lesion extending from the upper C5 to the C6-C7 levels. There is decrease in T2 hyperintensity compatible with evolution of surgical resection cavity. Hemosiderin staining involving the cord and volume loss is again seen. Areas of T1 hyperintensity and mild ill-defined enhancement again seen. No new or enlarging mass to suggest tumor progression are appreciated. Previously seen extradural fluid collection along the surgical tract has resolved.Degenerative changes are again seen including a central disc protrusion which indents the ventral cord at the C3-C4 level which appears similar to prior. There is moderate spinal canal and moderate bilateral neural foraminal stenosis at this level. There is also moderate spinal canal stenosis at C4-C5 related to small disc protrusion and ligamentum flavum thickening as well as moderate left and mild to moderate right neural foraminal stenosis at this level. These findings are unchanged. Mild C5-C6 disc bulge is also unchanged.

Output: 1. Compared to 4/20/2015, there has been evolution of postsurgical changes of resection of hemorrhagic intramedullary mass with interval decrease in size of resection cavity and resolution of previously seen extradural fluid collection. No findings to suggest tumor progression.2. Unchanged degenerative changes including disc protrusion at the C3-C4 level with mild cord flattening. No associated cord signal abnormality. There is also moderate bilateral neural foraminal stenosis at this level.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with new increased nerve root pain. Extensive disc degeneration is evident at the L5-S1 level with loss of disc height and T2 signal as well as fatty degenerative endplate marrow signal. The L5-S1 disc is bulging and there is a superimposed central and left paracentral extrusion which extends superiorly to the mid point of the L5 vertebral body. This extrusion minimally contacts the transiting left S1 nerve root. A mild generalized spinal canal narrowing is evident along with a mild left foraminal narrowing.Mild to moderate facet arthropathy is demonstrated at L4-5 and L5-S1. No other significant degenerative disease is seen. The spinal canal and neural foramina are are otherwise preserved.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No worrisome marrow replacement is seen.

Output: A disc extrusion is evident at L5-S1 migrating superiorly in the left paracentral zone along the L5 vertebral body. This extrusion mildly contacts the transiting left S1 nerve root and otherwise causes a mild generalized spinal canal narrowing.Facet arthropathy is evident at L4-5 and L5-S1. Otherwise, no significant degenerative disease is seen.


Instruction: Generate impression based on findings.

Input: Female, 84 years old, with altered mental status. Assess for leptomeningeal disease and brain metastases. Please note that this examination consists of primarily pre- and post contrast T1-weighted images as complete pre-contrast imaging was obtained for the brain and C spine recently, and due to patient request to terminate the exam early.Brain:A 2 mm focus of enhancement is seen within the right middle frontal gyrus which previously measured 3 mm. A very ill-defined 2-mm focus of enhancement within the left basal ganglia is also decreased size and conspicuity.Other small enhancing lesions noted on prior examinations are either undetectable or significantly reduced in conspicuity on the present study.No new enhancing lesions are detected. No mass-effect or parenchyma edema is suspected. No evidence of pathologic leptomeningeal or cranial nerve enhancement is seen.C-spine:Postcontrast images are significantly degraded by motion artifact. Within this limitation, no obvious spinal cord or leptomeningeal enhancement is seen. Bone marrow signal characteristics remain heterogeneous on T1-weighted images but without obvious pathologic enhancement. Multilevel cervical spondylosis is better assessed on prior imaging.T-spine:Postcontrast images are degraded by motion artifact as well as susceptibility in the upper thoracic region on the sagittal sequence. No obvious spinal cord or leptomeningeal enhancement is seen.The thoracic kyphosis is exaggerated. Vertebral body marrow signal characteristics are heterogeneous. No aggressive or worrisome areas of pathologic marrow enhancement are seen. Scattered small foci of enhancement within the upper thoracic vertebral bodies and within T8 are nonspecific. Mild scattered degenerative disk disease is seen without significant spinal canal or neuroforaminal stenosis.A right hilar mass is evident along with scattered additional areas of lung parenchymal nodularity and a small right pleural effusion.L-spine:Based on the number of rib bearing vertebral bodies, there appear to be 6 lumbar type vertebral bodies.The visualized spinal cord, conus and cauda equina are free of pathologic enhancement. No intraspinal masses are identified.T2 hyperintensity involving the marrow adjacent to the L5-6 (labeled L4-5 previously) endplates is again seen, particularly affecting the left aspect of L5 and the left L5 pedicle. Corresponding pathologic enhancement is also seen. The extent of this process is stable or at most mildly progressed relative to the prior examination from 1/1/15. As before, no evidence of pathologic epidural soft tissue or enhancement is seen. Mild inflammatory signal and enhancement is seen along the facets of the lower lumbar spine similar to prior. Mild enhancement seen along the L4 inferior endplate previously has resolved.Spondylosis is redemonstrated with disk bulging at every level. Disk degeneration is particularly severe at L5-6 where there is complete loss of disk height. Also noted is marked facet hypertrophy at lower lumbar levels. No significant interval change in the degenerative findings is seen in comparison with the prior examination.Resulting spinal canal stenosis at L4-5, and to a lesser degree at L5-6, does not appear to have significantly changed. Likewise marked foraminal narrowing at L3-4 on the right, L4-5 bilaterally, and L5-S1 on the left is also unchanged.Multiple renal cystic lesions are identified.

Output: 1.Interval resolution or reduction in size of several previously seen enhancing brain parenchymal lesions. No new lesions are detected, and there is no evidence to suggest intracranial leptomeningeal disease.2.Within the limitations of a significantly degraded examination, no clear evidence of leptomeningeal disease is seen in the spine, though image quality is not adequate to detect subtle abnormalities.3.Marked marrow signal abnormality and enhancement affecting the L5 and to a lesser degree L6 vertebral bodies (previously labeled as L4-5) is stable to most mildly progressed. Given the lack of any epidural or paraspinal soft tissue mass, the significant disk degeneration at this level, and the lack of convincing interval progression, findings are favored to represent reactive inflammation secondary to degeneration. Other etiologies including infection and metastatic disease, although not eliminated, are probably less likely.


Instruction: Generate impression based on findings.

Input: Thigh pain and tightness Right: We see no abnormal edema or enhancement within the muscles or fascia of the thigh to suggest myositis or fasciitis. The bone marrow signal is normal and there is no evidence of muscle atrophy. There is moderate osteoarthritis of the hip with enhancement suggesting mild synovitis. Osteoarthritis also affects the knee with enhancement suggesting mild synovitis.Left: We see no abnormal edema or enhancement within the muscles or fascia of the thigh to suggest myositis or fasciitis. The bone marrow signal is normal and there is no evidence of muscle atrophy. There is moderate osteoarthritis of the hip with enhancement suggesting mild synovitis. Osteoarthritis also affects the knee with enhancement suggesting mild synovitis.

Output: Osteoarthritis of the hips and knees. There are no soft tissue abnormalities to suggest myositis or fasciitis.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis with angiomyolipomas. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Right liver lobe multiseptated cystic lesion is unchanged, measuring 3.6 x 2.5 cm. Punctate additional hyperintense foci, likely cysts. No evidence of intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Partially duplicated right collecting system. No evidence of hydroureteronephrosis.Postsurgical changes from partial left nephrectomy.The right renal interpolar exophytic enhancing lesion measures approximately 2.5 x 1.9 cm (series 12/49), compared to 2.4 x 2.7 cm previously.The more inferior lesion measures approximately 1.1 by x 0.7 cm (series 12/6/1963), compared to 1.1 x 0.8 cm previously. These lesions do not have significant macroscopic fat content.Additional punctate foci are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Exophytic right renal enhancing lesions are unchanged in size. Given the history of tuberous sclerosis and pathology of partial nephrectomy these lesions likely represent lipid poor angiomyolipomas.2.Postsurgical changes from partial left nephrectomy.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB:2/7/1948)Reason: rule out myelopathy History: spasticPROVIDER/ATTENDING NAME: RAYMOND ROOS RAYMOND ROOS Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small endplate osteophytes present this level. There is loss of disc space height and disc desiccation as well as Schmorl's nodes at this level. There are bilateral uncovertebral osteophytes at this level. There is mild narrowing of neural foramina bilaterally at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation and diffuse disc bulge at this level. There are bilateral uncovertebral osteophytes at this level. There is mild narrowing of neural foramina bilaterally at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation and a disc bulge at this level. There is associated mild narrowing of the neural foramina. There are bilateral uncovertebral osteophytes at this level. There is mild narrowing of neural foramina bilaterally 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.MRI thoracic spine:There is a compression fracture present at T11 with approximately 30% loss of vertebral body height and minimal retropulsion. The vertebral body at this level has high signal on T1 and mildly elevated signal on T2 STIR. There is no significant compromise to the spinal canal associated with this compression fracture.The thoracic vertebral bodies are appropriate in the overall alignment. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.There is a compression fracture at the T11 vertebral body level without significant compromise spinal canal or neural foramina. In general it has a benign appearance. It appears to be in the subacute or early chronic phase.2.There are some mild degenerative changes present in the cervical spine without significant compromise to the spinal canal or neural foramina. There is mild narrowing of neural foramina the lower cervical spine.


Instruction: Generate impression based on findings.

Input: There are a few small foci of T2 hyperintensity in the periventricular white matter, subcortical white matter of the frontal lobes and right external capsule, which are non-specific. The pituitary gland is borderline small in size. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Small foci of T2 hyperintensity in the cerebral white matter are non-specific, but may represent chronic small vessel ischemic disease versus a demyelinating process. 2. The pituitary gland is borderline small in size, which can be due to atrophy or pseudotumor cerebri, for example.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 16 years old. MR arthrogram. History of dislocation x2. Evaluate HAGL and labrum. ROTATOR CUFF: The rotator cuff appears intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a tear of the superior labrum extending from the posterior to anterior labrum likely representing a SLAP lesion. In addition, there is deformity of the posterolateral aspect of the humeral head compatible with a Hill-Sachs deformity. Along the anterior inferior glenoid, the labrum appears detached which mostly represents an osseous Bankart lesion. Mild bone marrow edema is present in the humeral head. BICEPS TENDON: The biceps tendon appears intact. ADDITIONAL

Output: 1. Findings most likely representing an osseous Bankart lesion. This can be confirmed with a CT if clinically warranted. 2. SLAP lesion.3. No evidence of a rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 74 year old female. Urothelial cancer. Evaluate for progression. 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: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Postsurgical findings of cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy.BONES, SOFT TISSUES: Fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 51-year-old woman, evaluate for progression of meningioma and cervical or lumbar cord or nerve root compression. BRAIN: This examination is mildly limited by patient motion. A right parietal extra-axial mass is stable from the exam in 2011 and there is no significant surrounding mass effect or edema. There is no signal abnormality on the diffusion-weighted images to suggest infarct. Susceptibility weighted images are normal without evidence of hemorrhage. There are a few small, scattered areas of subcortical white matter hyperintensity on FLAIR images suggestive of small vessel ischemic disease. The ventricles and cisterns are normal in size and configuration. There is a partially empty sella. The orbits are unremarkable. Flow voids of the major intracranial vasculature appear normal.CERVICAL SPINE: This examination is mildly limited by patient motion. There is narrowing of the inferior endplate of T7 and superior endplate of T1 in the AP dimension. Additionally, there is posterior scalloping deformity from C7 to T1. The intervertebral disc space is preserved, but these findings are highly suggestive of congenital fusion. There is degenerative disc disease at C6/C7 with a new shallow protrusion, just to the left of midline. There is mild effacement of the subarachnoid space anterior to the cord with mild flattening of the cervical cord, left greater than right, otherwise the cord signal remains normal. There is minimal neural foraminal stenosis at C6/C7. There is loss of normal cervical lordosis. Vertebral body heights are preserved. The bone marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils and visualized portion of the posterior fossa are unremarkable. The visualized paraspinal structures are normal.LUMBAR SPINE: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is slight exaggeration of the normal lumbar lordosis. The bone marrow signal is benign. The conus medullaris is normal in position. The paraspinal soft tissues are within normal limits.degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is ligamentum flavum hypertrophy and facet disease with a mild facet joint effusion on the left. No spinal canal or neural foraminal stenosis.L4-L5: There is ligamentum flavum hypertrophy and facet disease with mild facet joint effusions bilaterally. No spinal canal or neural foraminal stenosis.L5-S1: There is disc desiccation with very mild disc bulge. There is ligamentum flavum hypertrophy and facet disease with a mild facet joint effusion on the right. The neural foramina are mildly narrowed bilaterally. There is no spinal canal stenosis. There is a probable cyst posteroinferior to the right articular facet which is not in the spinal canal but this is only included on the sagittal images.

Output: 1.Stable small right parietal meningioma.2.Findings highly suggestive of congenital C7/T1 fusion with new mild disc bulge at C6/C7 causing mild effacement of the spinal canal. No abnormality in cord signal.3.Multilevel lumbar facet joint arthropathy with mild narrowing of the neural foramina at L5/S1, otherwise no significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 51-year-old female with left knee swelling and pain. Evaluate for meniscal tear. MENISCI: There is diffuse attenuation of the medial meniscus likely reflecting extensive chronic attritional tearing. There are linear foci of intermediate signal intensity within the anterior and posterior horns which extend to the tibial articular surface, representing additional tears. An ossicle replaces much of the posterior horn of the medial meniscus near its root. The root of the posterior horn of the lateral meniscus is ill-defined and likely reflects chronic tearing. There is intermediate signal intensity within the body of the lateral meniscus, which extends to the free edge, likely representing fraying. There is extensive intermediate signal intensity within the anterior horn of the lateral meniscus consistent with intrasubstance degeneration and degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage of the weightbearing portion of the lateral femoral condyle with associated degenerative subchondral signal abnormality. There is also thinning of the articular cartilage of the lateral tibial plateau posteriorly. There is near full-thickness degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle and to a lesser degree the medial tibial plateau. There is moderate degeneration of the articular cartilage of the patellofemoral compartment with findings suggestive of focal delamination of the articular cartilage along the medial facet of the patella. There are large tricompartmental osteophytes, which have progressed since the prior examination.LIGAMENTS: The ACL is not visualized suggesting chronic rupture. The PCL appears intact. The collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Moderate to severe tricompartmental osteoarthritis which has progressed slightly when compared to the prior examination as well as degeneration and degenerative tearing of both menisci as described above.2. Nonvisualization of the ACL indicating a chronic tear.


Instruction: Generate impression based on findings.

Input: 99 year old male with history of fall striking head; rule out bleed. Low attenuation lesions identified in the left posterior parietal region and right posterior parietal region with surrounding edema; given recent MRI, these likely represent metastases with surrounding edema. The appearance is unchanged from previous.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Unchanged appearance of brain metastases without acute bleed.


Instruction: Generate impression based on findings.

Input: Female, 2 years old, with microcephaly, hypoxic brain injury in infancy, hemiparesis, history of seizures. Encephalomalacia is redemonstrated within the right cerebral hemisphere in a largely watershed distribution similar to that seen on the prior examination. The degree of encephalomalacia has, however, progressed. Much less extensive encephalomalacia is seen within the left cerebral hemisphere, mainly along the precentral gyrus and within the subjacent deeper white matter, also somewhat more prominent when compared to the prior examination.Additional more focal areas of tissue loss and/or signal abnormality are seen in the bilateral basal ganglia, similar to prior, as well as within the cerebellar hemispheres, also similar to prior. Vague signal abnormality within the bilateral thalami is new when compared to the prior examination.No evidence of restricted diffusion is seen to suggest acute ischemia. No parenchymal edema or mass effect is observed. A punctate focus of susceptibility is seen along the left caudothalamic groove compatible with microhemorrhage. No significant intracranial hemorrhage or any abnormal extra axial fluid collection is seen.On postcontrast imaging, no pathologic parenchymal or extra-axial enhancement is detected.

Output: 1.Sequelae of extensive prior ischemic injury are demonstrated, most conspicuously within the right cerebral hemisphere where the pattern is largely in a watershed distribution.2.Conspicuity of chronic appearing ischemic injury has increased within the cerebral hemispheres and at the level of the thalami, which could represent evolution of old lesions or interval accumulation of additional lesions. Lesions within the cerebellum appear grossly unchanged from prior.3.No evidence of acute ischemia is detected on this examination, nor of any other definite acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Reason: eval for RTC tear History: very limited ROM about shoulder after acute injury- fall. ROTATOR CUFF: The tendons and muscles of the rotator cuff appear normal for age.SUPRASPINATUS OUTLET: Minimal osteoarthritis affects the AC joint. We see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. There is a small amount of fluid within the joint, but no frank effusion. Given the limitation of a non-arthrogram study, the glenoid labrum appears intact. There is minimal degeneration of the articular cartilage of the glenohumeral joint.BICEPS TENDON: Given the limitations of a non-arthrogram study, the tendon of the long head of the biceps appears normal. ADDITIONAL

Output: 1. Normal appearing rotator cuff.2. Mild edema within the posterior soft tissues may represent a contusion or sequela of recent injection.3. Mild osteoarthritis of the AC joint.


Instruction: Generate impression based on findings.

Input: 27 years Female (DOB:12/25/1988)Reason: r/o structural lesion History: seizuresPROVIDER/ATTENDING NAME: SANDRA LYNN ROSE SANDRA LYNN ROSE The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No intracranial mass lesion is appreciated which can explain the patient's seizure.


Instruction: Generate impression based on findings.

Input: 20-year-old female with knee pain, evaluate for ACL rupture or meniscal tear. MENISCI: Linear T2 abnormality extending to the articular surface involving the anterior horn of the lateral meniscus. Posterior horn of the lateral meniscus is within normal limits.Abnormal intrameniscal signal in the posterior horn of the medial meniscus may represent mucoid degeneration.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the patellar articular cartilage. There is focal thickening of the articular cartilage overlying the lateral femoral condyle.LIGAMENTS: Anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The lateral collateral ligament complex is intact. The medial collateral ligament is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex tear of the anterior horn of the lateral meniscus.2.Focal thinning of the articular cartilage of the lateral femoral condyle. Generalized thinning of the articular cartilage over the patella.3.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 34 year old female. History of BRCA with liver mets. Increasing bilirubin. ABDOMEN:LIVER, BILIARY TRACT: The left and right intrahepatic ducts are diffusely dilated with transition in the hepatic hilum at Klatskin's point, where there is an enhancing ill-defined intermediate T2 signal lesion likely representing metastatic disease. Tumor invades the common hepatic duct from Klatskin's point to the mid-CBD, with resultant obstructive dilatation of the cystic duct remnant (series 601, image 19). Innumerable bilobar hepatic metastases, including a 3.4 x 3.1 cm right hepatic lobe lesion (series 401, image 27). Cholecystectomy clips.Hepatic artery and main portal vein as well as right and left branches are patent. The distal portal vein branches are attenuated by the metastases but patent.SPLEEN: Multiple T2 hypointense, mildly enhancing splenic lesions measuring up to 1.2 x 0.8 cm (series 1204, image 49), suspicious for metastases.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic foci in the thoracolumbar spine consistent with metastatic disease. At T12-L1 level, there is a left sided 9 mm intradural lesion that is suspicious for a metastasis (series 1203, image 333). OTHER: Small amount of perihepatic ascites.

Output: 1. Diffuse intrahepatic biliary ductal dilatation due to obstructing metastatic disease at Klatskin's point. Tumor also invades the common duct from Klatskin's point down to the mid-CBD.2. Innumerable hepatic and multiple bone metastases. Likely splenic metastases.3. Intradural lesion at T12-L1 suspicious for a metastasis.


Instruction: Generate impression based on findings.

Input: Ms. Kasprzak is a 35-year-old female with personal history of left breast lumpectomy in July 2012 for DCIS and microinvasion treated with radiation and tamoxifen therapy. Personal history of benign right breast biopsy in 2012 for intraductal papilloma. Family history of breast cancer in maternal grandmother (diagnosed at the age of 37) and maternal aunt (diagnosed at the age of 42). There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the left upper breast. Mildly enhancing focus anterior to the biopsy clip in the right inferior breast is stable, compatible with prior history of benign breast biopsy. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. Surgical scarring in the left axilla is stable.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 50-year-old female with right breast cancer in need MRI for further evaluation There is scattered fibroglandular tissuein both breasts.Moderate nodular parenchymal enhancement is noted bilaterally with multiple enhancing foci none of which are uniquely enhancing.In the right breast 12:00 position there is an oval-shaped mass with irregular margins measuring 18 x 21 x 18 mm ( AP X ML X CC) demonstrating heterogeneous enhancement and a clip artifact within it corresponding to biopsy proven cancer.No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Unifocal cancer measuring 18 x 21 x 18 mm in the right breast 12:00 position.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Cardiac arrest [427.5], Reason for Study: ^Reason: extent of brain injury after MI History: cardiac arrest There are restricted diffusion lesions on bilateral basal ganglia, thalami, caudate nucleus, midbrain and bilateral hippocampal gyri. Especially on bilateral basal ganglia lesions, there are scattered susceptibility artifact on gradient-echo technique indicating possible petechial hemorrhagic conversion. Above described findings are compatible with diffuse anoxic injury of the brain.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection. 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: Multifocal restricted diffusion areas with scattered susceptibility artifacts especially on bilateral basal ganglia, consistent with diffuse anoxic injury of the brain with a possible petechial hemorrhagic conversion on bilateral basal ganglia lesions as described above.


Instruction: Generate impression based on findings.

Input: Dizziness and ataxia There is no evidence of intracranial hemorrhage, mass or edema.There is a questionable area of hypodensity in the subcortical white matter of the left frontal lobe. A while this may be artifactual, MRI of the brain is recommended to evaluate for possible white matter abnormality. The ventricles and basal cisterns are normal in size and configuration.The calvarium and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Questionable area of hypodensity in the left corona radiata region of the left frontal lobe. While this may be artifactual, MRI is recommended to fully evaluate.


Instruction: Generate impression based on findings.

Input: 31-year-old female with pelvic pain. Question of small bowel inflammation. 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: Subcentimeter T2 hyperintense lesion in the left kidney is too small to accurately characterize but likely a simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal simple-appearing cyst measuring up to 5.1 cm (series 14/28).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites, likely physiologic.

Output: 1.No bowel wall thickening or enhancement.2.Left adnexal simple-appearing cyst measuring up to 5.1 cm, for which follow-up pelvic ultrasound in 3 months is recommended to ensure resolution.


Instruction: Generate impression based on findings.

Input: 40 years, Male, surveillance, day 56 of trial. Grade III anaplastic oligodendroglioma. Again seen are postsurgical changes of right frontal lobe tumor resection with interval increase in thick enhancement along the posterior aspect of the resection cavity compared to 11/2/2015. For example in the sagittal postcontrast images, the thickness of this area of enhancement measures 27 mm in the AP dimension, previously 20 mm. There is also corresponding increase in intermediate T2/FLAIR hyperintensity which on perfusion images demonstrates elevated cerebral blood volume. There is also mild increase in T2/FLAIR hyperintensity in the right frontal lobe extending inferiorly into the basal ganglia and right temporal stem. There is mild increase in mass effect with increased effacement of the right lateral ventricle midline shift from approximately 6 mm to 9 mm. CSF filled resection cavity in the right frontal lobe is again seen as well as a thin extra-axial collection beneath the craniotomy. Again seen are foci of intraparenchymal hemorrhage along the medial aspect of the resection cavity slightly increased since 11/2/2015. No uncal herniation. No hydrocephalus. Major flow-voids are preserved.

Output: 1. Postoperative changes of right frontal lobe tumor resection are again seen. Compared to MRI from 11/2/2015, there is interval increase in thick irregular enhancement along the posterior aspect of the resection cavity with corresponding increase in intermediate T2/FLAIR hyperintensity. Increased cerebral blood volumes are also demonstrated within this region. Although some of these findings may be treatment related, overall findings are suspicious for tumor progression and recommend continued close follow. 2. Compared to 11/2/2015, there is mildly increased vasogenic edema and mass effect including slightly increased midline shift from 6 mm to 9 mm.


Instruction: Generate impression based on findings.

Input: 26 years Female (DOB:2/23/1990)Reason: eval structural lesion History: head traumaPROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small. There is an infundibulum at the origin of the right posterior communicating artery. The left vertebral artery is larger than the right vertebral artery. There is an infundibulum at the origin of the right superior cerebellar artery.

Output: There is no evidence for traumatic brain injury or intracranial cerebrovascular traumatic injury.


Instruction: Generate impression based on findings.

Input: Ms. Bauer is a 54-year-old female with personal history of bilateral mastectomies with retropectoral silicone implant reconstruction. She has a personal history of LCIS and positive family history of breast cancer in her mother, diagnosed at the age of 46. The patient is status post bilateral mastectomies with retropectoral implants. The implants are intact bilaterally. No residual enhancing glandular tissue is appreciated.No abnormal enhancement is seen in either reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female 37 years old Reason: evaluate for osteonecrosis History: hip pain Femoral heads are well formed and seated within well formed acetabula. No acute fracture, dislocation or avascular necrosis of the femoral heads are noted. No joint effusion. The tendinous insertions of the hamstring and gluteal musculature are intact.The joint spaces are normal.The sacroiliac joints, pubic symphysis and lower lumbar spine are unremarkable.No pelvic ascites.On the postcontrast imaging, no abnormal enhancement is noted.There is symmetric marrow changes involving the femoral diaphysis without a sclerotic margin on the T1 weighted image. Findings more more likely due to fatty marrow changes rather than medullary infarcts.

Output: No MR evidence of avascular necrosis of the femoral heads.


Instruction: Generate impression based on findings.

Input: History of renal cell carcinoma status post partial nephrectomy ABDOMEN:LIVER, BILIARY TRACT: 5 mm T2 hyperintense focus in the inferior right hepatic lobe is nonspecific but likely benign. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Probable small right adrenal adenoma.KIDNEYS, URETERS: Postsurgical changes in the lateral aspect of the right kidney. Probable hemorrhagic cyst in the left kidney. Bilateral simple renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Postsurgical changes without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: 19-year-old female with right Achilles pain. Evaluate for right Achilles tendon partial rupture. TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. ADDITIONAL

Output: No evidence of Achilles tendon injury, as clinically questioned.


Instruction: Generate impression based on findings.

Input: 60 year-old female. Right upper quadrant pain, transaminitis in patient status post liver wedge resection for pancreatic cancer. Evaluate for biliary obstruction, liver morphology. ABDOMEN:LIVER, BILIARY TRACT: Post-surgical findings of left hepatic lobe wedge resection. 2.7 x 2.2 cm lesion in the residual left hepatic lobe that is intrinsically T1 hyperintense without appreciable enhancement on post-contrast sequences, most likely a hematoma.Mild central intrahepatic and markedly diffuse extrahepatic biliary ductal dilatation measuring up to 2.6 cm with transition point at the pancreatic head mass.Subcentimeter left hepatic lobe cyst. Post-surgical findings of cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Heterogeneously enhancing pancreatic head mass is 5.9 x 4.6 cm (undermeasured on prior CT). Pancreatic duct upstream to this mass is dilated at 5 mm. The mass is again seen to abut the GDA and 180 degrees of the SMV, which is attenuated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged portacaval lymph nodes, similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes in the spine. Post surgical changes in the anterior abdominal wall.OTHER: Small amount of pelvic ascites.

Output: 1.Intrahepatic and marked extrahepatic ductal dilatation is due to the obstructing pancreatic head mass consistent with known pancreatic carcinoma.2.Previously noted fluid collection in the superior margin of the left hepatic lobe on prior CT is likely a small hematoma.


Instruction: Generate impression based on findings.

Input: 50 year-old female with pain, evaluate for patella chondromalacia MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The medial facet of the trochlea and trochlear groove appear flattened, consistent with dysplasia. Heterogeneity of the cartilage along the medial and lateral undersurface patella indicating partial thickness degeneration. There is a small associated focal full thickness cartilage defect along the posteromedial tibial plateau with underlying cyst formation. Addiontal increased T2 signal is present in the lateral tibial plateau and intercondylar notch. LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The patella tendon and quadriceps tendon are intact.ADDITIONAL

Output: 1. Findings consistent with trochlear dysplasia partial-thickness patellofemoral chondromalacia.2. Small, focal full-thickness articular cartilage defect in the posteromedial tibial plateau with underlying cyst formation.3. Intact cruciate and collateral ligaments.


Instruction: Generate impression based on findings.

Input: Clinical question: Altered mental status. Signs and symptoms: Known PNET with edema. Unenhanced CT of brain:On axial image 15 there is a soft tissue density mass at the level of the cranial gland which is a new finding since prior study. This mass measures 15.5-mm x 14.5-mm. In comparison with prior examination there is further expansion of brain parenchymal through the left temporal rhinectomy site. The underlying brain parenchymal demonstrate lower density which may indicate further encephalomalacia. There is also further increase in the size of the left temporal horn secondary to ex vacuo cavitation. Diffuse low attenuation consistent with edema in the left frontal lobe with extension into the corpus callosum however is a new finding since prior exam. This results in mass effect and slight deviation of midline in the anterior frontal region. There is also extensive low-attenuation in the pattern of vasogenic edema in the right hemisphere which is also new since prior exam. There is further dilatation of the lateral ventricles. The combination of above findings results in slight effacement of cortical sulci on the right side.Above-described findings could be secondary to obstructive hydrocephalus due to presence of a new mass at the level of pineal gland. Further evaluation with an MRI is recommended.Images through posterior fossa are stable and unremarkable.

Output: 1.New mass measuring 15.5-mm x 14.5-mm and the pine needle region.2.Interval increase in the size of the supratentorial ventricular system which is concerning for obstructive hydrocephalus. Extensive edema of brain parenchyma which may represent trans- ependymal exudate of CSF. Further evaluation with an enhanced MRI is recommended to evaluate for other possible causes for extensive bilateral white matter edema.


Instruction: Generate impression based on findings.

Input: Left neck tail of parotid lesion. There is a heterogenous, but rather well-defined mass in the tail of the right parotid gland that measures up to 33 mm. There is an additional nodule more superiorly within the left parotid gland that measures up to 15 mm. The right parotid gland and bilateral submandibular glands are unremarkable. The imaged portions of the upper aerodigestive tract are unremarkable. There is no evidence of significant upper cervical lymphadenopathy. The imaged portions of the orbits and intracranial structures are unremarkable. There is fluid within the bilateral mastoid air cells, right more than left.

Output: A mass in the tail of the right parotid gland that measures up to 33 mm and an additional nodule more superiorly within the left parotid gland that measures up to 15 mm are compatible with Warthin tumors.


Instruction: Generate impression based on findings.

Input: 78 year-old female with new radicular pain and back pain. The vertebral body heights are preserved. There is approximately 4 mm anterolisthesis of L4 on L5. Alignment is otherwise maintained. Bone marrow signal is within normal limits. No abnormal enhancement is identified. Multilevel degenerative disc disease with findings as described below.T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: Minimal disc bulge. No significant spinal canal or neural foraminal stenosis.L2-L3: Moderate disc bulge asymmetric to the right. Mild facet hypertrophy. Moderate hypertrophy of the ligamentum flavum. Minimal left and moderate right neural foraminal stenosis. Moderate spinal canal stenosis.L3-L4: Postsurgical changes from left L3 laminectomy. Mild disc bulge. No significant spinal canal or neural foraminal stenosis.L4-L5: Post surgical changes from left L4 laminectomy. Diffuse disc bulge. Moderate facet arthropathy. Minimal right and moderate left neural foraminal stenosis. Minimal spinal canal stenosis.L5-S1: Trace disc bulge. No significant spinal canal or neural foraminal stenosis.

Output: 1. Postoperative changes from left L3 and L4 laminectomies.2. Multilevel spondylitic changes with moderate left L4-5 and right L2-3 neural foraminal stenosis.3. 4 mm anterolisthesis of L4 and L5.


Instruction: Generate impression based on findings.

Input: History of brain metastasis. Interval evolution of postsurgical changes is seen related to left parietal craniectomy for resection of metastatic calvarial lesion. Cranioplasty with titanium mesh again noted. There is small focus of T1 hyperintensity and enhancement at the inferomedial margin of the craniectomy defect which was present on prior from 4/6/2015 and nonspecific. No residual tumor within this location is definitively appreciated. Brain parenchyma demonstrates no evidence of infarct, hemorrhage, mass, or abnormal enhancement to suggest intraparenchymal metastatic disease. Ventricles are within normal limits without evidence of hydrocephalus. Major flow-voids are preserved. Unchanged punctate focus of enhancement in the left frontal calvarium, coronal post gadolinium series 1102 image 26.

Output: 1. Evolution of postsurgical changes of left parietal craniectomy and cranioplasty without evidence of tumor progression/recurrence at this site. Unchanged punctate foci of enhancement adjacent to the inferior medial margin of the craniectomy defect which is nonspecific. Unchanged punctate focus of enhancement in the left frontal calvarium which may represent an additional metastatic osseous lesion. 2. No intraparenchymal metastatic lesion is appreciated. No evidence of intracranial mass effect.


Instruction: Generate impression based on findings.

Input: History of giant left hepatic lobe hemangioma. ABDOMEN:LIVER, BILIARY TRACT: Mildly prominent liver measuring up to 19.6 cm in the craniocaudal dimension likely in part due to a normal variant Reidel lobe. The left lobe extends into the left upper quadrant.There are numerous bilobar liver lesions.The largest is a complex left hepatic lobe partially exophytic mass which is hyperintense on T2-weighted imaging with numerous internal septations, measuring 12.1 x 8.1 cm (series 401/28), unchanged. This lesion demonstrates peripheral nodular discontinuous contrast pooling which progresses centrally on delayed imaging compatible with a giant hemangioma.Multiple additional smaller lesions with similar imaging characteristics are noted in both lobes of the liver.Segment 6 T2-weighted mildly hypointense in T1-weighted hypointense lesion demonstrating homogeneous arterial phase enhancement, lobular contour, and isointensity on delayed imaging, compatible with a focal nodular hyperplasia, unchanged in size measuring 3.4 x 3.0 cm (series 1 102/217).SPLEEN: Previously seen splenic focus may have been perfusional.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen ill-defined heterogeneous enhancement at the level of the right lower rib cage is not evident on today's study.OTHER: No significant abnormality noted.

Output: 1.Stable left hepatic lobe giant hemangioma with additional smaller bilobar hemangiomata.2.Segment VI peripheral lesion with imaging findings consistent with focal nodular hyperplasia, unchanged.


Instruction: Generate impression based on findings.

Input: Limited examination for operative planning demonstrates bilateral transfrontal brain electrode lead placement with tips near the level of the subthalamic nuclei. There is decreased T2 hyperintensity surrounding the leads bilaterally. There is no intracranial mass. There is no midline shift or herniation. The ventricles and basal cisterns are unchanged in size and configuration. There is a small left parietal lobe developmental venous anomaly. There is a mucous retention cyst in the right sphenoid sinus. There are scattered T2 hyperintense foci in the calvarium. The extracranial soft tissues are unremarkable.

Output: 1. Bilateral deep brain electrode leads with tips near the level of the subthalamic nuclei.2. Scattered T2 hyperintense foci in the calvarium, which are incompletely characterized, but may represent hemangiomas.


Instruction: Generate impression based on findings.

Input: Brain lesion, preop planning: left side weakness. There are postoperative findings related to parieto-occipital craniotomy. There are multiple foci of extra-axial tumor along the posterior falx cerebri and tentorial leaflets with associated extensive vasogenic edema in the adjacent brain parenchyma bilaterally superimposed upon right occipital lobe encephalomalacia with ex vacuo dilatation of the right lateral ventricle. Tumor appears to extend into the superior sagittal sinus. Skin-based fiducial markers are present.

Output: Preoperative planning MRI demonstrates multiple foci of recurrent meningioma along the posterior falx cerebri and tentorial leaflets with associated extensive vasogenic edema in the adjacent bilateral cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: Reason: Acute Right knee pain with effusion. Lateral joint line tenderness History: Acute Right knee pain with effusion. Lateral joint line tenderness MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. There is abnormal T2 signal in the lateral tibial plateau and lateral femoral condyle, consistent with bone marrow edema. There is a nondisplaced fracture through the lateral tibial plateau. There is a T2 hyperintense/T1 hypointense lesion in the posterior medial metaphysis of the distal femur extending to the growth plate which may represent a small nonossifying fibroma.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Nondisplaced lateral tibial plateau fracture.Findings communicated to Dr. Benjamin at 11:00 AM on 10/4/16.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with acromegaly, follow-up pituitary microadenoma. A hypoenhancing, T2 hypointense mass is evident within the anterior aspect of the sella measuring 10 mm transverse, 12 mm AP and 12 mm CC. There has been no significant interval change in the size or morphology of this lesion when compared to the prior exam.As before, the lesion extends into the suprasellar cistern and may very slightly contact the optic chiasm. No convincing evidence of cavernous sinus involvement is seen.On limited views of the brain parenchyma, scattered small foci of white matter T2 hyperintensity are redemonstrated appearing grossly similar to the prior exam, a nonspecific finding which may be related to microvascular ischemic disease.

Output: No significant interval change in the size or morphology of a pituitary macroadenoma.


Instruction: Generate impression based on findings.

Input: Altered mental status and stroke. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is periventricular and subcortical T2/FLAIR hyperintensity in a similar distribution to the prior MRI. The ventricles are prominent in proportion to the sulci compatible with parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute infarction, acute intracranial hemorrhage, or mass.2. Periventricular and subcortical white matter chronic small vessel ischemic disease is not significantly changed from the prior MRI.


Instruction: Generate impression based on findings.

Input: 58 years, Female, evaluate GBM. On Avastin. Imaging was mildly degraded by motion. Stable postsurgical changes from right temporoparietal craniotomy with partial right temporal lobe tumor resection. There is minimal associated susceptibility, due to residual blood products. There is persistent nodular enhancement surrounding the right temporal lobe resection cavity. Anterior to the resection cavity, there is increased extent of T1 multinodular enhancement, measuring approximately 31 x 25 mm, previously 12 x 11 mm. There is increased right temporal FLAIR T2 hyperintensity. Perfusion imaging in this region demonstrates increased cerebral blood volume. A focus of restricted diffusion located on the margin of the right lateral ventricle occipital horn, measuring up to 1 cm, is unchanged. There are no new areas of restricted diffusion. No acute intracranial hemorrhage is identified. The ventricles are unchanged in size and configuration, with the lateral ventricles persistently mildly dilated. Major flow-voids are preserved.

Output: Interval increase in nodular enhancement and FLAIR hyperintensity with areas of elevated cerebral blood volumes in the right anterior temporal lobe. Findings are suspicious for tumor progression.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Note is made of anatomic variation of a hypoplastic right vertebral artery which primarily ends in PICA as well as partial persistent right fetal PCA circulation.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries. There is poor visualization of the right vertebral artery throughout its entirety, and the left vertebral artery is large. The proximal 4 cm demonstrates a tiny lumen with a patent origin and uniformity of lumen caliber.There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.

Output: 1.Negative MRI of the brain.2.Negative MRA of the brain.3.There is poor visualization of the right vertebral artery throughout its entirety, and the left vertebral artery is large. The proximal 4 cm demonstrates a tiny lumen with a patent origin and uniformity of lumen caliber. Given the brain MRA demonstrates what appears to be a hypoplastic distal right vertebral artery primarily ending in PICA, overall these findings most likely indicate congenital vertebral artery hypoplasia. However, since the right vertebral lumen is not visualized in its entirety, prior dissection cannot entirely be excluded. If deemed beneficial, a CTA of the neck could be obtained to evaluate for lumenal enhancement as well as the size of the transversarium foramen which can indicate congenital hypoplasia when small.


Instruction: Generate impression based on findings.

Input: History of osmotic demyelination. There is interval decreased prominence of the T2 hyperintense lesions in the bilateral basal ganglia, thalami, and pons, as well as resolution of the associated restricted diffusion related to the prior osmotic demyelination event. There is unchanged mild, diffuse, nonspecific, bilateral periventricular white matter T2 hyperintensity. There has also been mild interval increased prominence of the ventricular system and sulci due to cerebral volume loss. There is faint patchy T1 hyperintensity in the bilateral basal ganglia and cerebral peduncles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval evolution of the pontine and extrapontine myelinolysis with resolution of the associated edema and resultant diffuse cerebral volume loss.2. Faint patchy T1 hyperintensity in the bilateral basal ganglia and cerebral peduncles may be secondary to chronic hepatic encephalopathy.


Instruction: Generate impression based on findings.

Input: Pain. Left hamstring avulsion? There is thickening of and branching increased signal intensity within the proximal semimembranosus tendon. Some fibers of the semimembranosus can be followed to their origin high on the superolateral facet of the ischial tuberosity; however, there is new fluid signal intensity/edema partially separating the tendon from the tuberosity and extending down the free semimembranosus tendon and along the medial aspect of the semitendinosus muscle. Edema continues caudally along the semimembranous muscle belly, although I see no frank edema within the muscle itself. Edema also courses laterally from the tendon to surround the sciatic nerve, but the nerve itself appears normal. Additional interfascial edema is noted between the quadratus femoris and proximal adductor magnus muscle. The adductor magnus tendon can be followed to the ischial tuberosity. The conjoined tendon shows intermediate signal intensity suggesting tendinosis but can be followed to its origin on the inferomedial facet of the ischial tuberosity. The sacrotuberous ligament appears intact. The marrow signal intensity of the ischium is normal. There is thickening of the distal tendon of the rectus femoris due to an old injury. The remaining musculature of the proximal left thigh is unremarkable. The left hip joint appears normal for age.On the large field-of-view images, the right hip joint and right hamstring complex appear normal for age. There is a lipoma between the right gracilis muscle and the remaining adductor musculature.

Output: Imaging findings are compatible with with an atypical or "stretching" type strain injury of the posterior thigh, including partial avulsion of the semimembranosus tendon, as described by Askling et. al. (Am J Sports Med, 2007, volume 35, page 1716).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 35 year old male with a history of non-ischemic cardiomyopathy referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 182 ml/m2 (normal range: 74+/-15), the LVEDV is 351 ml (normal range 142+/-34), the LV end systolic volume index is 148 ml/m2 (normal range 25+/-9), the LVESV is 285 ml (normal range 47+/-19).There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. LV morphology consistent with non-compaction. The pre-contrast native myocardial T1 relaxation time of the mid septum is normal (950 ms). There is no evidence of myocardial iron overload.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 63 ml/m2 (normal range 31+/-9), and the RVESV is 121 ml (normal range 54+/-17). There is non-compaction of the RV.Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (LVEF 19%). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 2. The right ventricle is normal in size with severely reduced systolic function (RVEF 29%).3. There is non-compaction noted of the LV.4. There is non-compaction of the RV.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 51 year old male with tachycardia-induced cardiomyopathy, atrial flutter 2:1, primum ASD s/p repair age 7 years ago, cleft mitral valve, APVR, likely interrupted IVC with azygous continuation. Referred for MRI evaluation of anatomy and function. Left VentricleThe left ventricle is moderately to severely dilated with moderately depressed systolic function. The overall LV ejection fraction is 36%. The LVEDV is 320 ml (normal range 142+/-34), the LV end diastolic volume index is 154 ml/m2 (normal range: 74+/-15), the LVESV is 204 ml (normal range 47+/-19) and the LV end systolic volume index is 98 ml/m2 (normal range 25+/-9). The LV mass is 143 g (normal range 164+/-36) and the LV mass index is 69 g/m2 (normal range 85+/-15). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation times are mildly elevated (1140-1190 ms) in the interventricular septum and the left ventricular lateral wall which are mildly elevated. These values are suggestive of underlying mild diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely dilated. Previous atrial septal defect repair is noted with 2 small residual defects apparent, one at the proximal end of the repair site and the other at the distal end of the repair site.Right VentricleThe right ventricle is severely dilated with severely depressed systolic function. The overall RV ejection fraction is 16%. The RVEDV is 410 ml (normal range 142+/-31), RV end diastolic volume index is 197 ml/m2 (normal range 82+/-16), the RVESV is 344 ml (normal range 54+/-17), and the RV end systolic volume index is 165 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is at least mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely but there appears to be moderate to severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is at least mild-moderate pulmonic regurgitation. There is inadequate data to quantify PR on this study.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsThree pulmonary veins drain normally into the left atrium. The right lower pulmonary vein drains into the left atrium. The right upper pulmonary vein, however drains into a confluence that could be part of a baffle system which then enters the left atrium. Pulmonary ArteryThe main pulmonary artery is dilated (41 mm). The branch pulmonary ateries bifurcate at the same level.Venous AnatomyThe SVC drains normally into the right atrium. The infra-hepatic segment of the IVC is absent. The hepatic veins drain into the right atrium. There is a significantly dilated azygous vein which drains into the SVC. The coronary sinus drains into the left atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are some enlarged paratracheal lymph nodes noted. The bronchial anatomy is consistent with left isomerism (both right and left bronchi are hyparterial). 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 moderately to severely dilated with moderately depressed systolic function. The overall LV ejection fraction is 36%.The native T1 myocardial relaxation times are mildly elevated (1140-1190 ms) in the interventricular septum and the left ventricular lateral wall which are mildly elevated. These values are suggestive of underlying mild diffuse fibrosis or infiltration.2.The right ventricle is severely enlarged with severely depressed systolic function. The overall RV ejection fraction is 16%.3.There is moderate-severe mitral regurgitation4.There is at least mild-moderate pulmonary regurgitation5.There is severe left atrial dilation. 6.Three pulmonary veins drain normally into the left atrium. The right lower pulmonary vein drains into the left atrium. The right upper pulmonary vein, however drains into a confluence that could be part of a baffle system which then enters the left atrium. 7.Previous atrial septal defect repair is noted with 2 small residual defects apparent above and below the repair site.8.The SVC drains normally into the right atrium. The infra-hepatic segment of the IVC is absent. The hepatic veins drain into the right atrium. There is a significantly dilated azygous vein which drains into the SVC. 9.The coronary sinus drains into the left atrium.10.There are some enlarged paratracheal lymph nodes noted. 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: intraparenchymal hemorrhage History: CT findings. Corrected gestational age at birth 34 1/7 weeks, preterm delivery. Vaginal forceps delivery with subsequent drop in hemoglobin and hematocrit. Apgar of 8 and 8. There is a small focus of intraparenchymal hemorrhage involving the left paramedian frontal lobe with associated restricted diffusion and T1 hyperintensity. There is an additional tiny punctate focus in the right frontal lobe with restricted diffusion, subtle T1 hyperintensity and subtle hyperdensity on recent CT and suspected to represent an additional petechial focus of hemorrhage. There is minimal edema associated with the left frontal lobe hemorrhage without mass effect, midline shift, or herniation. There are punctate foci of restricted diffusion within the left periventricular white matter compatible with acute white matter injury.There are bilateral subdural hematomas along the bilateral posterior parieto-occipital and posterior temporal convexities as well as along the cerebellar hemispheres without significant mass effect. Brain parenchyma appears otherwise appropriate for patient's early gestational age. No hydrocephalus. Remainder of the extra cranial soft tissues appear unremarkable.

Output: 1. Small left frontal lobe intraparenchymal hematoma similar to CT allowing for differences in technique. There also appears to be an additional punctate focus in the right frontal lobe. No significant associated mass-effect.2. Small bilateral subdural hematomas without significant mass effect, which may be related to birth related injury.3. Two foci of restricted diffusion in the left parietal white matter compatible with white matter injury of prematurity.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 33-year-old male with effusion, lateral pain and tender to palpation one week after hit by car MENISCI: Intermediate signal within the posterior horn of the medial meniscus may represent intrasubstance degeneration without evidence of discrete tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Edema type signal is noted within the lateral femoral condyle and lateral aspect of the patella. Articular cartilage is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Bone marrow edema within the lateral femoral condyle and the lateral aspect of the patella without evidence of fracture or ligamentous injury. 2.Intrasubstance degeneration within the posterior horn of the medial meniscus without evidence of discrete tear.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: 88-year-old female with shoulder pain, limited motion. ROTATOR CUFF: There is thickening of the supraspinatus tendon with intermediate signal intensity near its insertion at the greater tuberosity indicating tendinosis. There is mild fatty infiltration of the supraspinatus muscle. There is moderate fatty atrophy of the infraspinatus muscle; the infraspinous tendon appears intact and normal. The subscapularis and teres minor tendons and muscles are morphologically normal.SUPRASPINATUS OUTLET: Severe degenerative changes affect the acromioclavicular joint with osteophyte formation and spur formation along the undersurface of the acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritic changes affect the glenohumeral joint with joint space narrowing, osteophyte formation and subchondral cysts. There is a small effusion within the glenohumeral joint. The glenoid labrum appears morphologically normal on this nonarthrogram study. There is a paralabral cyst abutting the spinoglenoid notch and is most likely the cause of the moderate fatty atrophy of the infraspinatus muscle due to mass effect on the suprascapular nerve.BICEPS TENDON: The long head of the biceps tendon appears normal and intact throughout its course with small amount of fluid in the tendon sheath communicating with the fluid in the glenohumeral joint.ADDITIONAL

Output: 1. Tendinosis of supraspinatus tendon. No full-thickness rotator cuff tear.2. There is moderate fatty atrophy of the infraspinatus muscle most likely caused by a paralabral cyst abutting the spinoglenoid notch due to mass effect on the suprascapular nerve.3. Moderate to severe degenerative changes of the acromioclavicular and glenohumeral joints as described above. There is a small effusion within the glenohumeral joint.


Instruction: Generate impression based on findings.

Input: Clinical question: Pontine hemorrhagic stroke. Signs and symptoms: Pontine hemorrhagic stroke. Nonenhanced brain MRI:Examination demonstrates a previously known large acute hemorrhagic stroke of the pons with surrounding edema which mildly extends into the bilateral middle cerebellar peduncles. Findings results in expansion of the pons and with subtle mass effect on the fourth ventricle which remains widely patent. There is also tiny amount of intraventricular spread of hemorrhage visible in the dependent bilateral occipital horns on susceptibility MRI images.Images through supratentorial space demonstrate fairly extensive periventricular and subcortical and to a lesser degree in the right basal ganglia foci of FLAIR and T2 hyperintensity suggestive of extensive chronic small vessel ischemic strokes. This findings are associated with multiple tiny foci of susceptibility signal changes consistent with chronic microhemorrhages. Susceptibility signal changes are also present in bilateral cerebellar hemispheres however without convincing evidence of associated FLAIR hyperintensity.There is mild prominence of supratentorial ventricular system for age and consistent with ex vacuo dilatation secondary to chronic small vessel ischemic strokes. This appearance is similar to prior head CT studies.The CSF cisterns remain widely patent and midline is maintained.There is no evidence of cortical signal abnormality to suggest chronic or acute cortical ischemic strokes.Signal void of major intracranial arterial branches are present. Signal intensity of the intracranial venous sinuses are unremarkable.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.The unenhanced brain MRA:Patent bilateral vertebral arteries which are symmetrical in size. Patent basilar artery and its distal branches.Patent right internal carotid artery, right anterior and middle cerebral arteries. Mild atherosclerotic disease of the distal branches are identified.Patent and unremarkable left internal carotid artery, left anterior and middle cerebral arteries. Mild distal vessel atherosclerotic disease is noted.

Output: 1.Acute hemorrhagic stroke of the pons with resultant mild expansion of the pons and subtle mass effect as detailed.2.Extensive supratentorial chronic small vessel ischemic strokes.3.Numerous foci of susceptibility signal changes in supra and infratentorial tentorial parenchyma within and beyond the regions of chronic small vessel ischemic strokes consistent with chronic microhemorrhages.4.Mild supratentorial ventriculomegaly as result of underlying parenchymal volume loss.5.Nonenhanced brain MRA demonstrate patency of all major arterial branches. Atherosclerotic disease of distal branches are however present.


Instruction: Generate impression based on findings.

Input: 17-year-old with history of germinoma s/p chemotherapy and radiation therapy. Off therapy evaluation Brain: There is no new mass or enhancement in the region of the pineal gland to suggest tumor recurrence. Again seen is susceptibility effect in the pineal region related to chronic blood products and/or mineralization. Again seen are right transfrontal surgical tracts related to prior third ventriculostomy and pineal mass biopsy. The remainder of the brain appears within normal limits. No evidence of parenchymal signal abnormality, edema or mass effect is seen. No pathologic parenchymal or meningeal enhancement is observed. The ventricular system is normal in size and morphology. Multiple small mucous retention cysts are seen in the bilateral maxillary sinuses. Spine: There is no evidence of mass lesions or abnormal enhancement within the spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. No suspicious osseous lesions are seen. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Stable examination with no evidence of recurrent tumor in the pineal region.2. No evidence of leptomeningeal disease in the brain or drop metastases in the spine.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with cranial pharyngioma, receiving radiotherapy, evaluate cystic lesions. Again seen is a primarily cystic, rim-enhancing lesion centered in the suprasellar cistern and third ventricle. Since the prior examination, there has been a slight decrease in size of the inferior aspect of the cystic lesion now measuring approximately 34 mm in the AP dimension, previously 40 mm. More superiorly, the lesion projects through the left foramen of Monro and into the left frontal horn to a similar degree as seen on the prior examination. The left lateral ventricle remains dilated, similar to prior with evidence of transependymal CSF flow. Subfalcine herniation and a midline shift to the right of up to 14 mm are unchanged. Evidence of left frontal approach biopsies again seen.

Output: 1.Slight interval decrease in the size of the inferior aspect of the cystic craniopharyngioma. Elsewhere, the lesion is not significantly changed.2.The lesion continues to obstruct the left foramen of Monro with stable left lateral ventricular dilatation.


Instruction: Generate impression based on findings.

Input: Lung cancer with brain metastases treated with WBRT. Punctate enhancing lesions at the grey-white matter junctions of the posterior left occipital lobe, inferior right parietal lobule, and right superior frontal sulcus are slightly more conspicuous and there is a new punctate T2 hyperintense focus adjacent to the right superior frontal gyrus lesion. There is unchanged patchy gyriform enhancement along the medial right occipital lobes and posterior left occipital lobe. There is unchanged diffuse cerebral white matter T2 hyperintensity, particular in a periventricular distribution. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: Punctate metastatic lesions at the grey-white matter junctions of the posterior left occipital lobe, inferior right parietal lobule, and right superior frontal sulcus are slightly more conspicuous. Otherwise, the patchy gyriform enhancing lesions along the medial right occipital lobes and posterior left occipital lobe appear unchanged.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: History of MS, worsening thoracic pain, Javed MRI protocol, MS activity History: Thoracic pain Brain MRIThere are multifocal various sized white matter FLAIR/T2 high signal intensity lesions consistent with multiple sclerosis. Although the scan parameters are and scanner are different from those of prior scan, there is no significant interval difference of the number, configuration and distribution of these multiple sclerosis lesions since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift. The midline structures and cranial-cervical junction are normal. Cervical SpinePreviously seen C6 spinal cord high signal intensity on T2-weighted images is more conspicuous than prior scan. However the medullary lesion at the level of C2 is not conspicuous on today's scan.Cervical vertebral body alignment is straightened but vertebral height appear to be normal and bone marrow signal intensity is normal.Intervertebral disc is desiccated indicating degenerative changes.Among them, diffuse bulging of disc is seen at the level of C5-6 which abuts thecal sac. Minimal neuroforaminal narrowing on the left side of C45, unchanged since prior scan. However, there is no evidence of significant spinal canal or neural foraminal stenosis.Thoracic Spine MRIMultiple patchy T2/STIR high signal intensity lesions seen at the level of T2, T3, T4, T5, T8 and T10 levels which considering the difference in MR parameters and technique, unchanged since prior scan.

Output: 1. No significant interval changes of multiple intracranial and cervical and thoracic spinal multiple sclerosis lesions since prior scan.2. Unchanged minimal degenerative changes of cervical spine including minimal C45 left neuroforaminal narrowing and disc dessication.