Instruction: Generate impression based on findings.

Input: Chronic hepatitis C. Mass seen on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: Mildly nodular heterogeneous liver morphology suggestive of chronic liver disease.1.2 x 1.1 cm mildly T2 hyperintense lesion in segment 3 (series 8/24) demonstrating restricted diffusion (series 501/26) and mild thin peripheral/rim enhancement. No definite arterial enhancement or intracellular fat.No additional focal lesion. Mild prominence of the common bile duct which tapers smoothly without a focal lesion. Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Mild prominence of the main pancreatic duct which tapers smoothly without a focal lesion. No significant pancreatic parenchymal atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large hiatal hernia or pull-through.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right sided pleural effusion appears loculated.

Output: 1.1.2 cm segment 3 lesion demonstrating restricted diffusion and rim enhancement does not meet AASLD criteria for HCC, however remains suspicious. Biopsy should be considered or liver protocol CT if not amenable to biopsy. 2.Loculated right-sided pleural effusion. Consider dedicated chest CT as clinically indicated.


Instruction: Generate impression based on findings.

Input: Female 74 years old Reason: 74F h/o chronic pancreatitis History: chronic pancreatitis seen on EGD/EUS ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Gallbladder contains a large gallstone. Biliary tree is normal in caliber and course.SPLEEN: No significant abnormality noted.PANCREAS: Heterogeneous appearance of the pancreatic tail and body with loss of the normal pancreatic lobulations. There is a subtle hypoattenuating halo surrounding the pancreas.No discrete lesion is identified. Mild scattered intrapancreatic ductal dilatation. Of note, there is mild persistent tail ductal dilatation with some ductal irregularity. No solid mass is identified.There is normal physiologic response to secretinADRENAL GLANDS: Right adrenal gland nodule that enhances measures 17 x 9 mm previously, 18 x 9 mm.KIDNEYS, URETERS: Status post right nephrectomy. Left kidney enhances homogeneously.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.Improvement in the pancreatic inflammation. The features of the pancreatitis suggests an autoimmune pancreatitis.2.No discrete pancreatic mass is identified.3.Mild scattered intrapancreatic ductal dilatation.4.Normal physiologic response to secretin.5.No change in the right adrenal nodule.


Instruction: Generate impression based on findings.

Input: New left lower back/flank subcutaneous nodule; please evaluate; history of spindle cell (monophasic) synovial sarcoma of left distal forearm. There is no discernible tumor in the soft tissues in the region of the skin markers. There is also no evidence of tumor within the lumbar spine. There is lumbarization of S1. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small eccentric left disc protrusion with mild left lateral recess spinal canal stenosis at L5-S1, but no significant narrowing of the neural foramina. There is no significant spinal canal or neural foramen stenosis of the other lumbar spine levels. The lower spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No discernible tumor in the region of the left lower back skin markers. 2. Small eccentric left disc protrusion with mild left lateral recess spinal canal stenosis at L5-S1.


Instruction: Generate impression based on findings.

Input: Lower extremity cellulitis The examination is significantly limited by the patient's body habitus, by motion artifact, and the inability to complete all sequences.There is diffuse subcutaneous edema and skin thickening of the lower extremity. There is some fluid signal tracking between the muscles of the lower extremity particularly medially with some increased signal is also noted involving the muscles themselves. Within the limits of exam, there is no focal fluid collection identified. There is no evidence of soft tissue gas on MRI.Marrow signal of the tibia and fibula appear normal.

Output: Significantly limited exam demonstrates extensive subcutaneous and muscle edema with fluid signal tracking intermuscularly.


Instruction: Generate impression based on findings.

Input: 30 yo female with loosely clustered calcifications at 3 o'clock position on mammogram in right breast. Family history of breast cancer diagnosed in sister at age 27. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Regional non-mass enhancement in the 3 o'clock position corresponds with the calcifications seen on mammography, extending from the mid to posterior depths, measuring 29 x 20 x 24 mm (AP x TR x CC). No abnormal enhancement in the left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1.Regional non-mass enhancement in the right breast 3 o'clock position, which corresponds with calcifications seen on mammography. This area was biopsied under ultrasound guidance later this same day. Pathology pending.2.No abnormal enhancement in the left breast.3.No abnormal lymph nodes.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 40 year-old female with history of ulnar cancer and rectovaginal fistula presenting with gas from vagina now concerning for rectovaginal fistula. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly dilated proximal small bowel loops with relatively decompressed distal small bowel loops. There is a paraumbilical hernia containing small bowel segments and the hernia may be the cause of this mild partial small bowel obstruction. No evidence of perforation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Endometrial cavity is distended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Infiltrative, soft tissue density around the rectum and in the bilateral ischiorectal fossa. There is a possible communication between the vagina and rectum on the right side. However MRI of the pelvis will be much better for depiction of the fistulous tract.

Output: Possible rectovaginal fistula on the right. MRI of the pelvis may be helpful for better depiction of the fistulous tract. Dilatation of the endometrial cavity. Perirectal inflammatory changes.Possible mild small bowel obstruction. The etiology is unknown but may be related to the periumbilical hernia containing small bowel segments.


Instruction: Generate impression based on findings.

Input: NF1 with malignant NST Within the left rhomboid and trapezium muscles is a well-circumscribed mass measuring approximately 6.5 x 6.4 x 4.3 cm in the greatest craniocaudal, transverse and AP dimensions. The mass is heterogeneously isointense on T1 sequences and hyperintense on T2 sequences and demonstrates heterogeneous enhancement following contrast administration.There is skin irregularity overlying the left shoulder and upper back relating to prior resection and reconstruction. Numerous foci of signal void are identified within the area representing susceptibility artifact from prior surgical intervention. A large amount of increased T2 signal is seen within the soft tissues surrounding the mass which likely reflect a combination of edema and postsurgical change. Following contrast administration, there is diffuse enhancement surrounding the mass which is likely reflective of edema and/or scar tissue from prior intervention.Innumerable enhancing nodules within the soft tissues consistent with known history of neurofibromatosis.

Output: Slight interval increase in size of residual and/or recurrent malignant peripheral nerve sheath tumor.


Instruction: Generate impression based on findings.

Input: Clinical question: Fracture? Signs and symptoms: Altered mental status, fall. Nonenhanced head CT:No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp the findings.Very extensive periventricular and subcortical low attenuation white matter of bilateral cerebral hemispheres is consistent with advanced small vessel ischemic strokes of indeterminate age. A small left high convexity posterior frontal chronic cortical stroke is also present.Extensive cavernous carotid vascular calcification and bilateral intracranial vertebral calcifications are noted. Limited images through the orbits are unremarkable. Paranasal sinuses and mastoid air cells are well pneumatized.CT of the cervical spine:No evidence of fracture or malalignment.Moderate to advanced degenerative disk disease, multi-level with significant bulging disks and ventral disk -- osteophyte complex formation is noted.Multi-level neural foraminal compromise secondary to degenerative changes is present. Multi-level mild central spinal stenosis is suspected.This findings can be more accurately evaluated with a dedicated MRI examination of cervical spine.Unremarkable perispinal soft tissues.

Output: 1.Nonenhanced head CT demonstrates no acute posttraumatic findings. Extensive small vessel ischemic strokes of indeterminate age.2.Nonenhanced cervical CT demonstrates no acute fracture or malalignment. Moderate to advanced degenerative changes of cervical spine with resultant multi-level neural foraminal compromise and suspected central spinal stenosis.


Instruction: Generate impression based on findings.

Input: 31-year-old male with left knee pain. Evaluate for chondromalacia. MENISCI: There is deformity and signal abnormality of the lateral meniscus, particularly involving the body and posterior horn, indicating complex tearing. Only a small remnant of the body of the meniscus remains. The anterior horn is relatively spared. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate to severe degeneration of the articular cartilage of the lateral tibiofemoral compartment, particularly involving the lateral femoral condyle and the lateral tibial plateau adjacent to the torn meniscus, with areas of near full-thickness to full-thickness cartilaginous degeneration. Intra-articular osteophyte formation and foci of degenerative subchondral signal are also seen in this region. There is a full-thickness cleft in the articular cartilage of the medial facet of the femoral trochlea. There is also heterogeneity of the articular cartilage of the median eminence of the patella, which indicates degeneration. There are also small medial and patellofemoral compartment osteophytes. The articular cartilage of the medial compartment appears relatively spared. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Osteoarthritis particularly affecting the lateral tibiofemoral compartment and also the patellofemoral articulation with loose bodies in the joint.2. Extensive tearing of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: There is mild dextrocurvature of the thoracic spine as seen on prior radiographs. Alignment of the thoracic spine is otherwise maintained. Vertebral body heights are normal. Bone marrow signal is benign.Mild degenerative changes are seen including disc desiccation and minimal disc bulges at multiple levels. There is some disc height loss at the T7-T8 level with subtle associated endplate changes. There is mild facet arthropathy in the lower thoracic spine. There is mild left T10-T11 neural foraminal narrowing and to an even lesser degree at the left T11-T12 level. Vacuum phenomena at T11-T12 better seen on same-day CT. There is otherwise no significant spinal canal or neural foraminal stenosis. The spinal cord is of normal caliber and signal. Paraspinous soft tissues are unremarkable. Degenerative changes in the cervical spine are partially imaged on the sagittal counting sequence. No evidence of high-grade cervical spinal canal stenosis.

Output: Mild degenerative changes in the thoracic spine without significant spinal canal stenosis or high grade neural foraminal narrowing at any level. No or cord signal abnormality. Additional details as above.


Instruction: Generate impression based on findings.

Input: 72 year old woman with history of CABG x2, with dyspnea on exertion, referred for evaluation of underlying ischemia.MEDICATIONS: ASA, Toprol XL, Crestor First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), the LVEDV is 171 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 87 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 95 ml/m2 (normal range 69+/-14), the RVEDV is 174 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 80 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are present. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Hereditary ataxia, unspecified [G11.9] / Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: scan ataxia AND acute leg weakness L History: ataxia; mild left leg weakness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There are gyriform susceptibility artifacts following bilateral frontal lobe around the area of frontal sinuses. This could represent artifacts from the frontal sinus air but also can represent prior subarachnoid space blood.There are evidence of encephalomalacia on bilateral frontal gyrus rectus, mesial and lateral orbital gyri (left worse than right) most likely represent prior traumatic contusion.Disproportional diffuse cerebellar volume loss is seen without definitive evidence of pontine volume loss. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate bilateral fetal PCAs with hypoplastic vertebrobasilar system which is a normal variation. There is no evidence of major intracranial arterial occlusion or stenosis.There is no arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Disproportional cerebellar volume loss without associated with pontine volume loss.3. Chronic bifrontal traumatic contusion.4. Hypoplastic vertebrobasilar system with bilateral fetal PCAs. No evidence of intracranial arterial luminal stenosis, occlusion or aneurysm.


Instruction: Generate impression based on findings.

Input: Leukodystrophy and epilepsy. Assess progression of brain involvement. Bilateral subdural effusions over the cerebral convexities have increased in size mildly. They have a maximum thickness of 13 mm on the right and 11 mm on left, compared to 6 mm and 8 mm previously. As before, the fluid is T2 bright, similar to CSF, and T1 hyperintense to CSF. The underlying prominent subarachnoid spaces as well as the ventricles are slightly smaller than previously though remain abnormally enlarged. There is no susceptibility effect in either the subdural or subarachnoid spaces. The confluent, T1-hypointense, T2/FLAIR-hyperintense signal involving the deep and periventricular cerebral white-matter is slightly less prominent. However, this apparent improvement may reflect evolution of the white-matter injury and white matter volume loss rather than an improvement in the disease process. There continues to be signal abnormality in the subinsular white-matter but relative sparing of the subcortical U fibers otherwise. T2-hyperintensity along the corticospinal tracts extending into the posterior aspect of the posterior limb of the internal capsules is unchanged. There is also abnormal T2-hyperintensity in the corpus callosum. Striated T2-hyperintensity in the pons is unchanged. Confluent T2-hyperintensity involving the deep cerebellar white-matter has slightly increased since the previous examination.Brain parenchymal volume loss continues to be symmetric other than being slightly more pronounced in the frontal and temporal lobes. The degree of volume loss has perhaps slightly increased from the prior examination.There is mild, smooth dural contrast enhancement and thickening, likely reactive to the effusions. There is no abnormal intracranial contrast enhancement otherwise. No acute infarct is seen. There is no mass or mass-effect. The major cerebral flow voids are intact. The posterior pituitary bright spot is absent. The orbits, skull, and scalp soft tissues are grossly unremarkable. Fluid signal is present posterior ethmoid and right maxillary sinuses as well as the mastoid air cells. There are also secretions in the posterior aspect of the pharynx along nasogastric and endotracheal tubes.

Output: 1.Since the previous examination of November 2015, there has been evolution of the brain parenchymal (predominantly white-matter) injury. Though the cerebral T2-hyperintense white-matter lesions appear less prominent and less discrete, associated volume loss is suspected to have mildly progressed since the previous examination. At the same time, the cerebellar white-matter T2-hyperintense abnormality has mildly increased. 2.The bilateral cerebral convexity subdural collections have slightly increased in size, which may reflect passive dilatation due to progressive underlying brain volume loss. The lack of susceptibility effect within the collections suggests that they may represent nonhemorrhagic effusions, though chronic subdural hematoma remains in the differential.


Instruction: Generate impression based on findings.

Input: Reason: PSC evaluate for dominant stricture or CCA History: PSC ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver without evidence of a suspicious mass. Unchanged regions of right hepatic lobe fibrosis. Irregular biliary ductal beading and intrahepatic strictures compatible with patient's known history of primary sclerosing cholangitis is again seen. The confluence of the hepatic ducts is diminutive in caliber.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst is again noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in intrahepatic biliary irregular beading compatible with known primary sclerosing cholangitis.2.Cirrhotic hepatic morphology without interval development of new hepatobiliary lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Left-sided week less. Signs and symptoms: Left-sided weakness CT of brain without infusion:Very subtle questionable patchy areas of low attenuation in the cortex of the right insula and right frontal lobe may represent an early acute cortical stroke. There is no definitive mass effect with the above findings. The density of brain parenchyma is otherwise unremarkable. No evidence of hemorrhage is detected. Images through the posterior fossa demonstrate possible small old right cerebellar stroke and otherwise are unremarkable. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.If clinical symptoms persist an MRI is recommended.

Output: Only questionable cortical low-attenuation in the right insular cortex and frontal lobe as detailed.


Instruction: Generate impression based on findings.

Input: Fall a few days ago. Ankle pain. Anterior tibial pain. Evaluate for fracture. Right ankle: There is mild soft tissue swelling, but I see no fracture or malalignment. The Achilles tendon silhouette is indistinct, and while this may simply be due to overlying soft tissue swelling, if there is clinical concern for Achilles tendon rupture, MRI may be considered for further evaluation.Right tibia/fibula: I see no fracture or other specific findings to account for the patient's anterior tibial pain.

Output: Mild soft tissue swelling but no fracture evident. The Achilles tendon silhouette is indistinct, and while this may simply be due to overlying soft tissue swelling, if there is clinical concern for Achilles tendon rupture, MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: Eval shoulder - please include pec major tendon History: pec major - possible partial tear The pectoralis muscles and tendons appear intact. This examination was not protocoled for detailed evaluation of the rotator cuff or the glenohumeral joint, however, there is perhaps a small amount of fluid within the glenohumeral joint without evidence of a large effusion. The imaged musculature of the left shoulder and chest is otherwise unremarkable. No bone marrow signal abnormality is seen.

Output: The pectoralis muscles and tendons appear intact.


Instruction: Generate impression based on findings.

Input: Male 51 years old with GBM, multiple recurrences, now on CCNU+Avastin+TTF Post-surgical changes of a right frontal craniotomy and partial tumor resection with stable overlying dural thickening/enhancement. There is a slight decrease in enhancement associated with the right frontal mass (12/49), although there appears to be an increased rind of enhancing soft tissue thickening along the lateral aspect of the lesion. The mass measures approximately 28 x 38 mm, not significantly changed from prior 27 x 42 mm. A small nodular focus of enhancement posteromedially appears slightly decreased from prior exam. Again seen is intrinsic T1 hyperintensity along the medial aspect of the resection cavity. Post-surgical changes of a right temporo-parietal craniotomy and partial tumor resection with stable overlying dural thickening/enhancement. A right temporal lobe lesion (12/67) measures approximately 20 x 20 mm, decreased in size from prior 28 x 30 mm. The lesion has a thin discontinuous rim of enhancement, markedly deceased from prior exam. The mass demonstrates mild restricted diffusion possible secondary to Avastin effect. Surrounding FLAIR signal abnormality appears improved in between the lesions. The previously described area of tram-trak enhancement in between the lesions also appears improved from prior exam. No new areas of enhancement identified.T2 hyperintensity within the left frontal and parietal lobes without associated enhancement appears similar to prior exam.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. Post-surgical changes of a right frontal and temporo-parietal craniotomy with partial tumor resection. The right frontal and temporal lesions appear overall improved from prior exam compatible with Avastin effect. There is however slight increase in masslike signal abnormality with enhancement along the lateral aspect of the right frontal lesion which is suspicious.2. T2 hyperintensity within the left frontal and parietal lobes suggestive of non-enhancing tumor again seen and appear stable from prior exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 63 year old male with history of coronary artery disease: an angiography on 2007 showed proximal total occlusion of the left anterior descending artery and non significant obstructions in the proximal ramus and right coronary arteries. Recently the patient has been complaining about shortness of breath. Referred to stress cardiac MRI for further evaluation. MEDICATIONS: aspirin, clopidogrel, carvedilol, hydrochlorothiazide, olmesartan, simvastatin, venlafaxine First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark artifact was seen only in the region of the septum with stress and at rest.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 48 ml/m2 (normal range: 74+/-15), the LVEDV is 103 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 46 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 106 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 163 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 82 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%).4. Normal RV size and systolic function (RVEF 50%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Lung adenocarcinoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of T2 hyperintensity in the cerebral and pontine white matter. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small probable hemangioma in the right parietal skull.

Output: 1. No evidence of intracranial metastases.2. Mild scattered foci of T2 hyperintensity in the cerebral and pontine white matter are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Ptosis, INO. There is a nidus of enlarged and tangled blood vessels measuring up to nearly 4 cm within the left occipital lobe supplied by the left posterior cerebral artery and drained by the superior sagittal sinus via a superficial cerebral vein. There is associated mild surrounding susceptibility effect, as well as nonspecific punctate foci of susceptibility effect in the left temporal and right parietal lobe. However, there is no evidence for acute intracranial hemorrhage. There are several foci of T2 hyperintensity in the periventricular and subcortical white matter and a chronic right corona radiata lacunar infarct. There is no evidence of acute cerebral infarction. There is no midline shift or mass effect. There is mild diffuse cerebral volume loss.

Output: 1. Left occipital lobe arteriovenous malformation. Please refer to the recent CTA report for additional details.2. Chronic right corona radiata lacunar infarct and scattered foci of periventricular and subcortical white matter abnormality likely related to chronic small vessel ischemic disease, without evidence for acute ischemia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pituitary tumor follow up. There is no significant interval change in the hypoenhancing pituitary mass, which measures 13 AP x 15 RL x 12 SI mm. The infundibulum is deviated to the right. There is slight protrusion of the tumor into the medial compartment of the left cavernous sinuses. There is no mass effect upon the optic apparatus. The partially imaged intracranial structures appear unchanged. There is advanced degenerative change of the left temporomandibular joint.

Output: No significant interval change in size of the pituitary mass, which likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: 40 year old with history of BRCA1 mutation. Family history of breast cancer in her mother. Breast parenchyma is almost entirely fat in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.High T2 hepatic lesions are again seen, and likely cysts or hemangiomas.

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


Instruction: Generate impression based on findings.

Input: 63 year old with biopsy proven IDC grade 2 with high grade DCIS in right breast presents for staging MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is an enhancing mass measuring 37 x 20 x 21 mm (AP x LR x CC) at 11 o'clock position in the right breast, corresponding to the biopsy proven cancer. Size of this enhancing mass corresponds to that of asymmetry on the mammogram. A marker clip is identified within this mass, at posterior third aspect.No other abnormal enhancement is present in the right breast. LEFT BREAST:There is a suspicious, clumped linear non-mass enhancement, measuring 20 x 3 x 10 mm at 3 o'clock position.AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven carcinoma at 11 o'clock position in the right breast.2. Suspicious, clumped linear non-mass enhancement at 3 o'clock position in the left breast. MRI guided biopsy is recommended.3. No abnormal lymph nodes in either axillary regionBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 36-year-old female. Evaluate for Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes with patent neoterminal ileum seen. Two short segment fibrotic strictures are seen of the distal ileum, compatible with changes of chronic inflammatory bowel disease. No significant bowel wall thickening or enhancement to suggest active inflammatory bowel disease. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings of chronic inflammatory bowel disease with two short segment fibrotic strictures of the distal ileum. No evidence of active inflammatory bowel disease or bowel obstruction.


Instruction: Generate impression based on findings.

Input: 86-year-old female with history of metastatic breast cancer, increasing hip and leg pain ACETABULAR LABRUM: There is degeneration and degenerative tearing of the superior labrum.ARTICULAR CARTILAGE AND BONE: There is marked narrowing of the joint with loss of articular cartilage and extensive subchondral cyst formation and edema within the acetabulum. Note is made of a left total arthroplasty not fully evaluated on this exam.SOFT TISSUES: The muscles and tendons appear grossly intact. ADDITIONAL

Output: Severe osteoarthritis affecting the right hip as described above.


Instruction: Generate impression based on findings.

Input: Recurrent cholangitis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology, with geographic areas of T2 hypointensity and heterogeneous enhancement. The mildly increased periportal signal intensity representing periportal edema versus inflammation is similar to prior studies. Small amount pericholecystic fluid likely due to cirrhosis, without specific features otherwise of cholecystitis.Multifocal intra-and extrahepatic biliary duct strictures are again seen and consistent with primary sclerosing cholangitis. The short segment stenosis just distal to the confluence of the right and left intrahepatic ducts is not significantly changed. The right and left intrahepatic ducts are again poorly visualized proximal to Klatskin's point, similar to prior exam. The common bile duct remains attenuated throughout its course with a short focal stenosis at the ampulla, similar to prior. No definite mass is identified. Overall the appearance is not significant changed compared to prior study. SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific periportal lymphadenopathy, which can be seen in the setting of primary sclerosing cholangitis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Multifocal intra-and extrahepatic biliary duct strictures consistent with primary sclerosing cholangitis, without significant interval change or focal mass evident.2. No acute abnormality identified.


Instruction: Generate impression based on findings.

Input: CN-VII bilateral weakness with complete facial weakness. The cisternal segments of the bilateral facial nerves are grossly intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and scalp soft tissues are grossly unremarkable. The bone marrow is diffusely hypointense on T1 and T2, perhaps due to anemia or renal osteodystrophy. There is a subcentimeter left maxillary sinus retention cyst. There is a mild right mastoid effusion.

Output: The cisternal segments of the bilateral facial nerves are grossly unremarkable, although assessment is limited without intravenous contrast. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: follow up brain metastases History: none. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 5-mm lesion located in the left cerebellar hemisphere which previously had a ringlike appearance and measured 8 x 10 mm axial dimensions. A small lesion in located in the right the superior semi-lunar lobule is not readily identified on the current exam. A left inferior parietal lobule lesion identified on the prior exam as the ringlike lesion measuring 6 mm malice simply a punctate lesion. A right caudate nucleus lesion previously identified is not readily identified on the current exam. A left centrum semiovale lesion is also not readily identified on the current exam. A right frontal lobe lesion along the lateral aspect of the superior frontal gyrus is also not readily identified on the current exam and previously measured 4 mm and was ringlike.There is redemonstration of a encephalomalacia along the right orbital gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility imaging there are punctate foci of signal loss present involving the subcortical junction which were also present on the prior exam. These are smaller and correspond to metastatic foci.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 demonstrate opacification of the left mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Since the previous exam there has been regression in size and the visibility of the brain parenchymal lesions compatible with metastatic disease.2.Encephalomalacia along the right orbital gyrus.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Since the prior exam patient has developed some opacification of left mastoid air cells which is a nonspecific and could to represent either fluid retention or inflammatory change. Please correlate with patient's clinical signs and symptoms.


Instruction: Generate impression based on findings.

Input: 76-year-old male with prostate cancer PELVIS:PROSTATE: Suboptimal examination due to the brachytherapy seeds.Prostate Size: 4.0 x 4.4 x 3.1 cm.Peripheral Zone: Scattered susceptibility artifact of prostate brachytherapy. T2 hypointensity in the right mid gland at the junction of the transitional and peripheral zone measuring 15 x 15 mm abuts the capsule with indistinct margins. Left mid gland 7 mm T2 hypointense lesion of the junction of the peripheral and transitional zone demonstrating early enhancement and early washout. A 4 mm T2 hypointense in the left gland base.Central Gland: Scattered susceptibility artifact of prostate brachytherapy. Moderate degree of benign prostatic hypertrophy.Seminal Vesicles: Asymmetry of the seminal vesiclesExtracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild sigmoid diverticulosis without evidence of diverticulitis.

Output: 1.Multiple T2 hypointense lesions centered in the mid gland at the junction of the transitional zone and peripheral zone as well as the left base as described above.


Instruction: Generate impression based on findings.

Input: Reason: ACL tear History: lateral knee impact with Rugby - + Lachman's, + McMurray's MENISCI: Tear of the root and posterior horn of the lateral meniscus with extrusion of the lateral meniscus. No definite medial meniscal tear.ARTICULAR CARTILAGE AND BONE: T1 dark and T2 dark focus in the lateral femoral condyle likely represents a benign bone island. Bone marrow edema of the posterolateral corner of the tibia and medial femoral condyle, likely contusion. Linear fluid signal in the mid patellar cartilage (series 6 image 13), likely representing partial thickness fissuring of the cartilage. Femorotibial cartilage appears intact. Moderate joint effusion.LIGAMENTS: There is complete tear of the anterior cruciate ligament. Posterior cruciate ligament is intact. Mildly increased signal around the medial collateral ligament, which may represent mild sprain. Lateral collateral ligament is intact. EXTENSOR MECHANISM: There is mildly increased signal at the patellar tendon attachment at the inferior patella, suggestive of tendinosis or interstitial tear. Quadriceps tendon is intact.ADDITIONAL

Output: 1. Complete tear of the anterior cruciate ligament with moderate joint effusion. 2. Posterior horn and root tear of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: 22-year-old female. Anterior hip pain. Evaluate for labral tear. ACETABULAR LABRUM: Gadolinium enters the anterior/superior labrum indicating a tear. The tear appears to extend from the 1 to 3 o'clock position and also appears to extend through the entire labrum on image 5, series 1301. The posterior labrum appears intact. ARTICULAR CARTILAGE AND BONE: Focal cartilage thinning along the superomedial aspect of the acetabulum is felt to represent normal variation rather than a true defect. We see no frank CAM or pincer deformity. Edema within the inferomedial aspect of the femoral neck suggestive of a stress reaction.SOFT TISSUES: Soft tissues about the right hip are unremarkable.ADDITIONAL

Output: 1. Labral tear, as described above.2. Mild edema along the inferomedial aspect of the right femoral neck suggestive of a stress reaction.


Instruction: Generate impression based on findings.

Input: Cellulitis of the left lower limb. Evaluate for osteomyelitis. TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: T1 heterogeneity of bones of hind and midfott, but most prominent within the talus. No cortical erosion or synovial enhancement. No fracture.ADDITIONAL

Output: 1.T1 heterogeneity most prominent within the talus, but identified in the hind and midfoot. No erosions or synovial enhancement. Findings are equivocal, probably within normal limits. Limited MRI of the contralateral ankle may be helpful to better evaluate bone marrow within the talus.2.Lateral and dorsal midfoot soft tissue edema. 3.Small ankle joint effusion.


Instruction: Generate impression based on findings.

Input: Vertebral body heights and alignment are maintained, better assessed on recent radiographs. There is severe susceptibility artifact, presumably related to metallic BB in the left prevertebral soft tissues, which severely distorts images of most of the cervical spine. No obvious cord signal abnormality or spinal canal stenosis in the most superior aspect of the upper cervical spine or visualized mid to distal cervical spine is appreciated.THORACIC SPINE

Output: 1. Severely limited, essentially nondiagnostic, evaluation of the cervical spine due to extensive susceptibility artifact related to metallic BB in the left prevertebral soft tissues.2. Prominent left paracentral disc protrusion at the left T7-T8 level which deforms the left ventral aspect of the cord. Minimal additional degenerative changes. There is no high-grade spinal canal stenosis at any thoracic level. No evidence of signal abnormality in the thoracic cord.


Instruction: Generate impression based on findings.

Input: left acoustic neuroma; please evaluate for stereotactic radiosurgery planningSigns and Symptoms: left sided hearing loss There is redemonstration of a 14 x 7 mm mass located in the left internal artery canal and left cerebellopontine angle cistern.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a left cerebellopontine angle cistern mass most likely representing an acoustic neuroma. It is unchanged since prior exam.2.Please note this exam was performed for the purpose of treatment planning and is a limited exam.


Instruction: Generate impression based on findings.

Input: Reason: 33 yo female with dx of von hippel lindau (VHL); evaluate for growth of existing pancreatic cysts and new or solid lesions History: 33 yo female with dx of von hippel lindau (VHL); evaluate for growth of existing pancreatic cysts and new or solid lesions. ABDOMEN:LIVER, BILIARY TRACT: Borderline enlarged liver measuring 19 cm in craniocaudal dimension. No focal lesion.SPLEEN: Ssplenomegaly measuring 13.3 cm in craniocaudal dimension. No focal lesion.PANCREAS: Innumerable cysts of varying sizes replaces the pancreas. For reference cyst in the distal body measures 1.4 x 1.3 cm (series 4 image 28), unchanged compared to prior 2014 outside CT (series 4 image 30). No suspicious lesion. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts, some of which demonstrate intrinsic T1 hyperintense signal compatible with hemorrhagic or proteinaceous cysts. For reference, left inferior pole cyst measures 6.2 x 5.3 x 6.6 cm (series 4 image 24, series 3 image 13), unchanged from prior outside CT (series 4 image 34, series 601 image 41). No suspicious lesion. 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: The junctional zone measures 1.3 cm, which can be seen in adenomyomatosis. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable innumerable pancreatic cysts.2.Stable multiple renal cysts.3.No definite suspicious lesion.


Instruction: Generate impression based on findings.

Input: 15-year-old male with medial joint line pain and swelling. Evaluate for meniscus tear. MENISCI: The medial and lateral meniscus appear intactARTICULAR CARTILAGE AND BONE: There is mild edema within the medial aspect of the patella. While this can be seen in patient's who recently sustained transient patellar dislocation, there is no edema within the medial retinacular structures or the lateral femoral condyle to support this, and this finding may represent a direct contusion to bone. There is also mild edema within the anteromedial aspect of the medial femoral condyle that may represent a direct bone contusion. The articular cartilage appears intact. The medial facet of the femoral trochlea appears mildly hypoplastic, relative to the lateral facet, which may reflect mild femoral trochlea dysplasia. There is slight lateral translation of the patella relative to the femoral trochlea. The tibial tubercle to trochlear groove distance measures 14 mm, within normal limits.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendon appear intact. The Insall-Salvati ratio is within normal limits.ADDITIONAL

Output: 1. Normal appearing menisci.2. Edema within the medial aspect of the patella and medial femoral condyle may represent bone contusions. While edema within the medial aspect of the patella can be seen in transient dislocation of the patella, there is no edema within the medial retinacular structures or lateral femoral condyle to support this.3. Edema within the superolateral aspect of Hoffa's fat pad can be seen in patellofemoral instability. There is also slight lateral translation of the patella relative to the femoral trochlea. The medial facet of the femoral trochlea appears slightly hypoplastic suggesting mild dysplasia.


Instruction: Generate impression based on findings.

Input: Liver lesion and complex renal cyst noted on screening ultrasound. 53-year-old male with chronic hepatitis B. ABDOMEN:LIVER, BILIARY TRACT: The right hepatic lobe lesion seen on the prior ultrasound is not definitely identified. An 8 mm T2 hyperintense lesion in the posterior right hepatic lobe (segment 6/7) appears to be a separate incidentally detected lesion based on size and location. This lesion demonstrates faint arterial enhancement with progressive enhancement on the hepatic, portal venous, and delayed phases, likely representing an hemangioma. Additional subcentimeter subcapsular cysts noted. The background liver is non-cirrhotic in appearance.Gallbladder adenomyomatosis noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 18 mm cyst in the left kidney lower pole, seen on the prior ultrasound, without associated soft tissue or enhancement. The left midpole calculus seen on prior ultrasound is not definitively seen on MRI, likely due to spatial resolution/slice thickness. Punctate nonenhancing T2 hyperintense foci in the right kidney are too small to characterize though likely also represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Right hepatic lobe lesion seen on the prior ultrasound is not definitely identified. 2. Subcentimeter posterior right hepatic lobe lesion likely representing an hemangioma. 3. Left renal cyst without suspicious features.


Instruction: Generate impression based on findings.

Input: Female, 82 years old, with facial droop and slurred speech. No restricted diffusion is seen. Mild scattered white matter T2 hyperintensity is seen. No edema or mass effect is detected. There is no acute intracranial hemorrhage or any abnormal extra-axial fluid. The ventricles and sulci are prominent compatible with likely age-related volume loss.

Output: 1.No acute intracranial abnormality.2.Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma. Status post TACE/RFA. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Mild cirrhotic morphology with fissural widening and subtle capsule nodularity. There is an ablation cavity in segment 6 of the liver from the patient's prior RFA. This contains increased T1 signal compatible with hemorrhage. There is no associated adjacent enhancement or washout to indicate residual tumor.There is an additional ablation cavity in the hepatic dome related to prior treatment. There is extensive adjacent increased T2 signal appearing similar to prior. There is early enhancement, but no washout of this region also appearing similar to prior and compatible with scarring.No areas of suspicious focal enhancement.The hepatic veins, portal veins, and hepatic arteries are patent.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.Post ablation findings in the hepatic dome and segment 6. No areas of suspicious washout to indicate residual tumor.2.Cirrhotic morphology of liver without evidence of portal hypertension.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:9/23/1980)Reason: MRI Brain/Head WWO History: HyperprolactinemiaPROVIDER/ATTENDING NAME: SHARON MANGUM SERVICES ANCILLARY MRI pituitary:There is partial empty sella. The pituitary measures 3mm in height. There is a 2mm non-enhancing focus within the midline of the pituitary gland just anterior to the infundibulum  The infundibulum of the pituitary gland is midline. No suprasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: 1.There is a small nodule in the pituitary measuring 2mm size. The possibility that this represents pituitary adenoma cannot be excluded.2.There is partial empty sella present which is non-specific3.


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: Neck pain with stiffness and radiculopathy, history of cervical spine surgery, fusion C5/C6 1995 Changes status post interbody fusion of C5-C7, with obliteration of the disc spaces. The cranial-cervical junction is normal. Mild reversal of the of the normal cervical lordosis, likely postsurgical. The cervical spine alignment is anatomic. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: C2-C3: No neuroforaminal narrowing or spinal stenosis. Mild left facet arthropathy.C3-C4: Small central disc protrusion. Left facet arthropathy with encroachment of the left neural foramen by osteophyte. Right foramen is patent. No spinal stenosis.C4-C5: Status post fusion. Left facet arthropathy with encroachment of the left neural foramen by osteophyte. Right neural foramen is patent. No spinal stenosis.C5-C6: Status post fusion. No neuroforaminal narrowing or spinal stenosis. C6-C7: No neuroforaminal narrowing or spinal stenosis. C7-T1: No neuroforaminal narrowing or spinal stenosis.

Output: Changes post fusion of C5-C7. Facet arthropathy with encroachment of the left neural foramina at C3-4 and C4-5. No significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 40 year old woman s/p heart transplant referred to evaluate for ischemia First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. There are no regional wall motion abnormalities present. Native myocardial T1 mapping images with motion artifact, thus not measured.Left AtriumThe left atrium with transplant anatomy. Right VentricleThe right ventricle is normal in size and systolic function. Right AtriumThe right atrium is with transplant anatomy. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function.4. Normal RV size and systolic function.5. When compared to the prior study, no significant change. Perfusion defect described on prior study likely an imaging artifact.6. Quantification of chamber size and function to follow as an addendum.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is a horizontally oriented posterior horn, body, and anterior horn of the lateral meniscus.There is blunting of the inner free edge of the medial meniscus suggesting presence of a radial tear.This intrasubstance degeneration of the medial and lateral menisci.ARTICULAR CARTILAGE AND BONE: There is severe cartilage loss of the medial compartment, particularly the anterior femoral condyle with full-thickness cartilage loss. Underlying degenerative marrow signal is noted. There is a moderate cartilage loss of the lateral compartment, particularly the tibial plateau. Underlying degenerative marrow signal is noted.A small full-thickness articular cartilage defect is seen in the lateral patellar facet. There is moderate thinning of the articular cartilage of the trochlea as well which is superimposed upon full-thickness loss of the articular cartilage of the lateral trochlea.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Tears of the medial and lateral menisci.2. Moderate osteoarthritis of the knee with areas full thickness articular cartilage loss, worst in the medial compartment.


Instruction: Generate impression based on findings.

Input: 67 years Male (DOB:3/11/1949)Reason: post stroke History: amsPROVIDER/ATTENDING NAME: ROBERT A. MULLIKEN 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 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 and is medium size. The right A1 segment is larger than the left A1 segment. The right posterior communicating artery is small to medium size. The left posterior cerebral artery has fetal origin. The left P1 segment is slightly smaller than the left posterior communicating artery and diameter. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is mild narrowing of the proximal right internal carotid artery with what appears to be some smooth plaque along the posterior aspect of the vessel just above the level of the carotid bulb. A smaller degree of plaque is present in the left carotid bulb.

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.No evidence for acute ischemic cerebral infarction or posterior reversible encephalopathy syndrome.4.MRI of the brain and MRA of the brain are within normal limits. There is a smaller plaque at the proximal internal carotid arteries.


Instruction: Generate impression based on findings.

Input: 45-year-old female recalled from screening mammography following identification of two new masses in the right breast, one at the 6:00 position, and the other at the 10:00 position. Six diagnostic mammograms of the right breast were performed including a standard ML view, spot compression MLO, ML and CC views as well as rolled medial and lateral CC views. Directed gray scale and color Doppler ultrasound was subsequently performed on the right breast.The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. The masses for which the patient was recalled appear as well-circumscribed oval masses at the 6:00 position and 10:00 position of the right breast. These are compatible with benign cysts as subsequently documented on ultrasound.Grayscale and color Doppler ultrasound identified two cysts as follows:1. A six o'clock periareolar 1.4 x 1.5 cm oval, circumscribed, anechoic cyst with posterior enhancement and no internal flow. This corresponds to the new mammographic finding. Incidentally, this cyst was seen on the prior MRI, and had completely benign features with no enhancement.2. A 10:00 periareolar 0.9 x 0.4 x 0.6 cm lobulated, circumscribed, anechoic cyst with posterior enhancement and no internal flow. The component lobulations measured 0.7 and 0.5 cm. These cysts correspond to the findings on the screening mammogram that triggered this exam.

Output: Simple cysts at the 10:00 and 6:00 positions of the right breast explain the findings on the recent screening mammogram that triggered this exam. No further evaluation is necessary. There is no mammographic evidence for malignancy. As long as the patient's physical examination remains normal, annual bilateral screening mammography is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There are multiple diffusion restricting oval lesions throughout the cerebral hemispheres, within the white matter. The largest area is in the left paramedian frontal lobe, with a slightly less circumscribed appearance. Additional lesions are seen in the left parietal centrum semiovale, left frontal lobe deep white matter, left paramedian parietal subcortical and deep white matter, right frontal lobe deep white matter, and left paramedian/midline splenium of the corpus callosum. A smaller area of mild diffusion hyperintensity is seen along the right occipital horn, with more impressive ADC hypointensity noted. There is questioned minimal punctate and linear enhancement in this region, although this could relate to a developmental venous anomaly given the multiple scattered other developmental venous anomalies noted, most prominent in the right frontal and parietal lobes.The lesions demonstrate mild central T2/FLAIR hypointensity, with peripheral rim of subtle FLAIR hyperintensity. The splenial lesion does demonstrate more diffuse mild FLAIR hyperintensity. There is no associated susceptibility artifact.The ventricles and sulci are prominent consistent with mild to moderate global volume loss greater than expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. There is a mildly hypoplastic left A1 segment. The middle and anterior cerebral arteries are otherwise unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRV HEAD: The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1. No acute infarct.2. Multiple oval areas of diffusion restriction throughout the cerebral white matter, including the left paramedian/midline splenium of the corpus callosum. No definite associated enhancement with only mild associated FLAIR abnormalities and central lower T2 signal. Differential diagnosis includes primarily neurotoxicity secondary to intrathecal methotrexate given the patient's history, although follow-up to resolution of imaging findings is recommended to exclude the possibility of underlying leukemic involvement such as chloromas.Reference article: Diffusion-Weighted MR Imaging of Early Methotrexate-Related Neurotoxicity in Children, AJNR 2005 26: 1686-1689 2. Questioned punctate enhancement in the region of the right occipital horn incidentally noted which could relate to a tiny developmental venous anomaly given the multitude of other scattered DVAs seen.3. Unremarkable MRA and MRV of the head.


Instruction: Generate impression based on findings.

Input: Meningeal irritation, evaluate for infectious process, structural cause for subdural hematoma, evaluate for aneurysm or other vascular abnormality, evaluate for extracranial vascular abnormalities MRI brain: There are bilateral subdural hematomas left larger than right with mild diffuse prominence of the overlying dura. There is local mass effect and sulcal effacement and slight midline shift to the right of approximately 4 mm. There is no diffusion restriction or thick rim enhancement of the subdural collections. There is a nonspecific punctate focus of susceptibility effect in the left cerebellum, which may be from prior microhemorrhage. There is no evidence of acute cerebral infarction. The brain parenchyma appears grossly unremarkable. There is no evidence of intracranial mass lesions. There is no abnormal leptomeningeal enhancement. There is mild mucosal thickening in the paranasal sinuses. The orbits are unremarkable.MRA brain: The intracranial arteries appear intact without evidence of aneurysm, stenosis, or dissection. The left vertebral artery terminates in the PICA, which represents a normal variant.MRA neck: There is conventional origin of the arch vessels. The carotid and vertebral arteries appear intact without aneurysm, stenosis, or dissection.

Output: 1. Persistent bilateral subacute subdural hematomas with no change in the associated midline shift.2. Mild dural reaction overlying the subdural hematomas, but no evidence of abnormal leptomeningeal enhancement or cerebral abscess.3. No evidence of aneurysm, stenosis, or dissection of the intracranial and cervical arteries


Instruction: Generate impression based on findings.

Input: Brain MRI:There is a 4.5 cm AP x 3.1 cm craniocaudal x 3.0 cm transverse dimension lesion located in the anterior left middle cranial fossa which is isointense to CSF on all sequences, does not contrast enhance, and does not demonstrate restricted diffusion.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. A small retention cyst versus polyp is noted in the right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Complete spine MRI:Small Schmorl's nodes are noted involving the endplates at several lower thoracic levels extending from T8/9 through T12/L1. Only 2 of the associated vertebral bodies demonstrate minimal anterior wedge deformity.There are no osseous deformities or stenoses.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The conus terminates at L1/2 and is normal in signal characteristics as well as morphology. There is no fat intensity within the filum. Upon prone maneuvering, the conus translates anteriorly.The visualized paraspinal contents are unremarkable. There is no abnormal enhancement.

Output: 1.There is a 4.5 cm AP x 3.1 cm craniocaudal x 3.0 cm transverse dimension arachnoid cyst within the anterior left middle cranial fossa.2.Small Schmorl's nodes are noted involving the endplates at several lower thoracic levels extending from T8/9 through T12/L1. Only 2 of the associated vertebral bodies demonstrate minimal anterior wedge deformity, thus this does not fit the criteria for the diagnosis of Scheuermann's disease.3.No osseous dysplasias or spinal cord abnormalities.


Instruction: Generate impression based on findings.

Input: 48-year-old male patient with left arm numbness. Question of ischemia/infarction. MRI BRAIN: There are no diffusion-weighted abnormalities to suggest acute ischemia. An area of encephalomalacia within the inferior left parietal lobe is consistent with a chronic ischemic infarct. There is an area of cortical T2 signal abnormality with associated susceptibility artifact within the right posterior parietal lobe, which is new from the prior MRI and consistent with a chronic ischemic infarct. There is also cortical T1 signal hyperintensity in this region consistent with laminar necrosis. Additional scattered foci of subcortical and periventricular white matter T2 hyperintensity likely represents chronic small vessel ischemic disease. A focus of susceptibility artifact within the left parietal lobe is unchanged and likely represents old blood product.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA BRAIN:There is normal flow related signal 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.

Output: 1. No evidence of an acute ischemic infarct.2. Chronic left inferior parietal lobe ischemic infarct and a chronic ischemic infarct involving the posterior right parietal lobe, which is new from the prior MRI. These findings occur on a background of chronic small vessel ischemic disease.3. Unremarkable MRA of the brain.


Instruction: Generate impression based on findings.

Input: Male 82 years old Reason: Eval for clearance of biliary stones, s/p ERCP on 2/12. Please perform study on Monday 2/15 (3 days post-procedure) History: jaundice, abd pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. There is mild central intrahepatic biliary ductal dilatation. Status post cholecystectomy there is small amount of debris remaining in the residual cystic duct which has low insertion. No definite debris within the common bile duct. Small foci of signal hypointensity along the anterior aspect of the duct suggests small air bubbles.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Lateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild inflammation in the right upper abdomen adjacent to the colon. There is a fluid collection with a fluid fluid level anterior to the hepatic flexure with a neck that extends near the porta hepatis and duodenal bulb. This has wall enhancement and has restricted diffusion and is suspicious for a collection possibly representing an abscess or biloma. The small bowel in the area have a mildly thickened wall. There is a mild generalized ileus. There is mild hyperenhancement of the peritoneum in the right upper abdomen.BONES, SOFT TISSUES: Postsurgical changes in the abdominal wall with mild body wall edema and trace ascites.OTHER: No significant abnormality noted.

Output: 1.Status post cholecystectomy with small amount of debris within the cystic duct. Mild central intrahepatic biliary duct dilatation.2.3.4 x 1.5 cm fluid collection anterior to the hepatic flexure representing either an abscess or biloma.Findings discussed with Dr. Krishnamoorthi at the time of dictation


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with numbness and weakness, history of neuromyelitis optica. Evaluate for new or worsening disease. Diffuse atrophy of the spinal cord is redemonstrated, particularly affecting the thoracic cord. Patchy abnormal signal is also redemonstrated in the cervical cord and to a lesser extent the thoracic cord. No pathologic spinal cord or leptomeningeal enhancement is appreciated. No epidural abnormalities are suspected.The thoracic kyphosis is slightly exaggerated, but spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow signal or enhancement is seen. Patchy opacification of the right mastoid air cells is noted.The intervertebral discs are grossly preserved with no significant disc bulging or herniation. No compromise of the spinal canal or neural foramina is detected.Bilateral pleural effusions have increased in size compared to the prior examination. The effusions have a somewhat loculated appearance in certain areas, and the adjacent lung parenchyma is enhancing.

Output: 1.Diffuse spinal cord atrophy and patchy abnormal signal are redemonstrated appearing grossly similar to the prior examination. These findings are compatible with the stated history of neuromyelitis optica. No definite evidence of any new or enhancing lesion is seen.2.Incidental note is made of bilateral pleural effusions, mildly increased in size since the prior examination, with a somewhat loculated appearance and with enhancement of the adjacent lung parenchyma. The possibility of infection is raised, for which correlation with clinical and laboratory findings may be helpful.


Instruction: Generate impression based on findings.

Input: Male 20 years old Reason: recurrent knee pain, impingement? History: right knee pain anterolaterally MENISCI: There is a complex tearing of the posterior horn of the medial meniscus with both vertical and horizontal components. No new lateral meniscus tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tearing of the posterior horn of the medial meniscus.2. Edema within the anterior patella which likely represents a bone contusion.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Signs and symptoms: MVC. No neck pain. Clinical question: 71-year-old.? Fracture. Nonenhanced head CT:Findings of small vessel disease of indeterminate age is present and evident by few small patchy periventricular and subcortical white matter low attenuation.No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. Limited view of the orbits are unremarkable.Nonenhanced CT of cervical spine:No evidence of fracture or subtle change is detected. The alignment of the vertebral column is unremarkable. Advanced degenerative disk disease at C6 -- C7 level and to a lesser degree at other levels are present. Sagittal reformatted images demonstrate significant bulge of disk material at C3 -- C4 which appears to be in contact with the ventral aspect of the cord. Possibility of a herniated disk cannot be ruled out. Please correlate with neurological exam and if needed follow-up with an MRI is recommended. Examination also demonstrated degenerative changes of posterior elements from C3 -- C4 inferiorly.Degenerative changes of cervical spine results in right neural foramina compromise at C5 -- C6 and left neural foramina at C6 to C7 level.

Output: 1.Nonenhanced head CT demonstrates minimal findings of small vessel disease of indeterminate age and otherwise unremarkable.2.CT of cervical spine demonstrates no evidence of fracture or malalignment. Extensive degenerative disk disease and hypertrophic changes of posterior elements are present. Significant bulge of disk material at C3 there C4 is best a patient on sagittal reformatted images and possibility of a herniated disk cannot be rule out.


Instruction: Generate impression based on findings.

Input: Ms. Einsele is a 64 year old female with a personal history of right breast lumpectomy in 2002 for DCIS treated with radiation and hormonal therapy. Family history of breast cancer in mother, maternal aunt, maternal first cousin, and paternal aunt. Patient is BRCA2 mutation carrier. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Stable post-lumpectomy changes are present in the right inferior breast. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Bilateral small pleural effusions noted.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out hydrocephalus. Signs and symptoms: concern for developmental delay. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.The cortical sulci, ventricular system and midline is within normal. There is prominence of subarachnoid space with CSF density which is within normal range for patient stated age. There is no evidence of any developmental abnormality or brain parenchyma on this non-infused head CT. If clinical concern persists follow-up with an MRI is highly recommended.Calvarium is intact.Limited view of the orbits are unremarkable.

Output: No definitive evidence of intracranial pathology for patient stated age. If there is concern for developmental delay follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Vomiting and headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: History of multiple myeloma in remission with distal femur lesion. Again seen is the moderate cortical thickening/irregularity, periosteal reaction, and endosteal scalloping of the distal femoral diaphysis previously visualized on radiographs and MRI. These findings are not significantly changed from prior examination.

Output: Chronic periosteal reaction is consistent with known myeloma however on the basis of this imaging, one cannot exclude a metastasis of an unknown primary.


Instruction: Generate impression based on findings.

Input: There is mild anterolisthesis of L4 on L5 and mild retrolisthesis of L5 on S1. There are defects at the superior endplates of the T12 and L1 vertebral bodies, again noted. There is multilevel loss of disc height and disc dessication. There is mild heterogeneity of the marrow signal. The spinal cord displays normal signal and morphology. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is some mild clumping of the nerve roots at the lower lumbar spinal canal.T12-L1: Bilateral facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild bilateral foraminal stenosis and moderate spinal canal stenosis. L2-L3: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild bilateral foraminal stenosis and moderate spinal canal stenosis. L3-L4: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to mild bilateral foraminal stenosis and progressed moderate spinal canal stenosis. L4-L5: Evidence of left laminotomy. Pseudo disc bulge and superimposed small central disc protrusion, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to effacement of the bilateral lateral recesses, mild bilateral foraminal stenosis and improved moderate spinal canal stenosis. L5-S1: Disc bulge with central to left paracentral to left foraminal disc protrusion, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to left greater than right lateral recess narrowing and mild bilateral foraminal stenosis with impingement of the descending left S1 nerve root. No significant spinal canal stenosis.

Output: 1.Degenerative spondylosis of the lumbar spine with interval progression of moderate spinal canal stenosis at L3-L4, improved moderate spinal canal stenosis at L4-L5 and unchanged moderate spinal canal stenosis at L2-L3. 2.Left laminotomy changes at L4-L5. 3.Left paracentral/foraminal disc protrusion at L5-S1 with impingement of the left S1 nerve.There is suspicion for some nerve root clumping in the lower lumbar spinal canal. Please correlate with clinical symptoms to assess for possible arachnoiditis.


Instruction: Generate impression based on findings.

Input: 59-year-old female with 3 day history of headache and now has altered mental status. Evaluate for bleed. Patchy nonspecific areas of low attenuation are seen in periventricular white matter with a more discrete focus seen in the right thalamus as well as vague hypoattenuation in the left pons. While these may represent sequela from small vessel ischemic disease, they are of indeterminate age and acute infarct cannot be excluded. If acute infarct is suspected, an MRI should be considered.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.High density material in the left globe may represent a dislodged lens.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Patchy, nonspecific areas of low-attenuation in the periventricular white matter with a more discrete focus seen in the right thalamus and vague hypoattenuation in the left pons. Without prior comparison studies, it is difficult to distinguish between sequela from small vessel ischemic disease from acute infarct. If acute stroke is clinically suspected, an MRI should be considered.Findings were discussed with the MICU service (pager 3577) via telephone at the time of dictation.


Instruction: Generate impression based on findings.

Input: History of glaucoma and bilateral optic atrophy with visual field deficits not consistent with glaucoma: altitudinal superior field defect OS, enlarged blind spot OD. Some of the sequences are degraded by patient motion. There is mild diffuse volume loss of the bilateral optic nerves and chiasm. However, there is no evidence of abnormal enhancement. There are bilateral lens implants. The extraocular muscles and orbita fat are unremarkable bilaterally. There is no evidence of intraorbital mass lesions. There is a small retention cyst and possible fluid within the right maxillary sinus.

Output: 1. Mild diffuse volume loss of the bilateral optic nerves and chiasm.2. Findings that may represent acute sinusitis.


Instruction: Generate impression based on findings.

Input: 45-year-old male with subacute cholestatic liver enzyme elevation with acute worsening of alkaline phosphatase in 300s one month ago at outside hospital, now 900s. Worsening of extensive tumor burden at multiple locations versus focal stentable obstruction secondary to malignancy. Exam limitations related to respiratory motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly measuring up to 20 cm in craniocaudal length. Numerous bilobar T2 hyperintense metastatic lesions predominantly of the right hepatic lobe relatively stable in size and number. Reference measurements listed below. As seen on the prior exam, there are 2 lesions extending beyond the hepatic capsule and into the right lateral and anterolateral subcutaneous tissues (axial series 5 images 26, 35). The lesions cause mass effect with narrowing of the intrahepatic IVC. There is marked attenuation versus possible occlusion of the main portal vein.Nonvisualization of the central right bile ducts due to multiple liver lesions. There are a few areas of mild intrahepatic biliary ductal dilatation measuring up to 7 mm in diameter (series 5 image 28). No extrahepatic biliary ductal dilatation. The common bile duct is at the upper limits of normal measuring 6.3 mm in diameter (coronal series 7 image 37). There is a possible abnormal soft tissue signal adjacent to the level of the bilioenteric anastomosis without significant biliary ductal dilatation (series 8 image 31).SPLEEN: Mild splenomegaly measuring 13 cm in length.PANCREAS: Status post Whipple procedure. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal infiltrative nodal adenopathy is similar compared to to the prior CT exam. Mildly enlarged periportal lymph nodes are noted.BOWEL, MESENTERY: Status post Whipple CT. Large volume ascites. Diffuse submucosal edema is noted. Small bowel loops are mildly dilated measuring up to 3.8 cm in diameter. No definite evidence for obstruction, and an ileus is suspected. A right lower quadrant small drain is in place. Peritoneal thickening in the posterior right upper quadrant demonstrating subtle restricted diffusion is concerning for peritoneal disease (series 9 image 152).BONES, SOFT TISSUES: Worsening anasarca.OTHER: New bilateral pleural effusions.INDEX LESION MEASUREMENTS (Current exam date/time: 12/12/2016 09:00:00)HEPATIC SEGMENT 4A LESION: 0.4 cm (Image 25, Series 5); 5.7 x 4.6 cm (Image 20, Series 8); 5.6 x 4.4 cm on prior (12/4/2016) (Image 40, Series 6).

Output: 1.Numerous bilobar hepatic metastases with at least 2 lesions extending beyond the hepatic capsule into the subcutaneous tissues. Reference measurements listed above.2.There is possible abnormal soft tissue signal adjacent to the expected level of the bilioenteric anastomosis (could reflect nodal disease) without significant upstream biliary ductal dilatation. Few areas of mild intrahepatic biliary ductal dilatation (measuring up to 7 mm) also noted. Retroperitoneal infiltrative nodal adenopathy is similar compared to to the prior CT exam. Mildly enlarged periportal lymph nodes are seen.3.Large volume ascites with mild dilated small bowel loops and diffuse submucosal edema. Findings most suggestive of a reactive ileus.4.New bilateral pleural effusions and prominent anasarca. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 38 years old, female, with history of dextro-transposition of the great vessels s/p Mustard procedure, who is transferred for tachy-brady syndrome. She is referred for Cardiac MRI to evaluate cardiac anatomy and function. Overall Anatomyd-TGA. There is a Mustard baffle that connects the SVC and IVC to the sub-pulmonic ventricle (i.e. morphologic left ventricle) via the mitral valve. The morphologic left ventricle communicates with main pulmonary artery. The pulmonary venous flow returns to the systemic ventricle (i.e. morphologic right ventricle) via the common atrium and tricuspid valve. The morphologic right ventricle communicates with the aorta.Systemic Venous ReturnThere is a baffle that connects the SVC and IVC to the sub-pulmonic ventricle (i.e. morphologic left ventricle) via the mitral valve. There is no obstruction or leak of the baffle noted. The IVC limb (26 mm) appears more dilated than SVC limb (12 mm).Systemic Ventricle (i.e. Morphologic Right Ventricle)The right ventricle is severely dilated and hypertrophied with severely reduced systolic function. The overall RV ejection fraction is 28.45%, the RV end diastolic volume index is 92.31 Ml/m2 (normal range 69+/-14), the RVEDV is 213.10 ml (normal range 110+/-24), the RV end systolic volume index is 66.04 ml/m2 (normal range 22+/-8), and the RVESV is 152.47 ml (normal range 35+/-13). Pulmonary Venous ReturnThere are four pulmonary veins which drain into the common atrium. There are no obvious obstructions of the pulmonary veins.Sub-Pulmonary Ventricle (i.e. Morphologic Left Ventricle)The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 55 ml/m2 (normal range: 65+/-11), the LVEDV is 127 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 72 ml (normal range 31+/-10), the LV mass index is 26 g/m2 (normal range 67+/-11), and the LV mass is 58 g (normal range 114+/-24). The intraventricular septum bows into the left ventricle but does not cause an obvious obstruction to flow through the left ventricular outflow tract. There is subaortic/RV muscle bundles in mid cavity that may potentially obstruct if hypertrophy progresses.Common AtriumThe interatrial septum has been resected resulting in a common atrium. Aortic ValveThe aortic valve opens widely and there is minimal aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.Great VesselsThe aorta is located anterior to the pulmonary trunk. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm or thoracic aortic dissection. The maximum diameter of the aorta is normal size. The main pulmonary artery is normal size. There are no proximal stenoses of the left and right pulmonary arteries. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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. dTGA anatomy. 2 s/p Mustard operation.3. Unobstructed Mustard baffle without leak.4. Significant dilated sub-aortic ventricle with hypokinesis.5. No subpulmonic/subaortic stenosis.6. No aortic regurgitation.7. No LGE noted.Reviewed the study with Dr. Varga.


Instruction: Generate impression based on findings.

Input: 59-year-old male with biopsy-proven multifocal HCC in right liver status post TACE/RFA in December 2014. Surveillance scan. LIVER, BILIARY TRACT: There is a 2.1 x 1.9 cm ablation cavity in the inferior right liver tip that does not demonstrate any residual internal or peripheral enhancement (series 10, image 122). Located more superiorly in the right liver, there is a second ablation cavity measuring 2.7 x 1.9 cm (series 10, image 132). Adjacent to this cavity, there is a nodular arterially enhancing lesion measuring 1.7 x 1.7 cm (series 10, image 52). This lesion also demonstrates some increased T2 and diffusion weighted signal with central washout on delayed phase images. Findings are suspicious for residual disease.The main portal vein is patent. No biliary ductal dilatation. Unchanged gallbladder wall thickening is likely reactive in the setting of cirrhosis. SPLEEN: Splenomegaly measuring 16.1 cm. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric adenopathy.BOWEL, MESENTERY: Small hiatal hernia, otherwise unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites. Nonspecific right lower lobe lung nodule. Extensive gastroesophageal varices.

Output: 1.Post-ablation changes in the right liver with nodular arterially enhancing lesion adjacent to the superior ablation cavity that demonstrates central washout. Findings are suspicious for residual HCC. 2.Cirrhotic liver morphology and findings compatible with portal hypertension as described above.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images of left breast (2/18/15) and breast MRI (2/19/15) performed at . For comparison, digital mammographic images (1/26/15), ultrasound images of left breast (1/26/15) are available. DIGITAL MAMMOGRAPHIC IMAGES OF LEFT BREAST (2/18/15):ML view and magnification views are submitted.An irregularly shaped mass with marker clip is present at 3 o'clock position in the left breast. This is a biopsy proven malignancy. Pleomorphic calcifications are associated with this mass. In addition, there is a small cluster of calcifications, measuring 1.5 mm, located 3 cm medially from the mass.BREAST MRI (2/19/15):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Multiple cysts are seen in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an irregularly shaped enhancing mass, measuring 30 x 15 x 20 mm (AP x LR x CC) at posterior 3 o'clock position in the left breast, representing the known carcinoma. Susceptibility artifact from the marking clip is present within the mass. No additional abnormal enhancing lesions 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: 1. Biopsy proven cancer in the left 3 o'clock position.2. A small cluster of calcifications is present at 3 cm medially from the known cancer in the left breast. Stereotactic core needle biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.