Instruction: Generate impression based on findings.

Input: 24-year-old male patient with history of Crohn's disease. Evaluate extent of disease and evaluate for small bowel disorder. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is bowel wall thickening, increased T2 signal, pericolonic edema, and hyperenhancement of a 20 cm segment of colon from the splenic flexure to the sigmoid colon. There is narrowing of the bowel caliber in this segment with loss of normal bowel features. At the transition to normal bowel, there is focal narrowing (series 5 image 21). In this area there is thickening of the adjacent abdominal wall and increased T2 signal, which may represent postoperative changes versus a sinus tract.There is mild bowel wall thickening, increased T2 signal, and enhancement of the distal 10 cm of rectosigmoid colon.The terminal ileum is within normal limits. No evidence of small bowelBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with acute on chronic inflammation in a segment of the descending colon with focal narrowing as described above, compatible with history of Crohn's disease.2.Mild rectosigmoid inflammatory changes.3.No evidence of small bowel involvement.4.Thickening of the abdominal wall and increased T2 signal adjacent to the focal narrowing in the sigmoid colon may represent postoperative changes versus a sinus tract.


Instruction: Generate impression based on findings.

Input: Post contrast images are slightly limited by patient motion. There is a prominent left frontal extra-axial mass which is T1 isointense to brain parenchyma and T2 hypointense, with associated scattered susceptibility. There is calvarial remodeling noted along the left frontal calvarium in this location, although without significant asymmetric hyperostosis. There is significant underlying left frontal lobe parenchymal T2/FLAIR hyperintensity as well as mild to moderate localized mass effect on the periphery of the left frontal lobe. The heterogeneously enhancing mass measures 2.2 x 2.9 cm in greatest axial dimensions on 14/131, x 2.8 cm oblique CC 1401/88. There is adjacent dural thickening and enhancement suggesting a dural tail. There is subtle blunting of the anterior body of the left lateral ventricle due to the minimal mass effect from vasogenic edema, as well as left frontal sulcal effacement.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes. There is a nonspecific punctate focus of susceptibility in the central pons which may relate to chronic hemosiderin deposition or mineralization. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There are a few questioned areas of subtle focal prominence along the distal cavernous left internal carotid artery for example on 1100/120 and 1101/117, which appear somewhat triangular shaped and may represent tiny infundibulum. The midline structures and craniocervical junction are within normal limits. There is also incidental hyperostosis frontalis interna.

Output: 1. Heterogeneously enhancing left frontal extra-axial mass with localized mass effect and underlying prominent left frontal lobe vasogenic edema with minimal deformity of the anterior body of the left lateral ventricle. Associated enhancing dural tail suggests that this mostly likely represents a meningioma, with osseous remodeling. Differential diagnosis would include a dural metastasis.2. Mild-moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 24-year-old female with Li Fraumeni syndrome, history of breast cancer, glioblastoma, and known hepatic masses. Family history of sarcoma. NECK: A 9 mm lesion in the inferior pons with T1 hyperintensity and peripheral T1 and T2 hypointensity is compatible with a cavernoma, better characterized on dedicated MR Brain performed on the same day. A right maxillary sinus mucous retention cyst. The thyroid is within normal limits. No significant lymphadenopathy. CHEST: No significant pulmonary consolidation. No significant lymphadenopathy. ABDOMEN: Redemonstrated are multiple liver lesions that are better characterized on same day MR Abdomen. Several of these lesions ate T1 bright suggestive of fat. Spleen is normal in size. No adrenal gland lesions. No evidence of bowel obstruction. No hydronephrosis.PELVIS: Right ovary is not visualized. A left ovarian T2 hyperintense cyst is present measuring 8 mm. No evidence of bowel obstruction. No significant lymphadenopathyTHIGHS:No suspicious osseous lesions are evident. No soft tissue lesions are evident.

Output: 1.Findings compatible with a cavernoma in the pons. This is better characterized on dedicated same day MR Brain. 2.Multiple liver lesions, two of which contain fat, suggestive of lipoma are again noted. Additional lesions are better characterized on dedicated MR Abdomen. Please see same day MR Abdomen for further characterization of all lesions. 3.No additional lesions in the neck, chest, pelvis, or thighs.


Instruction: Generate impression based on findings.

Input: Ms. Skoog is a 54 year old female who initially presented with a palpable thickening/tenderness in the left breast with subtle sonographic findings. She presents for same day MR evaluation and US guided biopsy of this area in the left breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.LEFT BREAST:Spanning the entire left upper outer breast, there is diffuse abnormal enhancement seen measuring approximately 6.6 x 4.0 x 6.9 cm (AP x ML x SI). The measurement in the AP oblique plane is approximately 10.3 cm. The enhancement extends from the pectoralis muscle into the nipple itself. Although the enhancement abuts against the pectoralis muscle, a discrete fat plane is seen and the pectoralis muscle is of normal contour and enhancement pattern. RIGHT BREAST: No abnormal enhancement is seen in the right breast. AXILLA:No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 10.3 cm span of diffuse abnormal enhancement seen in the left upper outer breast, spanning from the pectoralis muscle to the nipple. An US guided biopsy will be performed later day. (2) No MRI evidence of malignancy in the right breast. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 79-year-old male with PSA recurrence after prostatectomy in 2006.PSA of 1.76. Examination is limited given no endorectal coil per patient.PELVIS:PROSTATE: Status post prostatectomy. No definite enhancing soft tissue in the prostatectomy bed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness and numbness. Assess for worsening stenosis. Cervical spine: There is reversal of the usual cervical lordosis. The vertebral bodies are preserved in height. There is mild disc height loss at C3-C4 through C6-C7 with loss of T2 signal. There is mild degenerative marrow endplate signal alteration at C6-C7. Otherwise, there is no significant vertebral bone marrow abnormality. There is no abnormal spinal cord signal. The imaged portions of the brainstem and upper thoracic spinal cord are unremarkable.C2-C3: There is mild right neural foraminal stenosis by facet arthropathy. There is no spinal canal or left neural foraminal stenosis.C3-C4: There is a disc-osteophyte complex that results in moderate spinal canal stenosis, indenting the ventral aspect of the spinal cord. In addition, uncovertebral arthropathy causes severe foraminal stenoses bilaterally.C4-C5: There is a disc-osteophyte complex that causes mild spinal canal stenosis. In addition, uncovertebral and facet arthropathy result in severe foraminal stenoses bilaterally.C5-C6: There is a disc-osteophyte complex that results in moderate-to-severe spinal canal stenosis. In addition, right greater than left uncovertebral and facet arthropathy results in severe foraminal stenoses.C6-C7: There is a disc-osteophyte complex and ligamenta flava thickening result in mild spinal canal stenosis. Left more than right uncovertebral and facet arthropathy result in severe left and moderate right foraminal stenoses bilaterally.Lumbar spine: The lumbar spine alignment is anatomic. The vertebral bodies are preserved in height. There is mild loss of disc height and T2 signal at L2-L3 through L5-S1. There is an inferior L4 endplate Schmorl node. There is abnormal contrast enhancement involving the L3-L4 facets, worse on the right, also degenerative in nature. The conus medullaris has its tip at the upper L2 level. The conus medullaris and included caudal part of the spinal cord display normal signal and morphology. There are degenerative changes involving the sacroiliac joints, as manifested by bridging osteophytes. There are multiple bilateral renal cysts.T12-L1: There is no significant disc herniation, spinal canal stenosis or foraminal stenosis.L1-L2: There is no significant spinal canal or foraminal stenosis.L2-L3: There is a disc bulge, mild ligamentum flavum thickening, and facet arthropathy, without significant spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge with a small right paracentral protrusion, ligamentum flavum thickening, and facet arthropathy, which result in moderate central and right paracentral spinal canal stenosis, as well as mild bilateral neural foraminal stenoses.L4-L5: There is a disc bulge that is eccentric to the left, which along with ligamentum flavum thickening and facet arthropathy results in mild bilateral neural foraminal stenoses, but no significant spinal canal stenosis. There is a small posterior left facet joint synovial cyst.L5-S1: There is central disc bulge and bilateral facet arthropathy associated with mild foraminal stenoses bilaterally, but no significant spinal canal stenosis.

Output: 1. Degenerative cervical spondylosis at C3-4 through C5-6 with associated mild indentation of the spinal cord and extensive bilateral neural foraminal stenoses. 2. Multilevel degenerative lumbar spondylosis consists of moderate spinal canal stenosis at L3-4, as well as mild bilateral neural foraminal stenoses at L3-4 though L5-S1.


Instruction: Generate impression based on findings.

Input: 58 year-old male status post tonic-clonic seizure on heparin infusion. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal regions of diffuse hypodensity in a periventricular distribution within the deep white matter is consistent with small vessel ischemic disease, age indeterminate. No new cortical stroke is seen.Focal area of left posterior parietal encephalomalacia consistent with previous ischemia. If there is clinical concern for acute ischemia, an MRI may be considered.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: Multifocal regions of small vessel ischemic disease, age indeterminate. No definite cortical stroke is seen. If there is clinical concern for acute ischemia, an MRA may be considered.


Instruction: Generate impression based on findings.

Input: Retracting right-sided intraventricular clot and hydrocephalus with known midline shift. The images are generally degraded by patient motion. There is intrinsic T1 hyperintensity and susceptibility effect centered in the right caudothalamic groove region, as well as within portions of the lateral ventricle margins. There is dilatation of the third and bilateral lateral ventricles, left greater than right. There are linear bands within the right lateral ventricle, which may represent involuted blood clots and adhesions. There also appears to be cerebral volume loss, particularly in the left cingulate gyrus and frontal lobe region. There is mild patchy T2 hyperintensity along the right coronal radiata. There is mild midline shift to the right. There is no definite evidence of acute infarction. There is mild prominence of the subarachnoid spaces in the right frontal convexity region. The skull and extracranial structures are unremarkable.

Output: Sequela of right germinal matrix hemorrhage with retracted clot and ventriculomegaly that appears to be attributable to hydrocephalus superimposed upon cerebral volume loss.


Instruction: Generate impression based on findings.

Input: 24-year-old male with history of dermatofibrosarcoma sarcoma protuberans in the abdomen. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post surgical changes in the left rectus abdominis muscle. There is no abnormal focus of enhancement.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of a resection in the left anterior abdominal wall without specific evidence of local recurrence.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Hx of single brain met from breast cancer s/p resection. Now with worsening headache on left side. Evaluate resection cavity, edema, and for additional mets History: Hx of rectal carcinoid cancer in 2011 and breast cancer in 2009. Previously described about 3.4cm x 2.5cm sized left middle frontal gyrus resection cavity is again seen. Pre contrast T1 weighted images show subtle somewhat patchy high signal intensity within the resection cavity which shows low signal intensity on T2 weighted images, thus indicating possible evolving blood products. Relatively thick susceptibility artifacts following the margin of resection cavity indicate postoperative blood products again much lessen than prior.Surrounding edema around the resection cavity also decreased in its extent since prior scan.On Gad enhanced scan, previously seen enhancing margin surrounding the resection cavity now shows lesser degree of enhancement. In addition, the enhancement pattern is smoother than prior which showed somewhat nodular enhancement. There is diffuse thick enhancement of overlying dura which likely represent postoperative changes. Overlying scalp swelling appears to be resolved.There is no evidence of new abnormal enhancing nodular lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no 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. Post resection status of the left middle frontal gyrus lesion with expected postoperative changes. 2. There is no evidence of residual mass.3. There is no new abnormal enhancement on this scan.4. There is no evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Seizure followed by by left-sided weakness. Rule out ischemia. The left lateral ventricle is slightly larger than the right but without surrounding parenchymal signal abnormality. This is probably a normal variation. Otherwise, the CSF-containing spaces are normal in size. The brain shows no diffusion restriction or susceptibility artifact. There is no space-occupying brain lesion, midline shift or brain herniation. Gray-white differentiation is preserved. Major intracranial vascular flow voids are preserved. There is no destructive skull lesion or scalp abnormality. An 8 mm, well-circumscribed, homogeneously T2-hyperintense lesion within the mucosa along the nasopharyngeal wall, to the left of midline, is probably a small mucous retention cyst.

Output: Normal brain MRI examination.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with numbness on the right side of the penis. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male 13 years old Reason: evaluate aorta and bicuspid aortic valve History: headaches, chest pain Left VentricleThe left ventricle is normal in size. 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.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size.Right AtriumThe right atrium is normal in size. Aortic ValveThe bicuspid aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation however there is some dephasing superiorly concerning for stenosis. Peak velocity is 2.3 m/sMitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe aortic Valsalva sinus is slightly dilated. The ascending thoracic aorta is normal in size. There is a left sided aortic arch. High takeoff of right and left coronary arteries just above the sinus of ValsalvaAORTA MEASUREMENTS: aortic valve ring: 15.2 mmsinuses of Valsalva: 26.1 mmsinotubular junction: 13.7 mmascending aorta: 17.9 mmaortic arch: 18 mmdescending aorta: 15.2 mmdiaphragmatic hiatus: 12.5 mmPulmonary ArteryThe main pulmonary artery is normal in size. PULMONARY ARTERY MEASUREMENTS:MAIN: 16.8 mmRIGHT: 9.3 mmLEFT: 8.8 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.FUNCTIONAL:AORTA FLOW QUANTITATION: Stroke volume in ml: 58.9Forward flow volume in ml: 61.1Backward flow volume in ml: 2.29Regurgitant factor in %: 3.7PULMONARY ARTERIES FLOW QUANTITATION:Main pulmonary arteries flow quantitation values are as follows:Stroke volume in ml: 51.1Forward flow volume in ml: 51.3Backward flow volume in ml: 02.244Regurgitant factor in %: 0.5Extracardiac FindingsVisualized osseous structures look intact. Partial visualization of the solid organs and hollow viscus of the upper abdomen are of normal characteristics.

Output: 1. Mild aortic valve stenosis with a peak velocity of 2.3 m/s. 2. High takeoff of right and left coronary arteries just above the sinus of Valsalva3. Status post aortic coarctation repair with postsurgical changes of tortuosity but no stenosis.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: Reason: Sudden onset loss of smell, evaluate olfactory nerve History: anosmia, evaluate olfactory nerve The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially including olfactory region. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No intracranial lesion is appreciated which can explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Left long-standing closed click. The mandibular condyles translate anteriorly in the appropriate fashion on jaw opening. The temporomandibular joint disc also translates in the appropriate fashion and we see no specific findings to account for the patient's clicking. We see no temporomandibular joint effusion. There is a tiny focus of fluid signal intensity noted along the superolateral aspect of the right temporomandibular joint which may represent a small synovial cyst or ganglion. No frank osteoarthritic changes or erosions are identified.

Output: 1. Normal appearing left temporomandibular joint.2. Possible small synovial cyst or ganglion along the right temporomandibular joint which is not necessarily of any clinical significance. Otherwise, the right temporomandibular joint appears normal.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB:7/11/1986)Reason: high suspicion for pituitary adenoma History: severe headache, menorrhagia, bilateral galactorrhea progressively worse over past 3 yearsPROVIDER/ATTENDING NAME: MONICA CHRISTMAS MONICA CHRISTMAS MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is is tilted towards the left. The pituitary gland appears somewhat heterogeneous and enhancement pattern especially along its posterior right lateral and left lateral aspects.. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: No convincing evidence for pituitary lesion is appreciated. However, the infundibulum of the pituitary gland is tilted which raises suspicion for an underlying lesion on the right side.


Instruction: Generate impression based on findings.

Input: 29-year-old male patient with cystic focus medially adjacent to and continuous with the bulbous urethra on ultrasound. 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: There is an oblong nonenhancing T2 hyperintense midline structure within the region of the bulbous urethra which measures approximately 4.0 x 1.3 x 1.2 cm in the AP by craniocaudal by transverse dimensions (image 27, series 6 and image 52, series 5). This cystic structure appears to be in continuity with the urethra posteriorly. Furthermore, there is the suggestion of a lip of tissue separating this structure from the urethra anteriorly (image 28, series 6). The bladder is nondistended. The prostatic urethra is decompressed.

Output: Midline cystic structure which appears to be in continuity with the bulbous urethra; this could represent an anterior urethral valve, anterior urethral diverticulum, or less likely a Cowper's syringocele given location. Retrograde urethrogram may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Cervicalgia. Disturbance of skin sensation. Pain in limb. Cervical radiculopathy. Signs and symptoms: Right arm numbness, right arm pain, neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.There is a T2 hyperintense lesion present along the C5 vertebral body measuring 6 mm in diameter which is eccentric towards the left side of the vertebral body. It is centrally hypointense.There is a 10 mm lesion present within the T2 vertebral body eccentric towards the right side and associated with spiculations within it. This is suspicious for a atypical hemangiomaAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal . There is a right lateral recess disc protrusion present at this level associated with narrowing of the right neural foramen and mild encroachment of the right-sided exiting nerve roots..At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a small disc protrusion present at C5-6 associated with mild encroachment of the right-sided exiting nerve roots.2.A couple osseous lesions are present within the C5 and T3 vertebra. These are nonspecific and incidental. It is possible that these represent atypical hemangiomas, however, CT scan may help confirm this.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review is breast MRI (4/11/2015) performed at Little Company of Mary Hospital in Evergreen Park, IL. For comparison, prior mammograms and ultrasounds dating back to February 28, 2015 are available. Bilateral breast MRI was performed per outside hospital protocol without and with gadolinium based contrast.There are scattered fibroglandular tissue with moderate background parenchymal enhancement bilaterally. Multiple foci of enhancement are present throughout both breasts, none uniquely enhancing. An enhancing mass is noted at the approximate 11 o'clock position of the right breast, mid depth, which contains susceptibility artifact from a biopsy clip, compatible with the patient's known malignancy. This mass measures 2.0 x 1.5 x 2.1 cm. Approximately 1.1 cm medial and slightly anterior to the index lesion is a linear area of non-mass enhancement measuring 1.8 x 0.6 x 1.8 cm.No suspicious areas of enhancement are present within the left breast.No abnormal lymph nodes are present within the axillae.

Output: 1. Enhancing mass measuring 2.1 cm at the approximate 11 o'clock position of the right breast, compatible with the patient's biopsy proven malignancy.2. Linear area non-mass enhancement within the upper slightly inner right breast. MR guided Second Look ultrasound is recommended for further characterization and possible biopsy. If no sonographic correlate is identified, MR guided biopsy of this area the enhancement is recommended.3. Multiple foci of enhancement throughout both breasts, none uniquely enhancing. Six month follow-up MRI is recommended to assess stability.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 56-year-old female with history of hypoattenuating lesion in the pancreatic head on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Nonenhancing right hepatic lobe simple cyst. No suspicious hepatic lesion. No intrahepatic or ductal dilatation. The common bile duct appears normal. There is a punctate cyst in the inferior aspect of the right lobe of the liver.SPLEEN: No significant abnormality noted.PANCREAS: There is a T2 hyperintense lesion located within the pancreatic head correlating with prior CT findings (image 20 of series 801). Although this study is limited especially after contrast administration due to patient's body habitus and poor signal, no appreciable enhancement is present. There may be communication with the uncinate process duct (image 4 of series 1401).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small cystic lesion in the uncinate process of the pancreas likely represents a branch-type IPMN.


Instruction: Generate impression based on findings.

Input: Male 72 years old Reason: PET shows FDG uptake in left adrenal gland. MRI adrenal advised. Please assess for malignancy. History: HL on active therapy ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. The liver dome is incompletely imaged on this study.SPLEEN: Multiple subcentimeter lesions within the spleen which are isointense to fat on T2 weighted images and demonstrate arterial enhancement. These are nonspecific but may represent hemangiomas. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2.3-cm lesion within the left adrenal gland, isointense to the spleen on T2 weighted images. This is stable in size compared to remote CT 11/06/14. This demonstrates diffusion restriction and on out of phase images the majority of the lesion does not demonstrate signal drop out and it therefore is not compatible with a fat rich adenoma. The right adrenal gland is unremarkable. KIDNEYS, URETERS: Multiple T2 hyperintense lesions both kidneys are most consistent with renal cysts.RETROPERITONEUM, LYMPH NODES: Subcentimeter retrocrural lymph nodes are nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.2.3-cm left adrenal lesion is stable in size compared to prior study. This does not meet criteria for a fat rich adenoma and is indeterminate. Continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Pancreatic lesion found incidentally on CT ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology, no suspicious liver lesion. Adenomyomatosis of level of the gallbladder fundus. Rounded foci of signal void on T2-weighted sequence seen layering in gallbladder, corresponding T1 hyperintensity seen, findings consistent with pigment gallstones.SPLEEN: Splenomegaly, measures 14 cm in longitudinal dimension. 1.4 cm splenule.PANCREAS: At junction of pancreatic head and uncinate process is well-circumscribed 1.1 x 1 cm T2 hyperintense focus, likely a sidebranch intraductal papillary mucinous neoplasm. No suspicious nodularity or enhancement delineated. Nondilated pancreatic duct. Intrinsic T1 signal of pancreatic parenchyma is relatively maintained. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple varices. Small retrocrural, periportal and retroperitoneal lymph nodes, likely reactive in setting of chronic liver disease.BOWEL, MESENTERY: Percutaneous gastrostomy located in distal gastric body. Edematous bowel, likely reactive in etiology/related to hypoalbuminemic state. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of ascites. Moderate-sized left pleural effusion. Left-sided retroperitoneal hematoma formation seen on prior CT study not well assessed on current exam.

Output: 1. Well-circumscribed 11 mm nonenhancing T2 hyperintense focus located at junction of pancreatic head/uncinate process likely a sidebranch IPMN, no suspicious features depicted. Accounting for differences in technique and absence of intravenous contrast on earlier study, lesion was likely present on earlier noncontrast CT study from March 2015 (refer to image 42 series 3 on 3/23/15 CT study). 2. Cholelithiasis.3. Stigmata of cirrhosis, including nodular liver, splenomegaly and variceal formation. Large ascites and moderate-sized left pleural effusion.


Instruction: Generate impression based on findings.

Input: 41 years Male (DOB:10/25/1975)Reason: memory issues History: ? FTDPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.

Output: MRI of the brain is within normal limits. Incidental note is made of partial empty sella


Instruction: Generate impression based on findings.

Input: History of optic neuritis with left hemifacial spasm. Evaluate for demyelinating disease. There is no evidence of intracranial hemorrhage, mass effect, or acute infarct. There are minimal scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter and along the undersurface of the corpus callosum. There is no abnormal leptomeningeal or parenchymal enhancement. No lesions within the brainstem. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is a right lens implant. Dedicated orbital study was not obtained however there is some T2 hyperintense signal involving the left optic nerve (coronal T2 image 9/34) which may represent sequela of prior optic neuritis.

Output: 1.No evidence of intracranial hemorrhage, mass effect, or acute infarct.2.Several scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter are seen; while these are nonspecific, several of these lesions are in a periventricular distribution and at the calloso-septal interface raising suspicion for chronic demyelinating disease. No abnormal enhancement to suggest active demyelination.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left oral tongue squamous cell carcinoma status post left partial glossectomy, lymph node dissection, and radial forearm free flap reconstruction and left thigh skin graft to donor site. There are interval postoperative findings related to left partial glossectomy with flap reconstruction and lymph node dissection. There is no evidence of measurable residual tumor in the oral cavity. There is no residual significant cervical lymphadenopathy either. The thyroid, parotid glands, and remaining right submandibular gland are unremarkable. The osseous structures are unchanged. The orbits and imaged intracranial structures also appear unremarkable.

Output: 1. Interval postoperative findings in the oral cavity, without evidence of measurable residual tumor. 2. Interval left neck dissection, without evidence of residual significant lymphadenopathy.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 60 seconds

Output: Successful injection of lidocaine and steroid into the right hip joint.


Instruction: Generate impression based on findings.

Input: Male 65 years old Reason: to be done 3/ 2015. Side Branch IPMN r/o growth. Need MRI gad / MRCP secretin History: to be done 3/2015. Side Branch IPMN r/o growth. Need MRI gad / MRCP secretin. ABDOMEN:LIVER, BILIARY TRACT: Signal dropout on in phase images suggestive of iron deposition. SPLEEN: Signal dropout on in phase images suggestive of iron deposition. PANCREAS: Again seen is a nonenhancing cystic lesion in the head of the pancreas which communicates with the main pancreatic duct. This measures 1.1 x 0.9 cm (series 5, image 40), not significantly changed compared to prior study allowing for differences in imaging technique and compatible with a side branch IPMN. A smaller 4 mm cystic lesion superior to this is also unchanged (series 5, image 33). As on prior study, this does not demonstrate definitive communication with the duct. An additional 3 mm nonenhancing cystic lesion (series 5, image 47) arises from the main duct downstream from the dominant cystic lesion and also likely represents a smaller sidebranch IPMN and appears unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintensities within the kidneys are suggestive of renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Again seen are two cystic lesions within the pancreas likely representing side branch IPMNs as described above. These are unchanged compared to prior study.2.Additional cystic lesion which does not demonstrate definite communication with the pancreatic duct is also unchanged, most likely an additional IPMN.3.Findings suggestive of iron deposition within the liver and spleen.


Instruction: Generate impression based on findings.

Input: Headache. There are multiple small foci of T2 hyperintensity in the bilateral cerebral white matter, pons, and bilateral basal ganglia and thalami. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: Multiple small foci of T2 hyperintensity in the bilateral cerebral white matter, pons, and bilateral basal ganglia and thalami are nonspecific and may represent chronic ischemic disease or the sequela of a demyelinating or inflammatory process, but no evidence of acute infarct or mass lesions.


Instruction: Generate impression based on findings.

Input: 65-year-old female with history of NSCLC with leptomeningeal carcinomatosis. Receiving IT chemo. MRI BRAIN: When compared to the prior MRI brain study dated 10/1/2015 there is been interval placement of a right frontal approach Ommaya catheter with tip terminating within the left lateral ventricle near the foramen of Monro. There is T2/FLAIR hyperintensity surrounding the course of the catheter which may represent edema or gliosis. Small amount of pneumocephalus. There is abnormal layering diffusion signal within the occipital horns of the lateral ventricles which may be related to blood products or other material.No abnormal parenchymal or leptomeningeal enhancement. No intracranial mass or mass effect. No midline shift or herniation. The paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.MRI COMPLETE SPINE: Cervical spine:Alignment is maintained with no acute fractures or subluxation. No abnormal marrow signal or enhancement is noted. The craniocervical junction is maintained. The ligamentous structures are intact. The cervical spinal cord is normal in signal without abnormal enhancement. C2/3 demonstrates no significant spinal canal or neural foraminal stenosis. C3/4 demonstrates left uncinate and facet hypertrophy with associated moderate left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis. C4/5 demonstrates left facet hypertrophy causes mild left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis. C5/6 demonstrates severe left facet hypertrophy. There is mild-to-moderate left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis. C6/7 demonstrates mild bulging of the disc, bilateral uncinate and facet hypertrophy. There is mild to moderate neural foraminal stenosis bilaterally. No significant spinal canal stenosis. C7/T1 demonstrates bilateral facet hypertrophy associated with mild bilateral neural foraminal stenosis. No significant spinal canal stenosis. Thoracic spine: T1 shortening in the T9-T12 bodies suggests prior radiation therapy. No abnormal marrow signal or enhancement is noted elsewhere. T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates a tiny midline disc protrusion causing slight flattening of the anterior cord surface without intrinsic cord signal abnormality. T5/6 demonstrates a small midline disc protrusion causing slight flattening of the anterior cord surface without intrinsic cord signal abnormality.T6/7 demonstrates a tiny right paramedian disc protrusion without cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates a large central disc extrusion extending above the disc level causing anterior cord flattening without intrinsic cord signal abnormality. T9/10 demonstrates a large central disc extrusion extending above the disc level causinganterior cord flattening without intrinsic cord signal abnormality.T10/11 demonstrates a small left paracentral disc protrusion without cord encroachment. There is moderate to severe narrowing of the right neural foramen with enhancing tissue noted on the current and prior study. Finding may be related to scarring but recommend attention on follow-up. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Significant artifact limits evaluation on the postcontrast sequences of the lumbar spine however there appears to be improvement in the extent of nodular enhancement of the leptomeninges on the surface of the conus and cauda equina nerve roots. There does remain abnormal leptomeningeal enhancement which is better assessed on the sagittal sequences, however the nodularity appears improved.Alignment is anatomic. There are no fractures or subluxations. No abnormal marrow signal or enhancement is identified.L1/L2 demonstrates mild facet hypertrophy with no significant neural foraminal or spinal canal stenosis.L2/3 demonstrates mild bulging of the disc no significant neural foraminal or spinal canal stenosis. L3/4 demonstrates mild disc bulge and mild bilateral facet hypertrophy without significant neural foraminal or spinal canal stenosis. L4/5 demonstrates Diffuse annular disc bulge, ligamentum flavum thickening, severe left facet hypertrophy, moderate right facet hypertrophy, and a tiny left facet effusion. There is mild to moderate neural foraminal stenosis on the left and mild neural foraminal stenosis on the right. L5/S1 demonstrates mild bulging of the disc, ligamentum flavum thickening and facet hypertrophy with no significant neural foraminal or spinal canal stenosis. There is partial sacralization of L5.

Output: 1. No evidence of intracranial metastatic disease. Since the prior MRI brain study dated 10/1/2015 there has been interval placement of a right frontal approach Ommaya catheter. There is T2/FLAIR hyperintensity along the catheter tract which may represent edema or gliosis. No associated mass effect. There is small amount of pneumocephalus as well as abnormal layering diffusion signal related to dependent debris/blood products within the occipital horns of the lateral ventricles. These findings may be related to recent catheter manipulation/injection.2. There has been interval improvement in the extent of nodular enhancement of the leptomeninges on the surface of the conus and cauda equina nerve roots. 3. There is enhancing tissue filling the right T10-T11 neural foramen which is similar to prior. Finding may possibly be related to scarring but recommend attention on follow-up.


Instruction: Generate impression based on findings.

Input: 58 year old female with syncope and history of TIA. Evaluate for any neurologic disease Non-enhanced CT of brain:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age of 78. The gray -- white matter differentiation is preserved.Calvarium, visualized orbits, paranasal sinuses and mastoid air cells are unremarkable. Considering significant provided clinical data and unremarkable prior CT examination from 11 -- 27 -- 10 follow-up with an MRI is recommended.Minimal suspected a small vessel disease that was reported on prior study is not identified on this exam however the quality of this exam is suboptimal compared to prior study which may explain this difference.

Output: No evidence of acute intracranial process, mass effect, midline shift or hydrocephalus. Recommend follow-up with an MRI examination considering lack of any definitive finding on two CT examination of brain.


Instruction: Generate impression based on findings.

Input: Altered mental status, evaluate. Exam is extremely limited due to patient's motion. Only limited postcontrast images were obtained given recent noncontrast MRI of the brain and cervical spine.Limited postcontrast MRI of the brain does not demonstrate any gross pathological enhancement intracranially. The postcontrast evaluation of the cervical spine is extremely limited but no large enhancing lesion is identified.

Output: Extremely limited exam due to patient motion with no large areas of pathological enhancement within the brain or cervical spine.


Instruction: Generate impression based on findings.

Input: 25-year-old female patient with primary sclerosing cholangitis. Evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: There is mild interval decrease in distention of the gallbladder. Again seen is diffuse multifocal stricturing and narrowing of the biliary tree with associated atrophy and fibrosis of the right lobe of the liver.There is long segment narrowing of the common bile duct distal to the confluence of the common hepatic and cystic ducts (series 9 image 85), similar to prior. The intrahepatic biliary ducts appear unchanged compared to prior. No cholelithiasis.Hepatomegaly, measuring up to 22 cm in craniocaudal dimension.The intrahepatic portal veins are patent but attenuated.No abnormal enhancing lesions.SPLEEN: Mild splenomegaly and splenic varices, unchanged.PANCREAS: There is distal pancreatic duct dilatation, measuring up to 5 mm in maximal diameter, with associated narrowing of the pancreatic duct in the mid pancreatic body.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multifocal stricturing and dilatation of the pancreaticobiliary tree appear similar compared to prior examination.2.Long segment stricturing of the distal common bile duct with mild interval decrease in gallbladder distention.


Instruction: Generate impression based on findings.

Input: There is severe dextroscoliosis centered at L3-L4 which is unchanged from the recent radiograph of 5/4/2015. There is leftward subluxation of L2 relative to L3 measuring 10 mm and L3 relative to L4 measuring 9 mm. Multilevel severe degenerative disc disease has progressed with increased disc space loss at L1-L2. Expected progression of endplate degenerative changes which are slightly worse on the prior exam. Schmorl's node along the inferior endplates of L1 and L5 are new from the prior exam. Multilevel severe facet joint arthropathy with effusions is increased since the prior exam. Signal within the distal cord is normal with the conus ending at L1. A lateral disc protrusion at T10-T11 is new from the prior exam as seen on the lateral views.T12-L1: New left foraminal protrusion without significant spinal or neural foraminal stenosis.L1-L2: Diffuse disc bulge, asymmetric to the left is new. Ligamentum flavum thickening. Right facet arthropathy is increased with increased moderate right neural foraminal stenosis. No spinal stenosis.L2-L3: Diffuse disc bulge is increased. Ligamentum flavum thickening. Mild spinal stenosis is unchanged. No neural foraminal stenosis.L3-L4: Diffuse disc bulge with small annular tear which is new from the prior exam. Moderate spinal stenosis is unchanged. Moderate to severe left neural foraminal stenosis is unchanged. Facet hypertrophy has increased since the prior exam, encroaching on the left lateral recess, with increased ligamentum flavum thickening.L4-L5: Diffuse disc bulge is unchanged. Moderate left neural foraminal stenosis.L5-S1: Diffuse disc bulge is unchanged. Mild right and moderate left neural foraminal stenosis. No central stenosis.

Output: Progression of spondylosis most notably at L1-L2. Up to moderate-severe left foraminal stenosis at L3-L4 with moderate central spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 30-year-old female patient with history of rectal carcinoid resection. Evaluate for disease recurrence. ABDOMEN:LIVER, BILIARY TRACT: Stable segment eight cyst. Indeterminate subcentimeter lesion in segment 6/7 of the liver was present on prior examination.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: Scattered small subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No abnormal mass or area of enhancement involving the rectum suggest residual or recurrent disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus. Nabothian cysts noted. 1.9 cm physiologic cyst in the right ovary 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: Trace free fluid in the pelvis.

Output: 1.No evidence of residual or recurrent disease.2.Indeterminate subcentimeter lesion in segment 6/7 of the liver is unchanged from prior examination.


Instruction: Generate impression based on findings.

Input: chronic headache, old history of pituitary tumor. No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Although this study is not a dedicated study for pituitary gland, the left side pituitary gland appears to be resected and does not show enhancement on post Gad study.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Bilateral maxillary sinuses show retention cysts.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.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Post left pituitary gland resection status. 3. No evidence of intracranial arterial aneurysm, or arterial stenosis.


Instruction: Generate impression based on findings.

Input: 56 year-old female with strong family history of breast cancer in mother diagnosed at 72 and sister with bilateral breast cancer. Personal history of a right breast fibroadenoma removed in 1989. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Stability of bleed. Signs and symptoms: Altered mental status. Portable CT exam time in the mid or slices were obtained. Images through posterior fossa are compromised due to extensive artifact and patient motion however no gross abnormalities detected. Fourth ventricle is normal in size and in midline position.Images through supratentorial space demonstrate large hematoma likely secondary to hemorrhagic tumor in the left basal ganglia and extensive surrounding echogenic edema. A ring of low density within the hematoma is suspected of tumor. The hematoma measures 43.2-mm times 40-mm in transaxial dimension (axial image 19 of 34). There is significant mass effect on the left lateral ventricle and minimal extension of blood into the ventricle. Multiple small satellite hemorrhagic lesions are also noted. The midline shift of approximately 4.3 mm is noted. A small cortically based high convexity right posterior frontal hemorrhagic lesion is also present on axial image 24.In comparison with the prior MRI examination from 10 to 26/2009 no gross interval change in the size of hematoma is detected.

Output: Multiple hemorrhagic intracranial lesions. Largest within the left basal ganglia remains stable since prior MRI.


Instruction: Generate impression based on findings.

Input: Hypotonia and progressive hearing loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is faint linear enhancement in the left middle frontal gyrus, which likely represents a developmental venous anomaly. Otherwise, there is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The inner ear structures are unremarkable. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of infarct or other lesions to suggest an underlying mitochondrial disorder.


Instruction: Generate impression based on findings.

Input: History of T4N0 adenoid cystic carcinoma of the tongue. There has been interval evolution of post-treatment findings in the oral cavity, with decrease in size of a defect in the dorsum of the oral tongue. There is decreased swelling and diffuse high T2 signal and enhancement in the portions of the oral tongue and tongue surrounding the defect, without a discernible discrete tumor. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The imaged osseous structures, orbits, and intracranial structures are unremarkable. There are subcentimeter right lung nodules.

Output: 1. Interval evolution of post-treatment findings in the oral tongue with what may represent associated surrounding inflammation and perhaps denervation changes, but no measurable residual tumor.2. No significant cervical lymphadenopathy.3. Subcentimeter right lung metastases. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on findings.

Input: 42-year-old woman with history of chromophobe type renal cell carcinoma status post resection in 2008, subsequent hepatic metastasis ablation in 2015. ABDOMEN:LIVER, BILIARY TRACT: There is a new 8 mm T2 hyperintense round lesion in segment 7 at the dome (401/37). This lesion abuts the diaphragm, it is difficult to discern true enhancement. The previously seen segment 4A enhancing lesion is not visualized on today's study. There is no evidence of abnormal enhancement near the segment 6 resection cavity. There is no intra or extrahepatic biliary ductal dilatation. Gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Patient is status post left adrenalectomy.KIDNEYS, URETERS: Patient is status post left nephrectomy. No suspicious right renal lesion seen.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes without significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.New segment 7 lesion at the dome which abuts the diaphragm (making it difficult to discern enhancement) but is suspicious for a new hepatic metastasis.2.Hepatic ablation defect and left nephrectomy without evidence of local recurrence.


Instruction: Generate impression based on findings.

Input: Leg pain, history of disc herniation surgery in 2006 Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of lumbar lordosis as well as minimal retrolisthesis of L5 on S1. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.There appears to be mild developmental narrowing of the spinal canal. There are multilevel degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation and minimal bulge without spinal canal or neural foraminal stenosis.L4-L5: There is disc desiccation and mild bulge, and central dorsal annular fissure. Mild distention of the facet joints. No significant spinal canal or neural foraminal narrowing. L5-S1: There is severe loss of disc height and prominent Schmorl's node anteriorly. There is a disc bulge with a right paracentral disc protrusion component which effaces the right lateral recess and where there may be impingement of the right S1 nerve root. There is also partial effacement of the left lateral recess. No significant central canal stenosis. There is moderate to severe bilateral neural foraminal stenosis. There is evidence of prior right sided laminotomy.Atrophic native kidneys with cysts noted. Left lower quadrant presumed transplant kidney partially imaged.

Output: 1. Multilevel degenerative changes, particularly at the L5-S1 level where there is severe loss of disc height and a right paracentral disc protrusion which effaces the right lateral recess. There is also moderate to severe bilateral neural foraminal stenoses at this level. No significant central canal stenosis at any level.2. Postsurgical changes of right L5-S1 laminotomy.


Instruction: Generate impression based on findings.

Input: 49-year-old male with a history of urothelial carcinoma. Follow-up examination. 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: Status post right nephroureterectomy.RETROPERITONEUM, LYMPH NODES: Scattered prominent mesenteric lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postoperative changes without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsSigns and Symptoms: seizurePartial epilepsy with impairment of consciousness, intractable The exam is severely limited due to patient motion. On the diffusion-weighted imaging and sagittal T1 imaging was performed. These acquisitions are severely degraded by patient motion.There is encephalomalacia involving the majority of the left hemisphere and marked dilation of the left lateral ventricle. There is associated left-sided calvarial thickening.

Output: Examination is severely limited by patient motion and the patient's inability to cooperate with the exam. There is encephalomalacia involving the majority of the left hemisphere and marked dilation of the left lateral ventricle. A more complete exam is possible if the patient is sedated.


Instruction: Generate impression based on findings.

Input: 57-year-old male with headache. Evaluate for stroke. Foci of hypoattenuation in the left cerebellar hemisphere compatible with known infarcts seen on MRI. Periventricular hypoattenuating foci are consistent with minimal ischemic small vessel disease, age indeterminate. The cerebral and cerebellar hemispheres and the brain stem are otherwise normal morphologically and have normal CT attenuation. The ventricles are normal volume.No abnormal extra axial fluid collections, mass, intracranial hemorrhage. The calvaria and skull base are radiographically normal. Bilateral opacification of the maxillary sinuses. The mastoid air cells are normally pneumatized.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality. If there is clinical concern for an acute stroke, an MRI may be obtained.


Instruction: Generate impression based on findings.

Input: Reason: eval glut medius History: pain The lateral and main components of the left gluteus medius tendon can be seen inserting on the greater trochanter. The tendon appears slightly thickened and there is a high signal intensity cleft between the main and lateral components of the tendon just proximal to its insertion, which is compatible with a partial thickness tear. There is mild edema within the adjacent muscle and soft tissues. The gluteus minimus tendon appears slightly thickened on the left, which may represent mild tendinosis. The gluteus maximus muscle appears normal. The remaining musculature of the left hip appears normal.Mild osteoarthritis affects the left hip and bilateral SI joints. Although this study was not protocoled for detailed evaluation of the labrum, there is increased signal within the superior labrum which may represent degeneration/degenerative tearing. Similar findings affect the right hip as seen on the large field-of-view images. Mild-to-moderate degenerative disc disease affects lower lumbar spine. There is a transitional lumbosacral vertebra. On the large field of view images, bone marrow signal intensity is within normal limits.The uterus is not visible, presumably due to resection. There is a rounded left adnexal structure measuring just under 4 cm in greatest dimension with heterogenous signal intensity including bright areas on T1 weighted images and dark areas on T2-weighted images, suggestive of blood products of differing ages. This could represent a hemorrhagic cyst or endometrioma. A similar but smaller collection is noted to the right of midline. Further evaluation with gynecologic ultrasound is recommended.

Output: 1. Partial tear of the gluteus medius tendon at its insertion.2. Heterogenous adnexal collection may represent a hemorrhagic cyst or endometrioma, but evaluation is limited due to lack of intravenous contrast. Further imaging with gynecologic ultrasound is recommended.3. Osteoarthritis of the hips and other findings as described above.


Instruction: Generate impression based on findings.

Input: 77 years Female (DOB:9/11/1938)Reason: mri History: left arm painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is anterior fusion at C6-7 using metallic hardware..At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge and disc desiccation present.At C3-4 there is no significant compromise to the spinal canal. There are some endplate and uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots within the neural foramina. There is mild narrowing of the spinal canal is level. There is loss of disc space height and disc desiccation at this level. This is stable compared to prior exam.At C4-5 there is no significant compromise to the spinal canal. There are some endplate and uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots within the neural foramina. There is mild narrowing of the spinal canal is level. There is loss of disc space height and disc desiccation at this level. This is stable compared to prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height and disc desiccation at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is straightening of the normal lordotic curvature of the lumbar spine which was also the case on the prior exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated bilateral facet hypertrophy and ligamentum flavum hypertrophy with effacement of the fat at the lateral recess bilaterally. The nerve roots within the thecal sac or crowded. Compared to the prior exam there is some progression of spinal stenosis. There is a moderate to severe degree of spinal stenosis present at this level. The stenosis has progressed since the prior exam. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level. There is some crowding of the nerve roots within the thecal sac. Overall there is a moderate degree of spinal stenosis at this level. This stenosis has progressed since prior exam. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L2-3 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with some mild ligamentum flavum hypertrophy and triangulation of the thecal sac. There is some crowding of the nerve roots present at this level and partial effacement of the fat at the lateral recess bilaterally. Overall there is mild to moderate spinal stenosis at this level. This appears to have progressed compared to the prior exam. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes in the lumbar spine associated with moderate to marked degree of spinal stenosis at L4-5 and moderate spinal stenosis at L3-4 and mild to moderate spinal stenosis at L2-3. 2.There are degenerative changes present in the cervical spine worse at C3-4 and C4-5-4 there is encroachment of exiting nerve roots within the neural foramina and mild degrees of spinal canal narrowing which are stable compared to the previous exam.


Instruction: Generate impression based on findings.

Input: Male; 68 years old. Reason: R/O HCC History: Hx TACE/RFA, HCV, cirrhosis LIVER, BILIARY TRACT: Nodular liver contour is compatible with cirrhosis.Wedge shaped defect in segment 2/3 is compatible with the patient's chemoembolization/ablation defect. There is a lesion within the ablation bed that demonstrates intrinsic high T1 signal and measures up to 1.1 x 1.0 cm, unchanged (series 901/241). Again, there is questionable arterial enhancement and washout (only on subtraction images), and as a result, the lesion remains indeterminate and continued imaging follow-up is recommended.An additional nodular lesion near the ablation zone in segment 4 also demonstrates high T1 signal and mild enhancement without definite washout. This lesion measures 1.1 x 1.0 cm, unchanged (series 903/248).Near the dome of the liver, there is a T1 hyperintense, T2 hypointense lesion that does not demonstrate enhancement and measures 1.1 x 0.9 cm, unchanged and again most compatible with a dysplastic nodule (series 901/356). An additional punctate T1 hyperintense lesion in the right hepatic lobe is too small to accurately characterize and may be an additional dysplastic nodule (series 901/111).No biliary ductal dilatation. Patent hepatic vasculature. SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in post therapy changes of the liver. Segment 2/3 ablation bed lesion is again indeterminate, but stable, and continued imaging follow-up is recommended. Close attention on follow-up for additional T1 hyperintense lesions described above is also recommended.


Instruction: Generate impression based on findings.

Input: 58 year old man with multivessel coronary artery disease, referred for further evaluation of possible LV thrombus. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 152 ml/m2 (normal range: 74+/-15), the LVEDV is 378 ml (normal range 142+/-34), the LV end systolic volume index is 83 ml/m2 (normal range 25+/-9), the LVESV is 207 ml (normal range 47+/-19), the LV mass index is 74 g/m2 (normal range 85+/-15), and the LV mass is 184 g (normal range 164+/-36). There is apical dyskinesis. There is hypokinesis and thinning of the mid to apical inferior wall. There is a small area of late gadolinium enhancement in the apical inferior wall, indicative of a prior myocardial infarction and is not likely to be viable. There remainder of the myocardium is viable. There is no evidence of an LV thrombus.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 249 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 108 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 moderately dilated (37mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is no evidence of an LV thrombus.2. The left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%. There is apical dyskinesis. There is hypokinesis and thinning of the mid to apical inferior wall. There is a subtle area of late gadolinium enhancement in the apical inferior wall, indicative of a prior myocardial infarction and is not likely to be viable. There remainder of the myocardium is viable.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%.4. Moderate dilation of the main pulmonary artery.


Instruction: Generate impression based on findings.

Input: Right lower quadrant abdominal pain after punch to gut. Rectus muscle hematoma versus tear? Markers were placed along the anterolateral aspect of the right abdominal wall and right hip, presumably denoting the area of the patient's pain. I see no hematoma or muscle tear. A small lobulated focus of fluid is noted immediately anterior to the anterior column of the left acetabulum which may represent a paralabral cyst or fluid in the iliopsoas bursa. This may further evaluated with dedicated left hip MRI if clinically warranted. There is also prominence of the femoral head neck junction bilaterally suggesting a CAM deformity that can be associated with femoroacetabular impingement in the correct clinical context. The hip joints are otherwise unremarkable. The sacroiliac joints are unremarkable. The visualized musculature appears normal. The abdominal viscera, although not visualized in its entirety on this study, likewise appears normal.

Output: No muscle hematoma, muscle tear, or other specific findings to account for patient's right lower quadrant pain. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 39-year-old woman with history of rectal carcinoid status post resection. ABDOMEN:LIVER, BILIARY TRACT: Segment 8 cyst (401/45) unchanged. Focus of mildly increased T2 signal in segment 6 (401/39) unchanged from the prior examination but too small to accurately characterize.Gallbladder is distended with sludge, otherwise normal. There is no intra or extrahepatic biliary ductal dilatation.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: Scarring in the lower right quadrant abdominal wall favored to be related to prior ostomy.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Simple right follicular adnexal cyst noted, additional small follicles also noted. Uterine fibroids and nabothian cysts noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The visualized rectum is underdistended (making evaluation suboptimal), however there is no proximal dilatation to suggest obstruction. The region of the low anterior resection and reanastomosis appears similar to priors.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free pelvic fluid is noted, likely physiologic.

Output: Stable examination without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 21-year-old male with history of AML and severe avascular necrosis, now with significant R knee pain.VIEWS: Right knee AP, oblique, and lateral (3 views) 5/7/2015 at 12:55 There is patchy sclerosis of the distal femur and proximal tibia as well as focal areas of demineralization. The medial femoral condyle is flattened and contains a large subarticular crescentic lucency, this is new from to the prior study.

Output: Avascular necrosis of the distal femur and proximal tibia with subchondral collapse of the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: Reason: R/o osteomyelitis History: Relapsed AML, Persistent R ankle lesion, Neutropenic fever, Abnormal X-ray Note is made of soft tissue ulceration along the lateral aspect of the distal fibular metaphysis. There is a skin marker in the overlying area presumably corresponding to the patient's area of concern. There is subcutaneous edema type signal abnormality/inflammatory change in the surrounding area. There is no bone marrow signal abnormality in the surrounding area to suggest osteomyelitis. There is heterogeneous bone marrow signal which is nonspecific but may represent residual islands of red marrow versus a myeloproliferative disorder. There is subchondral cyst formation within the calcaneus about the calcaneocuboid articulation indicating degenerative change. The flexor and extensor tendons appear intact. There is circumferential fluid within the flexor hallucis longus tendon at the level of the master knot of Henry indicating a tenosynovitis, which can be seen in a tendon intersection syndrome. The Achilles tendon is normal in appearance. The peroneal tendons appear intact. The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The imaged components of the deltoid appear intact. There is a small amount of fluid within the tibiotalar joint. There is a small subtalar joint effusion. There is no enhancing mass or fluid collection on postcontrast sequences.

Output: 1. Ulceration and subcutaneous edema/inflammatory change along the lateral aspect of the ankle without evidence of osteomyelitis. No focal fluid collection to suggest abscess formation.2. Findings indicating a tenosynovitis of the flexor hallucis longus just proximal to the level of the master knot of Henry as described above.3. Small subtalar joint effusion.4. Osteoarthritis of the ankle.


Instruction: Generate impression based on findings.

Input: 22-year-old female with small bowel Crohn's disease status post stricturoplasty. Now with pain and obstructive symptoms.Additional history from medical record: As a sophomore in high school had abdominal pain and vomiting, and underwent small bowel stricturoplasty of 5 strictures. Senior year of high school had rectal abscess that ruptures and caused sepsis. Had setons placed at that time. Had abscess that ruptured, went into septic shock. Had setons placed (still have 4 years later) 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: Scattered prominent mesenteric lymph nodes are present.BOWEL, MESENTERY: Four definite areas of small bowel stricturing are identified, with a possible fifth area. Three of these areas demonstrate enhancing wall thickening, luminal narrowing, and proximal bowel wall dilation suggestive of acute on chronic disease. The longest of these areas is in the distal small bowel in the upper abdomen at midline (series 10, image 31) spanning approximately 8.5 cm. The second area just distal to this in the right hemiabdomen (series 10, image 28) spans approximately 3 cm. The third area in the central abdomen at midline (series 10, image 31) spans approximately 5 cm.A 4-5 cm region in the distal ileum closer to the ileocecal valve demonstrates wall thickening and luminal narrowing without definite wall enhancement (series 10, image 24). A questionable area of collapsed bowel in the right lower quadrant may represent the fifth site of stricturing, also without definite wall enhancement to suggest acute disease.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered prominent mesenteric lymph nodes are present.BOWEL, MESENTERY: Multifocal areas of enhancing wall thickening and luminal narrowing, as described above. BONES, SOFT TISSUES: The perineal region is incompletely imaged, however, two tracts are seen extending from the rectum to the right aspect of the gluteal cleft, likely reflecting the patient's known fistula tracts. No definite associated drainable fluid collection is identified on this limited evaluation.

Output: 1.Multifocal areas of persistent small bowel wall thickening and stricturing. At least four discrete sites are seen, three of which demonstrate enhancement, consistent acute on chronic inflammation. A questionable fifth site of ileal stricturing is suggested in the right lateral abdomen.2.Fistulous tracts incompletely imaged in the right perianal region, without definite associated drainable fluid collection.


Instruction: Generate impression based on findings.

Input: 56 year old female with history of previous cardiomyopathy (EF of 17% at nadir, improved to 40% by report), and a recent diagnosis of pulmonary sarcoidosis after presenting with hemoptysis requiring a right upper lobe wedge resection of her lung. She was referred for cardiac MRI to evaluate for cardiac sarcoid. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 109 ml/m2 (normal range: 65+/-11), the LVEDV is 216 ml (normal range 109+/-23), the LV end systolic volume index is 72 ml/m2 (normal range 18+/-5), the LVESV is 143 ml (normal range 31+/-10), the LV mass index is 48 g/m2 (normal range 67+/-11), and the LV mass is 95 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is a patch of late gadolinium enhancement involving the basal inferior wall but sparing the endocardium. The burden of late gadolinium enhancement involves approximately 5% of the myocardium. This region is additionally associated with increased T2-signal. The native T1 relaxation time is elevated at 1100ms which is elevated. Taken together these, findings are atypical for prior myocardial infarction and are consistent with the diagnosis of cardiac sarcoidosis in the inflammatory stage. Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 50 ml/m2 (normal range 69+/-14), the RVEDV is 100 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation noted.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 mildly dilated (31mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsRight lung with post surgical changes and volume loss. There is a small layering right pleural effusion. There are diffuse bilateral infiltrates and emphysematous changes of the lungs. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severely dilated left ventricle with moderately reduced systolic function (EF 34%). 2. There is a patch of late gadolinium enhancement involving the basal inferior wall but sparing the endocardium. The burden of late gadolinium enhancement involves approximately 5% of the myocardium. This region is additionally associated with increased T2-signal. Taken together these, findings are atypical for prior myocardial infarction and are consistent with the diagnosis of cardiac sarcoidosis in the inflammatory stage. 3. Normal size right ventricle with mildly reduced systolic function (EF 45%).4. Moderate mitral regurgitation. 5. Extracardiac findings as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 48 year old man with NSVT, referred for evaluation of possible cardiac sarcoidosis or scar. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 62 ml (normal range 47+/-19). 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. There is no evidence of acute inflammation or edema on T1 or T2 imaging.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Additionally, there is no evidence of acute inflammation or edema on T1 or T2 imaging.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Etiology of sciatica. Signs and symptoms: Right leg/buttock shooting pain, paresthesia. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral, however with straightening of lumbar lordosis.The signal intensity of vertebral column demonstrate changes related to degenerative disease and unremarkable otherwise.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild facet and ligamentum flavum degenerative and hypertrophic changes and unremarkable otherwise.L2-L3 demonstrate mild disc desiccation, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Although the degenerative changes are not significant at this level there is evidence of mild central spinal stenosis at this level which is believed to be at least partially secondary to congenitally small pedicles. No neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is severe central spinal stenosis which is disproportionate to degree of degenerative disease and is believed to be at least partially secondary to congenitally a small pedicle. No significant neural foraminal compromise.L4-L5 demonstrate advanced disc disease and loss of disc height, shallow broad-based disc protrusion extending from right paramedian to the left and far laterally on the left. Moderate bilateral ligamentum flavum hypertrophy is present. Mild facet disease without significant hypertrophic changes. Fluid signal intensity within bilateral articulating facets suspected for effusion or synovitis. Changes at this level results in significant central spinal stenosis, severe left neural foraminal compromise and mild to moderate on the right.L5-S1 demonstrates advanced disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophic changes. Mild central spinal stenosis and significant bilateral neural foraminal compromise (R>L) is noted.Examination also demonstrates fatty signal intensity of filum terminale extending from mid L3 level to mid L5. There is however normal termination of the cord at L1-L2 level the lower most visualized thoracic cord and conus demonstrate normal signal intensity.

Output: 1.Mild degenerative changes at L2-L3 with resultant central spinal stenosis.2.Moderate degenerative changes at L3-L4 with resultant central spinal stenosis.3.Advanced degenerative changes at L4/L5 and a left-sided broad-based disc protrusion results in significant central spinal stenosis.4.Advanced degenerative changes at L5/S1 results in mild central spinal stenosis.5.There is highly suspected congenitally short pedicle. Please review detailed report above.6.Neural foraminal compromise at L4/L5 and L5-S1 levels (some significantly) as detailed above.7.Thin fatty signal intensity of filum terminale extending from L3 to L5 however with normal termination of the cord at L1-L2 level.


Instruction: Generate impression based on findings.

Input: Female 18 years old with abdominal pain and ileocolonic Crohn's disease status post resection in 2014. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no enhancing liver lesion. No biliary ductal dilatation or ascites.SPLEEN: Note is made of a splenule.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average stool burden with evidence of slow transit through the neoterminal ileum. Status post ileocecectomy. There is no bowel wall enhancement or diffusion restriction to suggest acute inflammation. No stricture, sinus tract, fistula or abscess is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Numerous follicles are seen in both ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average stool burden with evidence of slow transit through the neoterminal ileum. Status post ileocecectomy. There is no bowel wall enhancement or diffusion restriction to suggest acute inflammation. No stricture, sinus tract, fistula or abscess is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post ileocecostomy. No evidence of acute small or large bowel inflammation.


Instruction: Generate impression based on findings.

Input: acute ataxiamalaise and fatigueClinical question: strokeSquamous cell skin cancerHypertensionOpen wound of chest (wall), without mention of complicationAbdominal aneurysm without mention of rupture MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is a punctate lesion in the pons and one in the left thalamus which are high signal on the T2 and the FLAIR MRI sequences.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of susceptibility effect in the right half of the pons.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Periventricular and subcortical white matter changes of a mild to moderate degree and a small pontine lesion are nonspecific. At this age they are most likely vascular related. 2.An isolated old microhemorrhage in the right half of the pons is nonspecific.3.There is no evidence for intracranial aneurysm.4.No evidence for extracranial cerebrovascular occlusive disease5.No evidence for intracranial cerebrovascular occlusive disease


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant melanoma of skin, unspecifiedClinical question: hx melanoma please assess disease statusSigns and Symptoms: melanoma The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for brain metastases on this exam.