Instruction: Generate impression based on findings.

Input: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex causes slight anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy. There is mild central, mild left neural foraminal, and moderate to severe right neural foraminal stenosis.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex causing slight anterior cord flattening without intrinsic cord signal abnormality, and bilateral uncinate hypertrophy. There is mild central, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.C5/6: Trace retrolisthesis C5 on C6, posterior osteophyte disc complex causing slight anterior cord flattening without intrinsic cord signal abnormality, and bilateral uncinate hypertrophy. There is mild central, severe left neural foraminal, and mild to moderate right neural foraminal stenosis.C6/7: Minimal posterior osteophyte disc complex and left uncinate hypertrophy. There is mild left neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C3/4: Mild central, mild left neural foraminal, and moderate to severe right neural foraminal stenosis.2.C4/5: Mild central, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.3.C5/6: Mild central, severe left neural foraminal, and mild to moderate right neural foraminal stenosis.4.C6/7: Mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 46 year old female status post right mastectomy for DCIS, presents today for routine follow up. No current breast complaints. No family history of breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. Stable to minimally increased round circumscribed mass in the left lower inner breast which correlates with a cyst on prior MRI. Stable scattered benign calcifications.No new dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast.

Output: Known left lower inner quadrant cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 36 year old male with OSA, asthma, GERD, sarcoidosis. Referred for cardiac MRI to assess for cardiac sarcoid. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%. The LVEDV is 171 ml (normal range 142+/-34), the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVESV is 93 ml (normal range 47+/-19) and the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9). The LV mass is 136 g (normal range 164+/-36) and the LV mass index is 61 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 966 ms in the ventricular septum and 1110 ms in the LV free wall (the latter is suggestive of underlying diffuse fibrosis or infiltration). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%. The RVEDV is 207 ml (normal range 142+/-31), RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVESV is 109 ml (normal range 54+/-17), and the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMediastinal lymphadenopathy and diffuse lung disease suggestive of sarcoidosis. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with mildly reduced systolic function. LVEF 46%. No regional wall motion abnormalities.2.The right ventricle is mildly dilated with mildly reduced systolic function. RVEF 48%. 3.There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 4. The native T1 myocardial relaxation time is 966 ms in the ventricular septum and 1110 ms in the LV free wall (the latter suggests possible underlying diffuse fibrosis or infiltration). Consider follow up cardiac MRI in 6 months for reassessment.5.Mediastinal lymphadenopathy and diffuse lung disease suggestive of sarcoidosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male; 66 years old. Evaluation for prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.9 x 5.5 x 5 cm (AP by transverse by craniocaudal).Peripheral Zone: Approximately 5 x 5 mm focus of dark T2 signal with restricted diffusion in the mid prostate gland right peripheral zone at the 7 o'clock position (series 401/67) is suspicious for prostate cancer.Central Gland: Heterogeneous and enlarged due to BPH.Seminal Vesicles: Normal in appearance.Extracapsular Extension: The capsule at the above-described focus is not well visualized, likely due to mild extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Single right pelvic sidewall enhancing lymph node is seen, which is subcentimeter in short axis (series 1601/106). No pathologically enlarged lymph nodes by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Single small focus of suspicious for prostate cancer in the right peripheral zone as detailed above.


Instruction: Generate impression based on findings.

Input: 17-year-old female with history of right knee instability. Evaluate for ACL tear. MENISCI: Intrasubstance signal is seen in the anterior horn of the lateral meniscus appears to be extending to the articular surface compatible with a radial meniscal tear. The medial meniscus demonstrates some increased signal in the posterior horn, however this does not extend to the articular surface and is unchanged from the prior exam, and the medial meniscus appears morphologically intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal abnormalities are seen in the lateral femoral condyle, the lateral posterior tibial plateau, and, to a lesser degree at the medial posterior tibial plateau and are compatible with bone contusionsLIGAMENTS: The anterior cruciate ligament is irregular and appears to be disrupted compatible with the tear. Posterior cruciate ligament and the medial and lateral collateral ligaments are are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.ACL tear as described above.2.Lateral meniscal tear as described above.3.Suprapatellar joint effusion.


Instruction: Generate impression based on findings.

Input: 28-year-old male with history of psoriatic arthritis. MENISCI: The menisci are intact bilaterally.ARTICULAR CARTILAGE AND BONE: There is mild superficial fraying of the articular cartilage of the patella mainly along the medial aspect. The femoral trochlea appears shallow with prominence of the lateral facet suggesting femoral trochlear dysplasia. The articular cartilage of the femoral trochlea is intact. There is edema within the superolateral aspect of Hoffa's fat pad which can be seen in patellofemoral instability. The Insall-Salvati ratio is within normal limits. The tibial tuberosity to trochlear groove distance measures 18 mm, borderline. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Superficial degeneration of the articular cartilage of the patella as above as well as anatomic findings which may predispose to patellofemoral instability.2. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompression, three-month follow-up. Interval postsurgical changes of Chiari decompression are seen including suboccipital craniectomy and resection involving the posterior aspect of C1 which was partially fused to the occipital bone. Cauterization of the right cerebellar tonsil is also noted. There has been mild interval increase in CSF spaces at the foramen magnum dorsally and to a lesser degree ventrally. CSF flow sequence is technically suboptimal but demonstrates improvement in biphasic flow posteriorly in the interval.There has been decrease in size of the cervical syrinx, for example at the upper C4 level, syrinx measures 1.3 x 1.9 mm in the axial plane, previously 2.5 x 3.1 mm. Craniocaudal extent from C2 to C4 is also slightly decreased.Partial atlantooccipital assimilation and mild widening of the atlantodental interval are again noted. Vertebral body heights are maintained. There is loss of cervical lordosis. Multilevel degenerative changes are again seen including small disc osteophyte complexes at the C3-C4, C5-C6, and C6-C7 levels. There is up to mild spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis at the C5-C6 level. Mild to moderate left and mild right neural foraminal stenosis is also present at the C6-C7 level. Spinal canal and neural foramina in the cervical spine are otherwise patent.

Output: 1. Expected postsurgical changes of Chiari decompression including cauterization of the right cerebellar tonsil with increase in CSF spaces and CSF flow posteriorly at the foramen magnum. There is decrease in size of cervical syrinx extending from C2 to C4.2. Atlantooccipital assimilation and borderline widening of the atlantodental interval again seen. Mild multilevel cervical spine degenerative changes are not appreciably changed and described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis. Please perform Dr. Javed's MS protocol. Compared with prior exam. Signs and symptoms: Numbness, weakness and ataxia. Pre and post enhanced rain MRI:Multiple tiny foci of FLAIR hyperintensity are noted in the subcortical white matter of bilateral cerebral hemispheres. Similar signal changes are also noted in the periventricular white matter of cerebral hemispheres and including periventricular white matter of bilateral anterior and mid temporal lobes. Few tiny similar signal changes are also present in the corpus callosum on the left similar to prior exam. Findings demonstrate no convincing evidence of interval progression or detectable abnormal enhancement. Similar to prior exam there is no definitive detectable lesion in the posterior fossa.Unremarkable cortical sulci and ventricular system as well as the CSF spaces and with maintained midline.Unremarkable images through orbits, paranasal sinuses and mastoid air cells.Unremarkable calvarium and soft tissues of the scalp.

Output: 1.Supratentorial findings of demyelinating disease without convincing evidence of interval change or detectable abnormal enhancement as detailed.2.Unremarkable exam otherwise for patient's stated age.


Instruction: Generate impression based on findings.

Input: There is redemonstration of T2/FLAIR hyperintensity involving the mildly expanded right cerebral peduncle and right greater than left ventral pons, similar in distribution to the most recent MRI fusion exam. An additional rounded area of slightly heterogeneous T2 hyperintense signal is present, centered in the lateral aspect of the right thalamus extending into the right posterior basal ganglia. There are foci of central susceptibility in this lesion in addition to a linear tract of susceptibility extending anteriorly from the lesion towards the right frontal burr hole, consistent with recent biopsy tract and probable associated chronic blood products. This lesion measures 1.7 x 1.6 cm on 701/20, compared to previous 1.4 x 1.4 cm. There is minimal patchy intrinsic T1 hyperintensity within the lesion with mild superimposed enhancement along superior posterior aspect in a nodular configuration on 1101/23. This enhancing nodule now measures 8 x 9 mm compared to previous 6 x 6 mm.In the area of the ring-enhancing lesion in the left anterior parietal subcortical white matter, there is now an irregularly shaped somewhat bilobed appearing structure with peripheral enhancement, now measuring at least 2.9 x 1.8 cm in greatest axial dimensions, previously measuring overall 1.6 x 0.8 cm. There is also progressive surrounding T2/FLAIR hyperintensity in this area. A teardrop shaped CSF signal intensity resection cavity is identified anteriorly and superiorly, without significant interval change.Perfusion imaging demonstrates relative hypoperfusion in areas of above described abnormal signal and enhancement except for mild peripheral hyperperfusion along the rounded right thalamic/basal ganglia mass.There is persistent ill-defined T2/FLAIR hyperintensity involving the left paramedian posterior frontal gyri white matter with minimal ill-defined linear enhancement on delayed post contrast images. There is questioned additional nonspecific gyral thickening and FLAIR hyperintensity involving the right greater than left mesial temporal lobes with extension into the right hippocampus and right paramedian occipital lobe cortex, although components of this could be artifactual.The ventricles and sulci are stable, with ex vacuo dilatation of the left lateral ventricle. The cisterns remain patent. There is no midline shift or mass effect. The above scattered focal masses demonstrate associated diffusion restriction suggestive of hypercellular tumor, although there is no area of diffusion restriction suggesting acute ischemia. 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.

Output: 1.Slight interval increased size of right posterior thalamic/basal ganglia heterogeneously enhancing mass status post biopsy with associated likely postoperative blood products. Mild hyperperfusion noted peripherally.2.No significant interval change in appearance of expansile right cerebral peduncle/right greater than left pontine mass.3.Interval increased size of now bilobed appearing peripherally enhancing left anterior parietal lobe white matter lesion with increased extent surrounding nonspecific nonenhancing T2/FLAIR hyperintensity, which may represent a combination of tumor progression and/or posttreatment effects.4.Persistent gyral thickening and abnormal signal with minimal enhancement along the left paramedian posterior frontal lobe gyri, with additional apparent questioned nonspecific right greater than left mesial temporal lobe FLAIR hyperintense gyral thickening and right occipital lobe cortical FLAIR hyperintensity. Continued follow-up is requested.


Instruction: Generate impression based on findings.

Input: Recurrent T2N2B squamous cell carcinoma of the base of the tongue, previously treated with concurrent cisplatin/RT and now receiving chemotherapy. There is an ill-defined ulcerative lesion centered in the left tongue base with extension into the glossotonsillar sulcus that measures up to 40 mm in length and 10 mm in thickness. There is diffuse edema within the supraglottic suprahyoid soft tissues of the upper aerodigestive tract, overlying skin, as well as the left submandibular gland. There is denervation change involving the left hemitongue. There is no evidence of significant cervical lymphadenopathy based on size criteria. There are multilevel posterior cervical disc-osteophyte complexes that narrow the spinal canal. The imaged intracranial structures and orbits are unremarkable. There is minimal scattered paranasal sinus mucosal thickening.

Output: 1. Extensive treatment effects in the upper aerodigestive tract region with an ill-defined ulcerative lesion centered in the left tongue base with extension into the glossotonsillar sulcus, which likely represents treated tumor. 2. No residual significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: 55-year-old man with history of back pain, compression fractures, and squamous cell carcinoma of the tongue. Thoracic Spine: There is diffusely increased T2 and decreased T1 signal in multiple cervical and thoracic vertebral bodies. In particular, the T3 vertebral body is collapsed with greater than 50% loss of height anteriorly, which is similar in appearance to 1/18/2016. Furthermore, at the T1 through T5 levels, there is apparent epidural tumor extending into the thecal sac, with compression of the spinal cord at the T4 level, and bilateral neural foramina, as well as extension of tumor into the paraspinous soft tissues. There is also abnormal bone marrow signal in the T10 vertebral with extension into the anterior epidural space and right neural foramen, but no spinal cord compression at this level. There are multiple bilateral perinephric tumors. In addition, there are enlarged cervical and upper mediastinal nodes. There appears to be debris in the trachea and pulmonary atelectasis. There is no spondylolisthesis.Lumbar Spine: Five lumbar type vertebral bodies are presumed to be present. There is high T2 and low T1 signal diffusely within in the L2 vertebral body, sacrum, and bilateral ilia. Furthermore, there appears to be epidural extension of tumor from the posterior L2 vertebral body into the right lateral recess and neural foramen, causing significant stenosis. Also, at the S1 level, there is partially imaged tumor in the central anterior epidural space, which is partially imaged, but pushes the thecal sac posteriorly. The vertebral body heights are preserved and the alignment is within normal limits. There is an intradural, extramedullary lesion in the thecal sac at the L3/L4 level measuring 27 x 18 x 16 mm with compression of the cauda equina nerve roots. There are multiple tumors within the right psoas muscle and bilateral retroperitoneal regions. There is mild degenerative spondylosis in the lower lumbar spine.

Output: 1.Multiple osseous metastases involving the axial skeleton, including a pathologic compression fracture of T3 and epidural tumor at T1 through T5 with compression of the spinal cord at the T4 level, and a metastasis in the thecal sac at the L3/L4 level with compression of the cauda equina nerve roots. However, assessment of metastatic disease is somewhat limited by the lack of intravenous contrast.2.Multiple abdominal and thoracic metastases. Please refer to the recent body CT for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB:9/29/1974)Reason: Brain lesion, stroke History: altered mental status, fevers, seizuresPROVIDER/ATTENDING NAME: JOHN P. KRESS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening and some inspissated secretions in the left sphenoid sinus. The visualized portions of the mastoid air cells demonstrate opacities bilaterally. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is no evidence for intracranial hemorrhage or mass.3.Retained secretions in the mastoid air cells are present. Possibility of underlying infection cannot be excluded.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with right-sided hand weakness after motor vehicle accident. T2 hyperintense foci are seen within the neural foramina along the right C8 and T1 nerve roots (see image 16 and 17, series 8; and image 30 and 36, series 5). The other neural foramina are free of similar findings. There may be mild increased STIR signal more distally along the right brachial plexus, though this is equivocal given some motion artifact. The finding cannot be confirmed on axial T2 images due to inadequate fat suppression.Otherwise, no specific abnormalities of the brachial plexus are seen. Postcontrast images are within normal limits. The spinal cord remains at midline within the thecal sac. There is no evidence of any abnormal intraspinal fluid. Bone marrow signal characteristics are also within normal limits.

Output: T2 hyperintense foci are demonstrated along the right C8 and T1 nerve roots. Without consideration of patient history, these would be attributed to normal variant perineural root sleeve cysts. However, given the right-sided symptomatology, and absence of similar findings elsewhere in the visualized spine, the possibility of mild injury to the nerve root sleeves is raised. If the distribution of the weakness correlates with C8 and T1 supply, then this possibility would become more likely.


Instruction: Generate impression based on findings.

Input: Eval for any lesions that could be responsible for confusionSigns and Symptoms: Is having discrete episodes of confusion, Neuro thinks possible Temporal lobe seizures. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear to the extent of visualization possible on this limited exam. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.Examination is degraded by patient motion.

Output: 1.Examination is limited due to patient's inability to cooperate and motion artifact. As a result any small or subtle lesions would be easily overlooked. If there is persistent concern an examination the patient is able to cooperate or with the help of anesthesia may be helpful.2.There is no evidence for acute cerebral infarction.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related (most likely given the PMH), related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: History of right mastectomy in 2006 with autologous reconstruction for ILC. Patient received radiation, chemotherapy and hormonal therapy. History of breast cancer in mother and maternal aunt. The patient is status post right mastectomy with autologous reconstruction. Heterogeneous fibroglandular tissue is present in the left breast.Minimal parenchymal enhancement is noted in the left breast.Right reconstructed breast: Postsurgical changes from a right mastectomy with autologous reconstruction are unchanged. No suspicious enhancing masses or non-mass enhancement is present in the right chest wall or reconstructed breast.Left breast: Stable nodular enhancement is present in the superior left breast anteriorly. Nonenhancing cysts are present. A stable 7 mm intramammary lymph node is present in the far posterior left breast. No suspicious enhancing masses, non-mass enhancement or uniquely enhancing foci are present.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Brain MRISignificant metallic artifacts on left suboccipital craniectomy site and right PICA origin area due to prior clipping, this degraded image quality.No evidence of acute ischemic or hemorrhagic lesion on this scan.There is focal encephalomalacia on the right frontal lobe which represent prior ventriculostomy tube track. Left posterior parieto-temporal approach ventriculostomy tube is demonstrated with metallic artifacts on the left scalp which represents burr hole and reservoir.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures are normal. Craniocervical junction cannot be precisely evaluated due to artifacts. However, the position of bilateral cerebellar tonsil appears to be unchanged. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral distal vertebral arteries cannot be evaluated precisely due to artifacts. No intracranial arterial aneurysm was seen. No significant (more than 50%) luminal stenosis of intracranial arterial system.C-Spine and T-SpineRedemonstration of syringomyelia from skull base to the level of T11-12 which does not show any significant interval change. The measured largest diameter of syrinx cavity appears to be stable.No change of mid to lower thoracic spine scoliosis.There is no evidence of spinal canal stenosis.No evidence of neuroforaminal stenosis.

Output: 1. Post-decompression status of Chiari malformation. 2. No evidence of acute ischemic or hemorrhagic lesion.3. Stable left parieto-temporal ventriculostomy tube, ventricular system size, bilateral cerebellar tonsil position, the extent of syrinx from skull base to T11-12 level and its size since prior scan.4. No change of midthoracic scoliosis.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB:1/25/1974)Reason: spontaneous subdural hematoma that had resolved, now with new headaches, please compare to prior imaging History: headachesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is some mild thickening of the right the dura along the superior aspect of the head.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 posterior communicating arteries are small. The left posterior communicating artery is much smaller than the right posterior communicating artery. The vertebral arteries are similar in size.There are some mild asymmetry in the size of the middle meningeal artery - the right being slightly larger than the left. This is a nonspecific finding no transcortical vasculature is identified on this exam though the top half of the head is not included on the 3-D time-of-flight.MRV brain:The left transverse sinus, sigmoid sinus and jugular veins are smaller than the right-sided counterparts. Recent CTs of the head demonstrated at the left jugular bulb and left sigmoid sinus groove are smaller than the right-sided counterparts indicating this asymmetry is congenital.The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left vein of Labbe is larger probably related to asymmetry in the venous drainage between the 2 hemispheres.There is asymmetry in the size of the superficial temporal veins with the right being larger than the left. No transcortical vasculature is identified.

Output: 1.Some mild thickening at the superior aspect of the intracranial dura on the right is present. This is a nonspecific finding and could represent reparative phase to the prior hematoma. Please correlate with patient's clinical history and imaging demonstrating prior subdural hematoma.2.Asymmetry in the size of the middle meningeal arteries. This is a nonspecific finding. Please note that the entire head was not included on the MRA exam. One possibility is that this may be related to meningeal reaction on the right side.3.There is no evidence for intracranial aneurysm or intracranial cerebrovascular occlusive disease4.There is no evidence for intracranial sinus thrombosis. Asymmetry in the size of the left transverse sinus, sigmoid sinus and jugular vein is most likely congenital.


Instruction: Generate impression based on findings.

Input: Male 37 years old Reason: history of testicular cancer and left RPLND 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: Nonenhancing T2 hyperintense lesion along the left lateral margin of infrarenal IVC measures approximately 2.5 x 1.9 x 6.4 cm and likely represents postsurgical seroma.BOWEL, MESENTERY: Multiple shotty mesenteric lymph nodes do not meet CT criteria for enlargement.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The left testis is surgically absent.

Output: 1.Status post orchiectomy. No evidence of metastatic disease in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: Reason: Possible Wartenberg Syndrome versus neuroma History: numbness in the right forearm The superficial radial nerve is visualized from the bifurcation of the radial nerve proximally to the level of the carpus. The nerve appears normal along its course and we see no mass associated with the nerve. The remaining soft tissues of the forearm appear normal without mass or signal abnormality in the musculature. We see no abnormal enhancement following gadolinium administration. The bone marrow signal intensity is normal.

Output: No mass or other findings to account for the patient's symptoms. Specifically, the superficial branch of the radial nerve appears normal along its course.


Instruction: Generate impression based on findings.

Input: Female, 24 years old. Reason: Rule out ligamentous tear. History of pain and swelling in the left knee. Limited evaluation due to artifact from metallic hardware.MENISCI: There is a vertical tear of the posterior horn of the lateral menisci. The posterior horn of the medial meniscus is abnormally small and fragmented. The anterior horns of both the medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Postsurgical changes related to prior ACL repair with 2 metallic anchors within both the distal femur and proximal tibia. The posterior femoral tunnel extends through the cortex as seen on prior radiograph. The articular cartilage within the medial and lateral compartments appears intact. The arterial cartilage within the patellofemoral compartment appears intact without focal defect.LIGAMENTS: The anterior cruciate graft is not well visualized and likely torn. The posterior cruciate ligament appears intact. The collateral ligaments appear intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Anterior cruciate graft is not well visualized and likely torn.2. Abnormally small posterior horn of the medial meniscus with fragmentation and vertical tear of the posterior horn of the lateral meniscus.3. Popliteal cyst which extends both medially and distally with debris which may represent meniscal fragments.4. Small fluid collection in the anteromedial aspect of the distal femur with surrounding inflammation of the subcutaneous fat which is consistent with a postoperative seroma.


Instruction: Generate impression based on findings.

Input: Hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. However, there is a cystic pineal gland that measures up to 12 mm with linear peripheral enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of inner ear abnormalities or cochlear nerve deficiency.2. Cystic pineal gland that measures up to 12 mm likely represents benign cystic change. However, a one year follow up brain MRI may be considered.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: Rotator Cuff Tear / Frozen Shoulder History: S/P Arthroscopy of Shoulder. ROTATOR CUFF: Supraspinatus tendinopathy but no discrete rotator cuff tear.SUPRASPINATUS OUTLET: Osteophytes and T2 hyperintense signal at the acromioclavicular joint indicating degenerative changes. Small amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Anterior and posterior labral fragmentation consistent with tear. Metallic artifact in the anterior soft tissues as well as screw tract in the femoral head due to prior surgery.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Anterior and posterior labral tears.2.Supraspinatus tendinopathy but no discrete rotator cuff tear.3.AC joint degenerative changes.4.No MR changes suggestive of frozen shoulder, but MR is insensitive for evaluation of frozen shoulder.


Instruction: Generate impression based on findings.

Input: 72 years, Female, gait disorder. There are multiple patchy areas and scattered foci of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with chronic small vessel ischemic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size for age. No abnormal parenchymal or meningeal enhancement is appreciated on the axial post gadolinium sequence. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is minimal mucosal thickening involving the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Moderate chronic small vessel ischemic disease. No evidence of acute infarct, hemorrhage, intracranial mass effect, or hydrocephalus.2. No abnormal enhancement. Please note only single axial post gadolinium sequence was obtained. Per technologist note, patient had a contrast reaction and was transferred to the ER.


Instruction: Generate impression based on findings.

Input: 56 year old female with hepatic encephalopathy. Still with poor mental status. New since prior examination is a focal area of well demarcated low attenuation in the left thalamus. Finding is non-specific and could possibly represent an area of stroke. A follow-up with an MRI is recommended if clinically considered warranted. This examination is otherwise stable. No initial hemorrhage, midline shift or hydrocephalus is detected.

Output: Focal area of low-attenuation in the left thalamus as detailed.


Instruction: Generate impression based on findings.

Input: T2N0 right lateral oral tongue squamous cell carcinoma. The right lateral oral tongue lesion is not discernible. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are intact. The osseous structures are unremarkable. The orbits and imaged intracranial structures are unremarkable.

Output: The right lateral oral tongue lesion is not discernible. No evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Persistent right knee pain s/p injury 6 wks ago MENISCI: There is intrasubstance degeneration of the medial meniscus without acute tear. The lateral meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: There is grade 1-2 chondral thinning in the medial tibiofemoral compartment. The lateral tibiofemoral compartments within normal limits. There is grade 2/3 chondral thinning in the patellofemoral compartment, particularly along the medial patellar facet and lateral femoral condyle. There is focal underlying edema at the patellar apex, likely degenerative.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The lateral collateral ligament complex is intact. There is mild T2 hyperintensity along the medial collateral ligament, suggesting grade 1 sprain. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Grade 1 sprain of the medial collateral ligament.2.Small joint effusion.3.Atypical Baker's cyst.4.Scattered mild chondral thinning, as above.


Instruction: Generate impression based on findings.

Input: PAIN, ROTATOR CUFF TEAR ROTATOR CUFF: Focal fluid intensity replaces supraspinatus tendon at its insertion indicating tear. The tear involves the bursal surface fibers and majority of the tendon thickness with possible sparing of the articular surface fibers. There is approximately 5 mm of retraction of the bursal surface fibers. Tear measures approximately 7 mm in AP dimension. Thickening and increased signal of the remaining supraspinatus tendon indicating moderate tendinosis. Mild atrophy of the supraspinatus muscle. Moderate tendinosis also affects the infraspinatus tendon with small foci of fluid along the myotendinous junction, indicating interstitial tearing. Mild to moderate atrophy of the infraspinatus muscle.Teres minor muscle and tendon are intact. Subscapularis muscle and tendon are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the right AC joint. Small amount of fluid in the subacromial/subdeltoid bursae.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. Increased signal intensity in the superior labrum suggestive of intrasubstance degeneration but no definite tear.BICEPS TENDON: Increased signal of the long head of the biceps tendon as it courses through the rotator interval suggestive of tendinosis and possibly partial thickness tearing.

Output: 1.Focal high-grade insertional tear of the supraspinatus tendon involving the bursal surface fibers.2.Rotator cuff and biceps tendinosis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of decreased rectal tone and back pain, evaluate for lumbar compression. There are apparently 6 lumbar vertebrae based on the position of the iliolumbar ligament. There is mild retrolisthesis of L5 on L6. The vertebral body heights are preserved. There is loss of disc space height at L5-L6 and L6-S1 with corresponding disc desiccation and bulges, which appear to have decreased in size. In conjunction with bilateral facet arthropathy, there is mild bilateral neural foraminal stenosis, but no significant spinal stenosis. The vertebral bone marrow signal is unremarkable. The distal spinal cord and conus medullaris display normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: There are apparently 6 lumbar vertebrae with degenerative spondylosis at L5-L6 and L6-S1 that results in mild bilateral neural foraminal stenosis, but no significant spinal stenosis.


Instruction: Generate impression based on findings.

Input: Pain and weakness with ambulation. Rule out arthritic changes or disc herniation. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Focus of low T1 and low T2 signal at the right S1 level may represent a bone island. Marrow signal changes at the L3-L4 to L5-S1 endplates are on a degenerative basis. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge and bilateral facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Loss of disc height with edema involving the disc and adjacent endplates which is probably on a degenerative basis. There is a disc bulge with partial effacement of the lateral recesses. Mild facet arthropathy. There is moderate to severe left and mild to moderate right neural foraminal stenosis.L4-L5: Disc bulge eccentric to the right and bilateral facet arthropathy. No significant central spinal canal stenosis. Partial effacement of the right lateral recess. There is moderate right neural foraminal stenosis and mild left neural foraminal stenosis.L5-S1: Disc bulge and moderate bilateral facet arthropathy. No significant spinal canal stenosis. There is mild to moderate right and moderate to severe left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine. There is no significant central spinal canal stenosis at any level. Neural foraminal stenoses from L3-L4 to L5-S1 as detailed above.2. There is edema at the L3-L4 disc space and adjacent endplates which is likely on a degenerative basis.


Instruction: Generate impression based on findings.

Input: Left knee pain for 2 weeks with swelling and warmth MENISCI: There is a radial tear of the posterior horn of the medial meniscus that extends into the root. There is mild degeneration of the lateral meniscus without tear.ARTICULAR CARTILAGE AND BONE: Mild cartilage thinning of the lateral compartment with areas of fissuring. Full-thickness cartilage loss in the central weightbearing zone of the medial femoral condyle. Mild chondral thickening and fissuring of the patellofemoral compartment. There is a joint effusion with mild synovitis.LIGAMENTS: The anterior posterior cruciate ligaments appear intact. EXTENSOR MECHANISM: Focal tendinosis of the distal quadriceps tendon.ADDITIONAL

Output: 1. Radial tear of the medial meniscus.2. Advanced atrophy of the gastrocnemius muscle, the etiology of which is not evident on the current exam.3. Degenerative changes of the medial compartment.


Instruction: Generate impression based on findings.

Input: There are postsurgical findings related to decompression of a right subdural hematoma with residual predominantly low T2 and intermediate to high T1 signal subdural collections along the right cerebral convexity measuring up to 8 mm in thickness and along the posterior left cerebral convexity measuring up to 2 mm ni thickness. There is approximately 4 mm leftward midline shift. There is a small area of high T2 signal with restricted diffusion in the inferior right frontal gyrus and a punctate focus of restricted diffusion in the right parietal lobe. There are small areas of encephalomalacia in the left basal ganglia and bilateral corona radiata and several scattered foci of cerebral white matter T2 hyperintensity without restricted diffusion. There are a few scattered foci of susceptibility effect in the bilateral cerebral hemispheres, which may represent chronic microhemorrhages. The ventricles are unchanged in size. The basal cisterns are patent. There is fluid in the bilateral mastoid air cells, which may be related to intubation.MRA HEAD

Output: 1. Postsurgical findings related to decompression of a right subdural hematoma with residual subdural collections along the right cerebral convexity measuring up to 8 mm in thickness and along the posterior cerebral convexity measuring up to 2 m min thickness. 2. Small recent infarcts in the inferior right frontal gyrus and right parietal lobe, with a background of chronic lacunar infarcts in the left basal ganglia and bilateral corona radiata and mild chronic small vessel ischemic disease.3. Significant steno-occlusive disease of the proximal right middle cerebral artery with slight reconstitution distally and the proximal portion of the intradural right vertebral artery is not discernible, which may be due to significant steno-occlusive disease as well, versus developmental severe hypoplasia.4. Post-treatment findings related to stent-coiling of a left anterior cerebral artery aneurysm and a right internal carotid artery aneurysm, without definite patency of the aneurysm sacs. Discussed with Dr. Castro at 12:30 PM on 7/10/16.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Meningioma surveillance. There are postoperative findings related to right orbitozygomaticotemporal craniotomy. There is no significant interval change in the right residual infiltrative enhancing mass that involves the right middle cranial fossa which extends into the right orbital apex, sella, suprasellar cistern, Meckel's cave, right greater than left cavernous sinuses, and right infratemporal fossa. There is unchanged encephalomalacia and gliosis in the anterior right frontal lobe and diffuse patchy areas of cerebral white matter T2 hyperintensity. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are denervation changes involving the right masticator muscles.

Output: No significant interval change in the right residual meningoma that involves the right middle cranial fossa which extends into the right orbital apex, sella, suprasellar cistern, Meckel's cave, right greater than left cavernous sinuses, and right infratemporal fossa.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: Again seen is horizontal tearing of the medial meniscus extending from the posterior horn into the body and portion of the anterior horn. The tearing appears more extensive than the prior examination. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the medial femoral condyle particularly overlying the area of the posterior meniscus. The extent of cartilage loss appears relatively similar to the prior examination. The articular cartilage of the lateral and patellofemoral compartments is thinned but without discrete full-thickness defect. There is redemonstration of a tiny ossicle within the posterior joint space just posterior to the PCL.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Progression of medial meniscal tear.2. Full-thickness cartilage loss of the medial compartment which appears similar to the prior exam. The articular cartilage of the lateral and patellofemoral compartments is thinned but without full-thickness defect.


Instruction: Generate impression based on findings.

Input: Clinical question: Bleed/mass. Signs and symptoms: Headaches, nausea and vomiting. Nonenhanced CT of head:Images through posterior fossa demonstrate ectopia of cerebellar tonsils consistent with Chiari malformation. The inferior pole of cerebellar tonsils are beyond the field of study. There is complete effacement of subarachnoid space at the level of foramina magnum with deformity of cerebellar tonsils. Follow-up with an MRI is recommended.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci and ventricular system remain within normal limits.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Chiari malformation with resultant deformity of cerebellar tonsils and total effacement of subarachnoid space at the level of foramen magnum . CT examination of brain is otherwise unremarkable.2.Recommend follow-up with an MRI examination of brain and including CSF flow study at the level of foramen magnum.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to prior craniotomy for resection of a right parietal arteriovenous malformation. There is minimal residual T2 hyperintensity surrounding the resection cavity compatible with gliosis as well as ex vacuo dilatation of the right occipital horn. There is also thin residual enhancement adjacent to the resection cavity compatible with granulation tissue. There are no dilated flow voids in this region. There is no evidence of acute intracranial hemorrhage or acute infarct. There is no hydrocephalus, midline shift or herniation. The major cerebral flow voids are intact.

Output: Expected evolution of postoperative findings related to resection of a right parietal arteriovenous malformation. No new flow-voids are seen to suggest residual or recurrent AVM.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with history of anaplastic astrocytoma, now off all therapy, compare to prior outside hospital MRIs. Evidence of a small craniotomy is again seen at the high left parietal vertex related to partial resection of a lesion within the left superior frontal gyrus. A bubbly cystic and hemosiderin stained cavity in the superior frontal gyrus is unchanged, and T2 hyperintensity in the surrounding parenchyma has decreased, particularly when compared to the examination of 1/16/2015. A short curvilinear area of mild diffusion restriction along the lateral margin of the cavity is new from prior. An irregular nodule of enhancement within the cystic cavity has not significantly changed from the immediate prior examination. However, this nodule, and previously demonstrated rim enhancement of the cystic tissue, have decreased when compared to older studies. No new enhancement is seen within or adjacent to the cavity, or elsewhere in the brain.Mild ex vacuo dilatation of the left lateral ventricle is unchanged. The remainder of the brain is unremarkable. Ill-defined T2 hyperintensity along the left lateral ventricle likely represents a treatment related effect. No suspicious lesions are seen in the right cerebrum.

Output: Findings are seen compatible with partial resection and subsequent treatment of a tumor within the left superior frontal gyrus. The size and morphology of a bubbly cystic cavity within the gyrus are not significantly changed. T2 hyperintensity surrounding the cavity has diminished when compared to prior examinations. A short curvilinear segment of restricted diffusion along the left lateral aspect of the lesion is new, but this is nonspecific and could reflect a treatment related effect. Attention on subsequent exams will be necessary. An enhancing nodule within the cavity is unchanged compared to the immediate prior study, possibly representing a combination of postoperative granulation and treated tumor. Enhancement in this region is in general reduced when compared to older exams.


Instruction: Generate impression based on findings.

Input: And clinical question: Fall, on Lovenox. Signs and symptoms: Headaches No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. No evidence of intracranial post traumatic finding.Multiple well demarcated lytic lesions of skull are noted. These lesions are well demarcated and demonstrate internal trabeculation. Findings are believed to a multiple skeletal capillary hemangiomas. MRI examination of brain from 10 -- 24 -- 2009 demonstrated several of these lesions.The less likely possibility of metastatic disease however cannot be entirely ruled out.Small hematoma in the right posterior high convexity parietal region is identified on axial image 25.Mastoid air cells, middle ear cavities and limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of intracranial post traumatic findings.2.Multiple well-demarcated and entirely intraosseous lytic skull lesions with internal trabeculation is believed to represent hemangiomas. Less likely possibility of metastatic lesion however cannot be entirely ruled out.3.Right posterior parietal scalp hematoma.


Instruction: Generate impression based on findings.

Input: 45-year-old with leiomyosarcoma presenting with liver failure and decreasing mental status. Assess for cerebral edema. There is no evidence of intracranial hemorrhage or midline shift. A hyperintense focus near the terminus of the right internal carotid artery is worrisome for an aneurysm or metastasis (image 11/34, series 2). Given the patient's history of metastatic malignancy, an MRI/MRA with contrast is recommended for further evaluation and characterization. An additional questionable hyperintense focus is noted more posteriorly (image 22/34, series 2).The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Hyperintense right cerebral lesion. An MRI/MRA with contrast is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Right arm radicular pain with extension of to the neck, assess for cervical spinal instability Cervical vertebral body heights are normal. There is exaggerated cervical lordosis as seen previously. There is mild osseous irregularity involving the cranial aspect of the odontoid process which is minimally progressed since prior study from 2009. There is small amount of fluid at the anterior atlantoaxial joint which is similar to prior. No evidence of cranial settling. Alignment of the craniocervical junction is preserved.Motion degradation slightly limits evaluation. No cord signal abnormality is appreciated. There are moderate multilevel degenerative changes throughout the cervical spine. There is mild progression of endplate degenerative changes at the C6-C7 level compared to 2009.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Left-sided facet arthropathy.C3-4: Small disc bulge and mild bilateral facet arthropathy. No significant compromise to the spinal canal or neural foramina.C4-5: Small disc bulge and bilateral facet arthropathy, relatively worse on the left. No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex with ligamentum flavum thickening contributing to mild spinal canal stenosis at this level. There is facet arthropathy on the left with which contributes to moderate left and minimal right neural foraminal narrowing C6-7: There is a disc osteophyte complex, ligamentum flavum thickening, and facet arthropathy. There is mild to moderate spinal canal stenosis. There is a moderate to severe right and moderate left neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing. Mild bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine which have slightly progressed since prior study from 5/18/2009. There is moderate to severe right C6-C7 neural foraminal stenosis which may be contributing to patient's described arm symptoms. Additional levels as above. No high-grade spinal canal stenosis.2. Mild osseous irregularity involving the odontoid process with mild fluid involving the anterior C1-C2 joint. These findings may be related to degenerative disease or history of rheumatoid arthritis and minimally worse since 2009. Craniocervical junction alignment is preserved on the supine MRI. Flexion-extension radiographs however may be helpful to assess for instability.


Instruction: Generate impression based on findings.

Input: 39 year old male patient with new onset seizure. Evaluate for structural abnormality. The study is slighted limited due to motion artifact and asymmetric positioning. 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. On narrow windows, there is the appearance of subtle increased FLAIR signal of the right cerebral hemisphere and cerebellum, which is favored to represent artifact. 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 a seizure focus, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: S/p craniotomy. Since the prior examination the patient has undergone suboccipital craniotomy. Air bubbles are identified in the suprasellar cistern and other basal cisterns as well as along the craniotomy site.The cervicomedullary junction is partially obscured by artifact.There is hyperdense thickening of tissues within the left cavernous sinus measuring 20 x 10 mm in axial dimensions identified on the recent MRI of the brain exam extending into the left superior orbital fissure.

Output: 1.Since the prior examination and the patient's undergone suboccipital craniotomy. The cervical medullary junction is not well evaluated. This is the location of the patient's known lesion.2.A mass in the left cavernous sinus is not present which is hyperdense on this CT scan appeared it does not appear substantially different than the exam from July of 2006 or the MRI from September of 2010.


Instruction: Generate impression based on findings.

Input: concern for lupus cerebritis, headache No evidence of acute ischemic or hemorrhagic lesion.Re demonstration of the partial right temporal lobectomy (middle and inferior temporal lobe anterior aspect), no change since prior exam.Scattered high signal intensity lesions on bilateral hemisphere on FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of right temporal partial lobectomy since prior exam.3. Non specific small vessel ischemic lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Subarachnoid hemorrhage. Signs and symptoms: Right-sided weakness. Unenhanced head CT:Examination demonstrates a large area of vasogenic edema in high convexity left frontal lobe with resultant effacement of adjacent cortical sulci.Within the region of vasogenic edema there is a superficially located mass measuring approximately 14.3 x 11.5-mm in transaxial dimensions on axial image 22. The prior measurements of this tumor on prior enhanced MRI on 6 -- 9 -- 11 there is 12.6 x 11 0.7-mm in size. This mass demonstrate mildly high-density which may represent minimal internal hemorrhage. There are no prior head CTs for comparison of the density of this mass. There in no evidence of parenchymal or subarachnoid hemorrhage or mass effect on the left lateral ventricle or midline shiftOther than the above described findings the study is unremarkable and in particular no additional similar abnormalities are identified.

Output: 1.Left precentral frontal lobe tumor with minimal internal high density measuring 14.3 x 11.5-mm with extensive surrounding vasogenic edema. The higher than brain parenchyma density of this tumor may represent minimal internal hemorrhage.2.Surrounding vasogenic edema and resultant effacement of the adjacent cortical sulci.3.No evidence of parenchymal or subarachnoid hemorrhage, midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 71-year-old male patient with elevated PSA. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 7.1 x 5.6 x 6.7 (AP x transverse x craniocaudal)Peripheral Zone: No suspicious lesion is identified.Central Gland: There is central gland hypertrophy with BPH nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: There are a few scattered non-specific subcentimeter lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious lesion is identified.2.Enlarged central gland compatible with BPH.


Instruction: Generate impression based on findings.

Input: Bony tenderness. Question of infection. Patient has rheumatoid arthritis per EPIC notes. LIGAMENTS: The scapholunate ligament is disrupted with resulting widening of the scapholunate interval.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted.BONES: There is cortical irregularity with decreased T1 signal and abnormal T2 signal involving the medial triquetrum, the lunate at the scapholunate articulation, the radius at the radiocarpal articulation, the scaphoid laterally, and in multiple sites within the capitate. No fracture is evident. ADDITIONAL

Output: 1. Ganglion cyst and erosive changes of several of the carpal bones and distal radius consistent with rheumatoid arthritis and less likely to be infection. 2. Disruption of the scapholunate ligament.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate left-sided numbness/weakness. Signs and symptoms: Left-sided numbness and weakness. Nonenhanced head CT:There is no detectable intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal. CT is insensitive for detection of early ischemic stroke. If clinical concern persists recommend MRI examination.Calvarium, paranasal sinuses, mastoid air cells and limited views of the orbits are unremarkable

Output: Negative head CT.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal carcinoma status post treatment. Brain: There is no measurable nasopharyngeal tumor. There is persistent diffuse enhancement in the central skull base and pterygopalatine fossae, which is likely treatment related. There are effusions within the bilateral mastoid air cells. There is no evidence of tumor in the cavernous sinuses. There is pansinus mucosal thickening and there are scattered secretions. There are unchanged mild scattered cerebral white matter T2 hyperintense lesions. There is no abnormal intraparenchymal enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is no evidence of acute infarction.Orbits: The bilateral orbits are intact, without evidence of tumors or optic nerve enhancement.

Output: 1. Post-treatment findings without evidence of measurable nasopharyngeal tumor.2. Unchanged mild scattered cerebral white matter T2 hyperintense lesions may represent chronic small vessel ischemic disease. 3. Bilateral tympanomastoid opacification may be attributable to Eustachian tube dysfunction.4. Diffuse paranasal sinus inflammation.5. The orbits are unremarkable.


Instruction: Generate impression based on findings.

Input: History of sinus cancer. Status post chemo/RT 3 -- 09 CT of the soft tissues of the neck with infusion:Images through the skull base demonstrate a large destructive mass with intracranial extension at the level of cribriform plate and planum study done. There is elevation of bilateral frontal lobes (right greater than left) due to spread of tumor from the sinuses into the intracranial space. On this examination no definitive evidence of edema all brain parenchyma and in particular in the frontal lobes is detected. Spread of tumor intracranially is believed to be extradural. MRI examination is recommended to confirm this finding.Destructive mass involves bilateral ethmoid air cells (right greater than left) and the bilateral extension of tumor into the orbits bilaterally (right greater than left. There is no definitive involvement of cavernous sinuses. Tumor within the sphenoid sinus is also noted. Extensive bony destruction of the sinuses is noted. The mass extends inferiorly into the nasal cavity and bilateral maxillary sinuses. There is no definitive evidence of erosion of hard palate. However the mass appears to extend inferiorly to the hard palate. In comparison with the prior examination no definitive appreciable interval change is detected.Images through the soft tissues of the neck demonstrate no definitive adenopathy. New since prior examination is a mixed soft tissue and fluid density on the right which appears to surround the right thyroid cartilage. This is best appreciated on axial images 49 through 56 on coronal images. This finding is best appreciated on on images 48 through 52 there is however no definitive erosion of thyroid cartilage. The exact etiology of this finding is not clear and follow-up with an MRI is recommended.Images through the apices of the lungs demonstrate very large bilateral necrotic cavity forming masses which are new since prior study. Please review dedicated CT of chest performed the same date.CT of brain with infusion.Likely epidural intracranial spread of tumor in bilateral subfrontal region however no parenchymal edema is detected. This examination is otherwise unremarkable.80 cc of Omnipaque 350 was utilized for this study.

Output: 1.Large destructive mass at the skull base with involvement of bilateral ethmoid, nasal cavities, bilateral maxillary sinuses and sphenoid sinus as detailed. There is evidence of extension of tumor intracranially as well. This findings remains stable since prior study.2.No evidence of lymphadenopathy in the neck.3.New since prior examination is a soft tissue and fluid density lesion surrounding the right thyroid cartilage of unknown etiology. Correlate with history and follow up with an MRI is recommended.4.CT of brain demonstrates epidural intracranial spread of tumor in bilateral subfrontal region without edema of the brain parenchyma and with no evidence of leptomeningeal or parenchymal enhancement.


Instruction: Generate impression based on findings.

Input: Unspecified transient cerebral ischemia [435.9], Reason for Study: ^Reason: eval for stroke History: L sided paresthesias Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Few scattered high signal foci on FLAIR images on subcortical white matter are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mucosal thickening of bilateral maxillary sinuses and partial opacification of the right mastoid air cells are seen.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate aberrant right subclavian artery which arises from distal aortic arch, and the right vertebral artery arises from the aberrant right subclavian artery.The right CCA, left CCA, left subclavian artery and left vertebral artery origin appear to be normal.Left vertebral artery is hypoplastic.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. C Spine MRI:The cervical spine is straightened with loss of normal lordosis.The cranial-cervical junction is normal. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. There is no evidence of abnormal enhancement, cord compression or mass.Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: focal central bulging of disc, no neuroforaminal narrowing or spinal stenosis. C4-C5: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. C5-C6: diffuse bulging of disc with central focal protrusion of disc which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis. C6-C7: central to left broad based disc protrusion which minimally narrows left side lateral recess, no spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. No acute ischemic or hemorrhagic lesion on this scan.2. Normal brain MRA.3. Aberrant right subclavian artery otherwise unremarkable neck MRA4. Multifocal various degree degenerative changes of Cervical spine including focal disc herniation at the level of C56, minimal left side lateral recess narrowing at the level of C67.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: subacute cvaSigns and Symptoms: cva, ams MRI of the brainThere is a focus of diffusion restriction present along the inferomedial aspect of the left cerebellar hemisphere measuring approximately 37 x 30 mm in axial dimensions. It is bright on T2 and FLAIR.. There is an additional punctate focus of diffusion restriction present in the left occipital lobe along the left cuneus. There is volume loss associated T2 and FLAIR signal change along the anteromedial and inferior aspects of the frontal lobes bilaterally involving the anterior aspects of the gyrus rectus and adjacent orbital gyri. There is more involvement on the right side than the left. There is some associated susceptibility effect present. These represent foci of encephalomalacia.A small focus of susceptibility effect is present adjacent to the aqueduct.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is not readily identified on this exam.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The left A1 segment is smaller than the right A1 segment. The posterior communicating arteries are not readily identified.

Output: 1.Subacute infarct involving the posterior, inferior and medial aspect of the left cerebellar hemisphere.2.Microinfarct involving the left occipital lobe in the cuneus.3.A small focus of encephalomalacia is present along the right cerebellar hemisphere. One possibility is that this is related to an old focus of infarction4.Small foci of encephalomalacia are present involving the medial right orbital gyrus and gyrus rectus and to a lesser degree left gyrus rectus and a small portion of the adjacent left orbital gyrus. Its location could suggest prior trauma. Please correlate clinical history.5.The left vertebral artery is not identified on small occlusion of the left vertebral artery.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with tracheomalacia, status post substernal goiter removal, vocal cord paresis, neck arthritis. Motion artifact decreases image quality on most sequences. Within this limitation, the following observations are made.Sequelae of left hemithyroidectomy is seen with no evidence of any masslike soft tissue in the operative bed. The right thyroid lobe is slightly heterogeneous and nodular, similar to prior CTs.Two T2 hyperintense, possibly cystic lesions are evident within the nasopharyngeal mucosa, both measuring less than a centimeter in diameter. No other significant aerodigestive abnormalities are seen though please note that subtle lesions of the larynx will not be adequately assessed on this examination due to artifact. The visualized salivary glands are within normal limits. No pathologic adenopathy is detected.A septated T2 hyperintense, T1 hypointense lesion is evident in the right paraspinal region adjacent to the first rib which appears to involve the neural foramina and which measures up to 24 mm in diameter. Similar but smaller appearing lesions are evident within the neural foramina of the adjacent low cervical and upper thoracic levels.

Output: 1.Sequelae of left hemithyroidectomy without suspicious or masslike tissue in the operative bed.2.Two subcentimeter probable nasopharyngeal mucosal cysts are seen.3.Multiple presumably cystic lesions are evident in association with the neural foramina of the low cervical and upper thoracic levels. These most likely reflect prominent perineural root sleeve cysts.


Instruction: Generate impression based on findings.

Input: Further characterization of L3 lesion, incidentally found on MRCP. There is a prominently T2-hyperintense, T1-hypointense, noncontrast enhancing lesion involving the posterior central part of the L2 vertebral body that measures up to 2 cm. This correlates with faint sclerosis on the previous abdominal CT scan. The lesion abuts the inferior endplate, where there is a small intrabody herniation of the disc. The lesion is relatively well circumscribed from the adjacent normal-appearing marrow and shows an incomplete T1 hyperintense rim. A smaller similar lesion is present in L1 vertebral body, also adjacent to an intrabody herniation. Otherwise, the marrow is notable for minimal to degenerative type I signal subjacent to the endplates at T11-T12 and L2-L3 anteriorly. Alignment is notable for sagittal straightening. The vertebral bodies are preserved in height and there is no osseous expansion or destruction. There is disc desiccation and moderate height loss at L3-L4 disc and desiccation without height loss at L4-L5 disc. The spinal canal is fairly preserved with only mild narrowing as described below. The conus medullaris tip is at the lower L1 level which is normal. The conus medullaris has normal shape and signal characteristics.T12-L1 and L1-L2: There is no spinal canal or neuroforaminal stenosis.L2-L3: There is a small (6 mm) left central disc extrusion with caudal migration, which effaces the left lateral recess and may be impinging on the left L3 nerve root. Otherwise, there is no significant spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge that is eccentric to the right resulting in mild narrowing of the right subarticular recess (posteriorly displacing the traversing right L4 nerve root) and barely touches the exiting right L3 nerve root. There is also right more than left mild facet arthropathy and ligamenta flava thickening. Otherwise, there is no significant central spinal canal or neural foraminal stenosis.L4-L5: A disc bulge is eccentric to the left and mildly narrows the left subarticular recess and the left neural foramen. The disc also abuts the left L4 nerve root extra foraminally, where there is also annular fissuring. There is moderate bilateral facet arthropathy and mild ligamenta flava thickening. Otherwise, there is no significant central spinal canal or right neural foraminal stenosis.L5-S1: There is no significant foraminal or spinal canal stenosis.

Output: 1.The T2-hyperintense, relatively well circumscribed lesions in L2 and L1 vertebral bodies without osseous expansion or destruction are nonspecific but may represent atypical hemangiomas. Given the lack of contrast enhancement or known primary cancer, neoplasm is a less likely consideration. However, an initial short-term (1-2 month) follow-up by MRI is suggested or comparison with prior studies if available.2.Relatively mild multilevel degenerative disease as described above.


Instruction: Generate impression based on findings.

Input: Pain. MENISCI: The lateral meniscus is intact. There is a truncated posterior horn of the medial meniscus with abnormal signal intensity seen consistent with a complex tear. Anterior horn of the medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the patella cartilage. Focal full-thickness defects are seen along the middle and lateral facet. There are foci of intermediate signal intensity within the distal femoral and proximal tibial metaphysis, consistent with red marrow. No stress fracture or contusion.LIGAMENTS: ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: Quadriceps and patellar tendons are within normal limits.ADDITIONAL

Output: 1. Complex tear posterior horn medial meniscus.2. Generalized thinning of the patellar cartilage with focal areas of full-thickness cartilage loss along the middle and lateral facet compatible with degenerative change.


Instruction: Generate impression based on findings.

Input: 58-year-old male with HCC, HCV, previous TACE/RFA. Evaluate liver lesion, masses, coronary calcification, vessel patency. ABDOMEN:LIVER, BILIARY TRACT: The known segment 8 ablation cavity measuring 4.5 x 3.4 cm in diameter contains precontrast T1 hyperintense signal (series 13 image 40), which could represent blood products versus proteinaceous material. No nodular enhancing focus of the ablation cavity. The portal and hepatic veins are patent.Posterior to the ablation cavity, there is a 1.1 x 0.7 cm precontrast T1 hypointense (series 13 image 40) lesion that demonstrates arterial enhancement and subtle delayed washout (series 14 images 41, 355) . This lesion also demonstrates T2 hyperintense signal (series 3 image 9) and no significant restricted diffusion. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A focal lesion of the T9 vertebral body demonstrates hyperintense signal intensity on the coronal T2 and axial fat-sensitive sequences most compatible with a benign osseous hemangioma (series 1300 image 15).OTHER: No significant abnormality noted.

Output: Posterior to the segment 8 ablation cavity, there is a 1.1 x 0.7 cm lesion with imaging findings consistent with HCC.


Instruction: Generate impression based on findings.

Input: Right arm pain and numbness, evaluate for disc herniation and nerve root entrapment. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with minimal anterolisthesis of C3 on C4 and C4 on C5 and mild retrolisthesis of C5 on C6 and C6 on C7. The cervical spinal cord has normal signal characteristics with mild dorsal displacement related to malalignment.Degenerative changes are seen throughout the cervical spine including multilevel facet arthropathy, disc osteophyte complexes, as well as loss of disc height at the C4-C5, C5-C6, and C6-C7 levels. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is moderate narrowing of the left neural foramen related to left facet arthropathy and uncovertebral hypertrophy. No significant compromise to the spinal canal or right neural foramen. C4-5: There is mild narrowing of the right neural foramen related to uncovertebral hypertrophy and facet arthropathy. There is partial effacement of the ventral thecal sac. No significant compromise to the spinal canal or left neural foramen. C5-6: There is small disc osteophyte complex and bilateral uncovertebral hypertrophy. There is moderate right neural foraminal narrowing and mild left neural foraminal narrowing. There is mild narrowing of the spinal canal.C6-7: There is disc osteophyte complex and bilateral uncovertebral hypertrophy. There is mild right neural foraminal narrowing and moderate left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative changes of the cervical spine as detailed above. There is up to moderate right neural foraminal narrowing at C5-C6 which may be impinging the right C6 nerve root. No high-grade spinal canal stenosis or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: A 40 year old female with personal history of congenital cleft tricuspid valve requiring tricuspid valve repair presenting for yearly evaluation of heart function. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 103 ml/m2 (normal range: 65+/-11), the LVEDV is 175 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 78 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is very small area of late gadolinium enhancement in the mid inferior wall of unknown significance. This was seen on previous CMR exams. This may represent a previous fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size (73ml).Right VentricleThe right ventricle is severely dilated with mildly decreased systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 130 ml/m2 (normal range 69+/-14), the RVEDV is 221 ml (normal range 110+/-24), the RV end systolic volume index is 68 ml/m2 (normal range 22+/-8), and the RVESV is 115 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated (102ml). Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely, there is thickening of the leaflets and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThere is evidence of tricuspid valve repair with annuloplasty ring present. There is qualitatively mild-moderate tricuspid regurgitation. TR RF (from LV and RV volumes) is < 10%.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with normal systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is small area of late gadolinium enhancement in the mid inferior wall of unknown significance. This was seen on previous CMR exams. This may represent a previous fibrosing, infiltrative, or inflammatory process.3. The right ventricle is severely dilated with mildly decreased systolic function, the RVEF is 48%. 4. Mild right atrium dilation.5. There is evidence of tricuspid valve repair with annuloplasty ring present. There is qualitatively mild-moderate tricuspid regurgitation. TR RF (from LV and RV volumes) is < 10%.When compared to the prior study, the patient's LV and RV volumes are similar, both LV and RV EF are marginally lower, side-by-side assessment of the tricuspid regurgitation is similar.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 55-year-old male with back pain, r le. S/p lumbar decompression. Again seen is a poorly defined lucency within the L4 vertebral body compatible with metastatic disease with pathologic fracture of the inferior endplate of L4 as seen on recent MRI. Severe degenerative disc disease affecting L4/L5 and L5/S1 with relatively mild degenerative disc disease affecting the upper lumbar levels. Moderate facet joint osteoarthritis affects the lower lumbar levels. There are minimal retrolistheses of L4 and L5 that appear stable between flexion and extension views. There is also an approximately 3 mm anterolisthesis of L3 that decreases slightly on extension views. Slight kyphosis of the lumbar spine centered at L3/L4. Mild superior endplate deformity of L2.

Output: Degenerative arthritic changes and metastatic disease as described above.Findings were discussed with Dr. Gina Bradley by phone on 5/15/2015 at 10:50 AM.


Instruction: Generate impression based on findings.

Input: Known left breast cancer, status post index lesion biopsy. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally with numerous scattered foci noted bilaterally. The index malignancy in the left breast near the 11:00 position is well seen as an enhancing mass with internal biopsy clip artifact measuring 2.1 x 1.9 x 2.1 cm. Additionally, projecting anterior and inferior to the proven malignancy, there is extensive nonmass enhancement measuring up to 5.5 x 6.0 cm when the index malignancy is included in measurements. Positionally, the previously noted satellite finding on ultrasound likely resides with the area of non-mass enhancement. Elsewhere in the left breast, there are numerous enhancing foci which appear symmetric when compared to the right side.Two left axillary lymph nodes are mildly asymmetric compared to the right, including a node with mild cortical thickening measuring 5 mm. A non-enhancing high T2 lesion near the skin of the left axilla is compatible with a benign skin cyst. No suspicious enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: Index left breast malignancy measures up to 2.1 cm and is associated with extensive nonmass enhancement, with total measurements up to 6.0 cm. Mildly suspicious axillary lymph nodes also noted. Depending on planned surgical management, ultrasound guided biopsy of the satellite lesion seen on the prior ultrasound and a left axillary lymph node can each be considered. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 7/14/2015 biopsy showed 3+4 disease in the left mid and left base. PELVIS:PROSTATE:Prostate Size: 3.1 x 4.9 x 4.3 cmPeripheral Zone: Infiltrative T2 weighted hypointense signal of the left mid gland through base measuring up to 2.4 x 2.0 cm (series 1001/19) and involving the transition zone . This is associated with restricted diffusion and early arterial enhancement.Central Gland: No significant abnormality noted. Seminal Vesicles: No cystic evidence of seminal vesicle invasion.Extracapsular Extension: The lesion has a broad based abutment with the neurovascular bundle, bulging and suspected extraprostatic extension (series 1301/image 17).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large tumor infiltrating the left mid gland to base with broad abutment with the neurovascular bundle and suspected focal extraprostatic extension. No pelvic lymphadenopathy or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: Meningioma: paresthesias. Brain: There are postoperative findings related to left pterional craniotomy. There is no measurable tumor in the region of the left sphenoid wing. There is no evidence of acute intracranial hemorrhage or infarct. There is minimal unchanged encephalomalacia along the anterior left temporal pole and left anterior basal ganglia. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged. Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are slight disc-osteophyte complexes at C4-5 and C5-6, but no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Stable postoperative findings without evidence of intracranial tumor recurrence.2. Minimal unchanged encephalomalacia along the anterior left temporal pole and left anterior basal ganglia. 3. No significant spinal canal or neural foraminal stenosis in the cervical spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial bleed and or obstructive hydrocephalus. No schizencephaly. Signs and symptoms: Emesis, irritability, I and head deviation to the left. CT of brain without infusion:There is significant interval increase in the size of fourth ventricle since prior examination. Prior MRI demonstrated normal size of the fourth ventricle. On the current exam expanded fourth ventricle upright mass effect on the pons and causes significant deformity of the quadrigeminal plate and appears to extend across the tentorium into the supra-tentorial space. Significant congenital deformity of bilateral schizencephaly with extensive extra axial CSF collection is again identified. There is bilateral larger extension of CSF into the extra-axial space with associated mass effect on the brain parenchyma since prior study.No evidence of hemorrhage is detected. Linear very high density material along the ependymal lining of the left temporal horn and occipital horn of the lateral ventricle are present calcification. These findings were noted on prior exam.

Output: 1.Significant interval enlargement of fourth ventricle since prior study.2.Larger amount of CSF in the extra-axial space with further increased mass effect on the brain parenchyma.3.Microcalcifications along the ependymal lining of the left lateral ventricle stable since prior study.4.No evidence of intracranial hemorrhage as clinically questioned.


Instruction: Generate impression based on findings.

Input: 71-year-old female with a history of breast cancer and with acute back pain. Evaluate for discitis. There is straightening of the lumbar curvature appearing similar to the prior exam. There is also some dextroscoliosis of the lower lumbar spine as seen on the recent radiograph. The vertebral body heights are preserved. There is variable disc height loss in the upper lumbar spine most prominent at the L2-3 level. Additional endplate degenerative changes including Schmorl's nodes are seen in the L1-L4 vertebral levels. There has been no significant change in edema and enhancement involving the left aspect of the superior L4 endplate which is likely on a degenerative basis. There is no evidence of discitis. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology and terminates at the L1 level. The paravertebral soft tissues are unremarkable. Degenerative changes are seen in the cervical spine as described below:T12-L1 and L1-L2: Mild loss of disc height and without significant disc protrusion or neural foraminal or spinal canal compromise. L2-L3: Moderate disc disease with a small disc bulge and mild facet arthropathy. Minimal right neural foraminal narrowing. No spinal canal stenosis.L3-L4: Moderate disc disease, minimal disc bulge and mild facet arthropathy. No significant compromise of the spinal canal and neural foramina.L4-5 and L5-S1: Mild disc disease without disc bulge or compromise of the spinal canal or neural foramina.

Output: 1.Redemonstration of mild degenerative changes throughout the lumbar spine without evidence of discitis. 2.No significant change in edema and enhancement involving the left aspect of the superior L4 endplate likely on a degenerative basis.3.No evidence of metastatic disease in the spine. No compression fractures.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, history of lower extremity weakness, pain, fecal incontinence. Brain:Patchy periventricular T2 hyperintensity is identified, a nonspecific finding which likely reflects chronic microvascular ischemic disease. No evidence of restricted diffusion is seen to suggest acute ischemia.No parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen.There is no evidence to indicate significant intracranial hemorrhage or any abnormal extra-axial fluid. The ventricular system is within normal limits for size.Lumbar:Fluid-filled defects are evident running through both sacral ala most compatible with fracturing. The soft tissues and marrow surrounding the defects demonstrate pronounced enhancement. On the left, there is a fluid component with rim enhancement which projects from the defect into the posterior paraspinal soft tissues.No abnormal marrow signal or pathologic enhancement is demonstrated within the midline aspects of the sacrum. The sacrum is truncated at the S3 level. There appears to be a small ventrally angulated bony fragment below the S3 level which is suggestive of a prior distal sacral fracture. The presacral soft tissues demonstrate marked edema with strandy enhancement, but no discrete or rim-enhancing collections are seen.Spinal alignment is otherwise unremarkable. The remaining vertebral bodies demonstrate normal signal intensity and morphology allowing for scattered intraosseous hemangiomas.The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Severe facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Moderate generalized spinal canal stenosis, particularly in the transverse dimension. Severe bilateral foraminal narrowing. L5-S1: Severe facet hypertrophy. No significant spinal canal stenosis. No significant neuroforaminal narrowing.

Output: 1.Bilateral fluid-filled defects in the sacral ala likely represent insufficiency fractures. The presence of enhancement within and along the fracture margins could simply be the result of reparative granulation which would indicate a subacute time course. Likewise, the presence of fluid within the defects, and projecting into the posterior soft tissues on the left, could represent inflammatory reaction. The possibility of superinfection is not excluded, though, and correlation with clinical and laboratory parameters is suggested. If a better anatomic assessment of the bony deformity is desired, further imaging with CT can be considered.2.Presacral soft tissue edema is also seen without evidence of any discrete rim-enhancing collections. As above, this may reflect a reactive process, but the precise nature of this inflammation is uncertain.3.Evidence to suggest a prior chronic distal sacral fracture.4.Degenerative findings most pronounced at L4-5 where posterior element hypertrophy results in a moderate spinal canal stenosis and significant bilateral foraminal narrowing.5.Apart from chronic microvascular ischemic disease, no significant intracranial abnormalities are detected.