Instruction: Generate impression based on findings.

Input: 64 years, Female, migraine headache with dizziness. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

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


Instruction: Generate impression based on findings.

Input: 28-year-old male with left foot chronic pain with weightbearing. Evaluate for left foot metatarsal or cuboid stress fracture. There is a 1 cm ossicle adjacent to the base of the fifth metatarsal that may represent an old ununited fracture, but we see no edema within the bone marrow of the metatarsals or bones of the midfoot to indicate a stress fracture. There is a lobulated focus of fluid signal intensity dorsal to the cuboid that is approximately 2 cm in the longitudinal dimension and approximately 8 x 11 mm in its greatest transverse dimension, likely representing a ganglion. Please note that this study was not protocoled for detailed evaluation of the ligaments and tendons, but we see no gross abnormalities.

Output: 1. Ossicle adjacent to the base of the fifth may represent an old ununited fracture, but we see no findings to suggest a stress fracture.2. Ganglion adjacent to the cuboid as described above.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with left hemianopsia and neglect, right MCA M2 occlusion, suspect subacute right cerebellar stroke. Restricted diffusion is seen within the right MCA territory involving the right corona radiata, insula, and a small portion of the right temporal lobe. Restricted diffusion is also seen within the inferior right cerebellar hemisphere in the distribution of the right PICA. There are punctate foci also seen in the right aspect of the medulla. No restricted diffusion is present on the left side of the brain.No evidence of significant parenchymal hemorrhage is seen. The diffusion restricted tissues show corresponding T2 hyperintensity and mild local mass effect. The fourth ventricle is consequently mildly effaced. No significant generalized mass effect or brain herniation is seen. The ventricles are otherwise normal in size and morphology.

Output: Acute infarction is seen in the distribution of the right MCA involving part of the corona radiata, insula and a small part of the temporal lobe. Acute infarction is also demonstrated in the right PICA territory involving the inferior aspect of the cerebellum with punctate foci also seen in the medulla.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type II. Left-sided weakness. The study is slightly technically limited related to body habitus.Cervical Spine:Alignment is notable for mild reversal of normal lordosis. Vertebral body height is preserved as well as the marrow signal. The spinal canal is preserved. The disc heights are preserved but there is mild loss of T2 signal from C2-C3 through C6-C7. The cervical spinal cord shows normal morphology and signal. Following contrast injection, there is no abnormal contrast enhancement. Included brain stem and lower cerebellum also show no abnormality.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: There is no spinal canal or foraminal stenosis.C4-C5: There is no spinal canal or foraminal stenosis.C5-C6: There is no spinal canal or foraminal stenosis.C6-C7: There is no spinal canal or foraminal stenosis.C7-T1: There is no spinal canal or foraminal stenosis.Small lymph nodes are present on both sides of the neck though more numerous in the left lower neck. None is enlarged by size criteria.Thoracic Spine:There is straightening of the lower thoracic spine. There is slight anterior height loss at T7 vertebral body similar to prior which may be congenital or less likely mild chronic compression deformity. No associated edema. The discs are notable for variable loss of T2 signal. There is also loss of the anterior height of the disc at T11-T12 associated with small intravertebral herniation/Schmorl's node into T12 vertebral body and present previously. There is ligamentum flavum thickening/calcification at the T11-T12 level. The spinal canal is preserved. There is no thecal sac compression. The spinal cord is normal in morphology and signal. There is also no significant foraminal stenosis.Lumbosacral Spine:Alignment is anatomic. Vertebral morphology is normal. Marrow signal shows no suspicious focality. Poorly defined contrast enhancement in the posterior L3 vertebral body at midline is likely related to the basivertebral vessels. There is moderate T2 signal and minimal height loss at the L4-L5 disc. The spinal canal is preserved. The neural foramina are preserved as well. The conus medullaris tip is lower than usual, at L2-L3. There is no abnormal contrast enhancement along the conus or the nerve roots. T12-L1: There is no spinal canal or foraminal stenosis.L1-L2: There is no spinal canal or foraminal stenosis.L2-L3: There is no spinal canal or foraminal stenosis.L3-L4: There is no spinal canal or foraminal stenosis.L4-L5: Disc bulge with a small central protrusion but no significant spinal or foraminal narrowing.L5-S1: There is no spinal canal or foraminal stenosis.

Output: 1.No findings to suggest neoplasm in the cervical, thoracic, or lumbar spine.2.No significant spinal canal stenosis at any level.3.Borderline low conus at L2-3. No fatty filum or other associated spinal canal lesions. Finding is nonspecific; correlate for any clinical signs of tethered cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 23-year-old female with perianal discomfort. Evaluate for fistula or abscess related to Crohn's disease. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Chronic wall thickening involving the visualized descending colon, as well as the sigmorectal colon, compatible with provided history of Crohn's disease and similar to prior study. Increased wall enhancement on postcontrast images, suggestive of active inflammatory bowel disease. Mild susceptibility artifact at the sigmorectal junction, most likely related to postsurgical change or surgical clips.BONES, SOFT TISSUES: A small perianal intersphincteric sinus tract is seen extending from the left 4 o' clock position and traversing superiorly to terminate in a 2.6 x 1 cm persistent left-sided focus (series 5/32). Additional tracts and collections seen on prior examination appear to have resolved.OTHER: Trace nonspecific pelvic ascites.

Output: 1. Small left perianal intersphincteric sinus tract/collection, not significantly changed.2. Findings suggestive of active on chronic inflammatory bowel disease of the visualized distal colon.


Instruction: Generate impression based on findings.

Input: Reason: assess for osteomyelitis, right great toe History: cellulitis There is extensive soft tissue edema and inflammation of the dorsum of the foot particularly around the first MTP joint without discrete loculated fluid collection. The underlying bone marrow signal appears normal without evidence of osteomyelitis. There is mild degenerative change of the midfoot.

Output: Extensive soft tissue inflammation of the dorsum of the foot particularly around the first MTP joint without discrete loculated fluid collection. There is no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Status post patellar dislocation. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is mild increased signal within the articular cartilage of the patella, without focal fluid-filled defect seen. The articular cartilage otherwise appears normal. The bone marrow appears normal.There is slight lateral translation and tilt of the patella relative to the femoral trochlea. The superior aspect of the femoral trochlea is flat, suggesting mild dysplasia. The TT-TG distance measures just over 1 cm, which is normal. The Insall-Salvati ratio is 1.25, at the upper limits of normal. LIGAMENTS: Minimal increased signal is seen within the MCL likely reflecting prior injury. However the MCL is intact with no edema otherwise seen. The LCL and cruciate ligaments are intact.The posterior fibers of the medial patellofemoral ligament are indistinct near the femoral attachment, and we cannot exclude the possibility of a chronic tear.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings suggestive of mild femoral trochlear dysplasia with mild lateral tilt and translation of the patella relative to the trochlea and a possible chronic tear of the proximal fibers of the medial patellofemoral ligament posterior.2. Mild superficial degeneration of the patellar articular cartilage.3. No loose bodies seen.


Instruction: Generate impression based on findings.

Input: 50 years, Male, lethargy, gait instability, history of malignancy. Additional history per chart, patient has history of HIV and metastatic NSCLC. There is a 7 mm enhancing nodule involving the lateral aspect of the splenium on the left which is contiguous with asymmetrically prominent enhancement of the left choroid plexus. The lesion including the intraventricular component is best seen on sagittal post gadolinium reformatted series 1103 image 74 where it measures up to 13 x 13 mm in the AP and craniocaudal dimensions. There is mild adjacent parenchymal FLAIR hyperintensity compatible with vasogenic edema. There is no significant intracranial mass effect. No midline shift or herniation. Moderate degree of motion degradation limits sensitivity to small lesions elsewhere in the brain however no additional lesions are definitively appreciated within this limitation. Subtle areas of enhancement along the left lateral ventricle wall are not well evaluated but may represent normal vasculature. Cavum septum pellucidum and cavum vergae incidentally noted. No hydrocephalus. No findings to suggest acute infarct or parenchymal hemorrhage, with small focus of susceptibility effect within the medial intraventricular component of the lesion which may represent minimal blood products or perhaps mineralization. Mild global parenchymal volume loss.

Output: 1. 13 x 13 mm enhancing lesion involving the left lateral ventricle choroid plexus and adjacent splenium of the corpus callosum is suspicious for metastasis. No additional lesions are definitively appreciated within the limitations of motion degradation. Patient had difficulty tolerating the examination due to pain.2. Mild surrounding edema associated with the above lesion. No significant intracranial mass effect.


Instruction: Generate impression based on findings.

Input: Acute onset quadriparesis. Evaluate for meningeal inflammation or cervical cord compression. MRI brain:Motion limited exam. Small foci of restricted diffusion are visualized in the posterior periventricular regions bilaterally as well as a somewhat larger focus in the right parietal parenchyma compatible with acute ischemic infarcts. Additional foci of restricted diffusion are also visualized within the brainstem pons suspicious for acute ischemic infarct here. There was restricted diffusion on the previous exam from a week ago in posterior circulation distribution. No evidence of mass effect, midline shift or herniation. There is diffuse punctate susceptibility abnormality located throughout the brain most likely representing hemosiderin deposition. The differential includes amyloid angiopathy or changes related to chronic hypertensive encephalopathy. Much less likely are multiple hemorrhagic metastases or numerous cavernous malformations. Assessment for enhancement is severely limited secondary to patient motion. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Bilateral mastoid fluid is likely secondary to intubation.MRI cervical spine:Motion limited exam. There is reversal of the cervical curvature and multilevel degenerative changes with grade 1 anterolisthesis of C2 on C3 and C3 on C4. Diffuse edema is seen in the cord beginning in the lower medulla, extending throughout the cervical spinal cord and including the visualized upper thoracic spinal cord. Although there are multilevel degenerative changes in the cervical spine, there is no evidence of acute cord compression. The cervical vertebral bodies are appropriate in height. Degenerative changes in the cervical spine are as described below:C2-3: There is a disc osteophyte complex and facet hypertrophy resulting in mild left neural foraminal stenosis. There is no right neural foraminal or central canal stenosis. C3-4: There is a disc osteophyte complex with uncovertebral and facet hypertrophy which causes mild to moderate right and moderate left neural foraminal stenosis. No central canal stenosis. C4-5: There is a disc osteophyte complex with right greater than left uncovertebral hypertrophy and facet hypertrophy. This causes severe right and moderate left foraminal stenosis with mild central canal stenosis.C5-6: There is a disc osteophyte complex with right greater than left uncovertebral hypertrophy as well as facet hypertrophy. This causes moderate right and mild to moderate left neuroforaminal as well as mild central canal stenosis.C6-7: There is a disc osteophyte complex with right greater than left uncovertebral hypertrophy with moderate to severe right and mild-to-moderate left neural foraminal stenosis. There is no central canal stenosis.C7-T1: No disc bulge. Mild facet hypertrophy but no neural foraminal or central canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Restricted diffusion in the posterior periventricular region bilaterally, right parietal parenchyma and brainstem pons are compatible with acute ischemic infarcts. Multiple small infarcts were noted on the recent previous MRI from a week ago also in a posterior circulation distribution.2.There is diffuse punctate susceptibility abnormality most concentrated within the parietal regions likely representing hemosiderin deposition. The differential most likely includes amyloid angiopathy or changes related to chronic hypertensive encephalopathy.3.Diffuse spinal cord edema beginning with the lower medulla, extending throughout the cervical spine and Including the visualized upper thoracic spine, without enhancement. No evidence of acute cord compression. The differential of cord edema is nonspecific including ischemic, inflammatory or neoplastic etiologies.4.Multilevel degenerative changes of the cervical spine which cause at most mild central canal stenosis at the C5-6 level and severe right neural foraminal stenosis at the C4-5 level. Additional degenerative changes are as described.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for radiolucent lesion in L3 vertebrae. Sclerotic lesion in the lumbar spine. Signs and symptoms: Assess radiolucent lesion in the L3 vertebrae. Pre and post enhanced lumbar MRI:Examination demonstrates a well-demarcated focus of T1 and T2 hyperintense vertebral body of L3 which saturates on sagittal fat sat series without enhancement and is consistent with a focus of fatty deposit.The signal intensity of the vertebral column otherwise demonstrate changes consistent with degenerative disc disease and unremarkable otherwise.There is no abnormal enhancement of the vertebral column, the most visualized thoracic cord, conus or the cauda equina. There is however expected mild enhancement of hypertrophic changes of the ligamentum flavum in the lower lumbar spineT11-T12 and T12-L1 levels demonstrate mild degenerative changes and unremarkable otherwise.L1-L2 demonstrate moderate disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate bilateral facet and ligamentum flavum hypertrophy and including mild bilateral facet effusion. Constellation of findings results in mild central spinal stenosis and moderate bilateral neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral (R>L) ligamentum flavum and facet hypertrophic changes which also includes right facet effusion. Constellation of changes results in significant central spinal stenosis, significant right and moderate left neural foraminal compromiseL4-L5 demonstrate moderate disc disease and loss of disc height, extensive bilateral (R>L) facet and ligamentum flavum hypertrophy. Constellation of changes results in grade 1 anterolisthesis and significant central spinal stenosis with moderate left and significant right neural foraminal compromise.L5-S1 demonstrate advanced disc disease with significant loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy and mild grade 1 anterolisthesis. There is no spinal stenosis or neural foraminal compromise.

Output: 1.Focus of marrow signal change in L3 vertebral body is consistent with a fatty deposit and there is no evidence of metastatic disease on this exam.2.Degenerative changes at L3-L4 with resultant moderate central spinal stenosis, extensive degenerative changes at L4-L5 level with significant central spinal stenosis. There are also associated neural foraminal compromise more significantly at L4-L5.3.Mild degenerative changes at other levels however without central spinal stenosis.4.Neural foraminal compromise at other levels as detailed per level above.


Instruction: Generate impression based on findings.

Input: 69-year-old male with elevated PSA. Prostate biopsy on 7/31/2014 joint findings suggestive of neoplasm in left lateral apex PELVIS:PROSTATE:Prostate Size: 3.6 x 4.9 x 4.2 cmPeripheral Zone: There is a lesion in the mid peripheral zone measuring 5 x 3 mm, immediately left of midline, which is hypoattenuating T2/ADC and suspicious for prostatic adenocarcinoma.Central Gland: Multiple nodules within the central gland likely reflect benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Enhancement and thickening within the right adductor rectus aponeurosisOTHER: No significant abnormality noted.

Output: 1.Mid peripheral zone lesion is suspicious for prosthetic adenocarcinoma. No extracapsular extension or lymphadenopathy identified.2.Enhancement and thickening of the right adductor rectus aponeurosis may be related to prior injury.3.Enlarged prostate with multiple central gland nodules likely related to benign prostatic hypertrophy.


Instruction: Generate impression based on findings.

Input: 58-year-old female with a history of lung adenocarcinoma presents with left-sided numbness and a hemorrhagic lesions identified on head CT, evaluate for brain metastases. There are several scattered ring-enhancing lesions throughout both cerebral hemispheres and in the cerebellar hemispheres with associated vasogenic edema. There is a bilobed ring-enhancing lesion in the right precentral gyrus measuring 15 x 14mm with surrounding vasogenic edema and punctate focus of susceptibility changes related to microhemorrhage. The lesion in the left parieto-occipital region in the periventricular white matter measures 11 x 19 mm also demonstrates subtle susceptibility effects and associated vasogenic edema. A small 4 mm lesion in the right coronal radiata, and 4 to 5 mm subtle enhancing lesion in the left middle frontal gyrus. In addition, there is a 8 x 7 mm enhancing lesion abutting the lateral margin of the left parieto-occipital fissure. A small 5 x 5 mm lesion is present in the left subcortical parietal lobe. There are 2 lesions measuring 5 mm and 6 mm in the right cerebellar hemisphere and 3 to 4 mm subtle enhancing lesion in the left cerebellar hemisphere.There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a 9 mm enhancing lesion in the right frontal calvarium concerning for metastasis.

Output: 1.Several (at least 10) scattered supratentorial and infratentorial ring-enhancing lesions consistent with brain metastases.2. 9 mm enhancing lesion in the right frontal calvarium suspicious for osseous metastasis.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: assess for new stroke History: right hand weakness, dysarthria, and facial droop Brain MRIThere is restricted diffusion lesion on the left periventricular white matter indicating acute ischemic infarction without evidence of hemorrhagic conversion.Scattered focal tissue lordosis on bilateral basal ganglia and thalami indicating altered focal chronic lacunar infarct.Patch and scattered high signal intensities on periventricular white matter indicating underlying nonspecific small vessel ischemic disease.There are susceptibility lesions on bilateral lateral ventricles' ependymal surfaces which indicate calcifications.There is also focal small susceptibility lesion on the right cerebellar hemisphere indicating chronic petechial hemorrhage.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collectionThe midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate tortuous courses of bilateral ICAs, MCAs, ACAs and vertebrobasilar system without evidence of focal significant (more than 50%) luminal stenosis. No aneurysm was seen.Left vertebral artery is dominant.

Output: 1. Acute ischemic infarction on the left periventricular white matter without evidence of hemorrhagic conversion.2. Atherosclerotic intracranial arterial system without evidence of focal luminal stenosis. No intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: 65years old, gentleman, with a history of coronary artery disease status post stents, is referred for cardiac MRI due to dyspnea to evaluate cardiac function and perfusion.MEDICATIONS: Aspirin, Lisinopril, metformin, metoprolol, Nitroglycerin, Xarelto, and rosuvastatin. First Pass PerfusionDuring hyperemia, perfusion defects were noted in the basal inferoseptum and the mid inferior wall. Additionally, a large perfusion defect (corresponding to the below described myocardial infarction) was noted in the basal to mid anterior wall & mid anterolateral and inferolateral walls.Viability/ Myocardial ScarThere is a large myocardial infarction involving basal to mid anterior wall and the the mid mid anterolateral and inferolateral walls. The basal anterior wall is transmurally infarcted and that segment is not likely to be viable . The mid anterior, anterolateral, and inferolateral walls are non-transmurally infarcted and have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is a large region of akinesis and myocardial thinning involving the basal to mid anterior wall and the mid anterolateral and inferolateral walls, which corresponds to the above described myocardial infarction. There is additionally mild tardokinesis of the basal inferior wall. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVEDV is 132 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 51 g/m2, and the LV mass is 109 g. No LV apical thrombus is noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 59 ml/m2 (normal range 82+/-16), the RVEDV is 128 ml (normal range 142+/-31), the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9), and the RVESV is 50 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSeveral hepatic cysts are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There are 2 perfusion defects. The first involves the basal inferoseptal and mid inferior walls. This defect is associated with a subtle wall motion abnormality but no underlying myocardial infarction and the territory is likely to be viable. The second defect is larger and is more likely to be due to the large underlying myocardial infarction rather than ischemia. It involves the basal to mid anterior wall and the mid anterolateral and inferolateral walls. This territory has an intermediate probability of viability. 2. Normal LV size with mildly reduced systolic function (LVEF 45%) with regional wall motion abnormalities as described above.3. Normal RV size and systolic function (RVEF 61%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: WeaknessClinical question: r/o strokeSigns and Symptoms: r/o stroke MRI of the brainNo diffusion weighted abnormalities are appreciated.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.Exam is limited by motion artifact.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 small. The posterior communicating arteries are intact and are fairly large. The vertebral arteries are similar in size.Exam is limited by patient motion artifact.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. 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. The origins of the great vessels from the aortic arch are not well visualized. Similarly the origins of the vertebral arteries from the subclavian arteries are not well visualized. To the extent of visualization possible there is no significant stenosis appreciated at the origins of the great vessels from the aortic arch. The origin of the left vertebral artery in particular is obscured by artifact and the course of the left vertebral artery appears rather attenuated.Exam is limited by patient motion artifact.

Output: 1.There is no evidence for acute ischemic cerebral infarction present.2.The left vertebral artery is suboptimally visualized. It is quite possible that this nonvisualization suggests disease involving the left vertebral artery. A CT angiogram may be of further benefit in evaluating this.3.No evidence for intracranial cerebrovascular occlusive disease.4.Examination is somewhat limited due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. The thoracic vertebral bodies are mildly heterogeneous related to focal fat deposition. Multilevel degenerative changes are present. No worrisome focal marrow signal abnormality is appreciated. At upper T4 vertebral level, there is a 2 mm focus of T2 signal along the left paramedian ventral cord, nonspecific. The spinal cord is slightly ventrally displaced at T4 with slight cord flattening in the AP dimension. Otherwise, spinal cord is of normal caliber and signal. The paraspinal soft tissue structures are unremarkable.At C6-C7 and C7-T1: There is mild left foraminal disc protrusion with resultant mild left neural foraminal narrowing. No spinal canal stenosis.At T4-T5, there is left paracentral/foraminal disc extrusion which extends 2 mm cranially, indenting the ventral thecal sac, resulting in mild left neuroforaminal narrowing. There is no spinal canal stenosis.T10-11: There is a small left paracentral disc protrusion without significant neural foramina or spinal stenosis.Remaining thoracic intervertebral disc levels show no significant disk bulge, herniation, spinal canal or foraminal stenosis.MRI lumbar spine: Motion limited exam. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. Mildly heterogeneous marrow signal related to focal fatty position. No worrisome focal marrow signal abnormality is appreciated. There is minimal loss of disc height at L5-S1 with disc desiccation. Remaining intervertebral disc heights are maintained. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. The paraspinal soft tissue structures are unremarkable.T11-T12: No significant disc disease or stenosis.T12-L1: No significant disc disease or stenosis.L1-L2: No significant disc disease or stenosis.L2-L3: Mild disc bulge which shallow left foraminal protrusion resulting in mild left neural foraminal narrowing. No spinal canal stenosis.L3-L4: Mild degenerative facet disease. No significant disc disease or stenosis.L4-L5: Mild degenerative facet disease. Minimal disc bulge and minimal bilateral neural foraminal narrowing.L5-S1: Facet arthropathy. Mild disc bulge with superimposed left foraminal disc protrusion with moderate to severe left neural foraminal narrowing, which may abut the exiting left L5 nerve root. Mild right neural foraminal narrowing. No spinal canal stenosis.There is linear area opacity in the right lung base may represent subsegmental atelectasis.

Output: 1. No evidence of spinal canal stenosis in the thoracic or lumbar spine.2. Mild degenerative spondylotic changes in the thoracic spine, mostly at T4-T5 resulting in mild left neural foraminal narrowing.3. Punctate focus of T2 signal abnormality in the left ventral cord at upper T4 vertebral level is nonspecific, but may represent mild myelomalacia. This likely relates to the incidental ventral displacement of the thoracic cord at T4 level with mild cord flattening and narrowing. Possibility of intradural extramedullary cystic focal lesion such as arachnoid cyst, versus ventral cord herniation is suspected. 5. Degenerative disc changes in the lumbar spine, worst at L5-S1, where there is disc bulge with superimposed left foraminal disc protrusion reflecting moderate left neural foraminal narrowing and possibly abutting the exiting left L5 nerve root. Correlate for left L5 radiculopathy.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, history of grade 2 astrocytoma of the spinal cord status post proton therapy one month ago plus temozolomide. Evidence of laminectomy is seen at C5 and C6 with fluid present in the laminectomy bed extending up to the dural. No evidence of dural discontinuity is seen.Expansile nonenhancing mass is redemonstrated within the cervical spinal cord. This lesion spans from C3-4 to the inferior endplate of C7 and has perhaps expanded in the craniocaudal dimension by 1 or 2 mm. In the transverse dimension, this lesion occupies a majority of the right and central aspects of the cord, measuring up to 14 x 10 mm at the C5-6 level, not significantly changed from prior. The expansile nature of this lesion results in effacement of the CSF space from C4 through C6.Expansile nonenhancing mass is also redemonstrated within the thoracic spinal cord. This lesion spans from the T2-3 level down to approximately T8. No definite evidence of any further progression in the craniocaudal extent is seen. Accurate measurements are difficult due to the presence of motion artifact, but no significant change in the transverse dimensions of this mass are suspected. For example, at the T4 level, the tumor measures approximately 10 x 9 mm, and previously measured 11 x 9 mm. Minimal nonexpansile cord signal abnormality extending inferiorly within the left lateral cord from the T8 level down to T10 is less well appreciated than on the prior examination.Mild reversal of the cervical lordosisis seen. Degenerative endplate irregularity is evident at the mid to lower cervical levels. Mild cervical spondylosis at C4-5 and C5-6 and C6-7 is unchanged.At L4-5, grade 1 anterolisthesis with disc bulging and disc uncovering is seen. Along with marked facet arthoropathy with effusions and ligamentum flavum thickening, these findings contribute to a severe spinal canal stenosis with crowding and impingement of the cauda equina nerve roots. A blush of enhancement within the nerve roots at this level likely represents compression related vascular engorgement. The neural foramina do remain patent. These findings have not significantly changed.No other areas of significant spinal canal or neuroforaminal stenosis are seen at any point in the spine. Vertebral body morphology, except as discussed above, is unremarkable. Fatty marrow replacement involving the entirety of the cervical vertebral bodies and the posterior aspects of the thoracic and upper lumbar vertebral bodies, is compatible with radiation therapy.

Output: Multifocal spinal cord tumor is redemonstrated. The lesion in the cervical cord shows no significant change in maximal transverse dimension, and perhaps a very slight increase in craniocaudal extent. The magnitude of this potential increase is, however, on the order of 1 or 2 mm and may be technical. The lesion in the thoracic cord shows no significant interval change in maximal transverse dimension or craniocaudal extent, allowing for motion artifact.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticusClinical question: epilepsySigns and Symptoms: seizuresComments: Pre op laser fiber | Since the prior exam the patient has undergone depth electrode placement and right-sided burr hole placement. One probe extends to the right parietal bone the brain parenchyma with tip along the medial aspect of the right temporal lobe another three course through the right temporal lobe medially with the tips along the medial aspect of the right temporal lobe. There is associated scalp soft tissue swelling present.There is T2 hyperintense signal present along the posterior aspect of the right subcentral lobule. This was not present on the prior exam.There is intracranial air present on the current exam as well as more subdural fluid.No abnormal foci of enhancement are appreciated within the brain parenchymaThe 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.The patient status post recent multiple depth electrode placement with associated postoperative change. 2.Some new edema is present along the posterior aspect of the right subcentral lobule


Instruction: Generate impression based on findings.

Input: 66-year-old female with primary sclerosing cholangitis status post lobectomy revealing high-grade dysplasia. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes of left lobectomy and hepaticojejunostomy. Prominent distal common bile duct is noted. There is mild right hepatic biliary ductal dilatation with evidence of mild stricturing in the proximal right hepatic biliary duct. Segment 6 perfusion abnormality at the site of the prior drain is again noted. Right biliary drain is present.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: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postoperative changes of left hepatic lobectomy with hepaticojejunostomy. 2.Mild right intrahepatic biliary ductal dilatation with evidence of mild stricturing compatible with history of primary sclerosing cholangitis.


Instruction: Generate impression based on findings.

Input: 9-year-old female with Langerhan's cell histiocytosis involving the pelvis. PELVIS:A heterogeneous, enhancing lesion is again identified within the right iliac wing. The lesion has further decreased in size since prior study and measures up to 0.8 x 1.4 x 1.8 cm (series 1001/17 and series 1101/15) on postcontrast images, previously 0.8 x 2.2 x 2.4 cm. Previously seen cortical involvement associated with this lesion appears decreased as well. No new enhancing lesions are identified to suggest additional sites of disease. Slight high signal of the left anterior superior iliac spine is most likely related to the normal physis.

Output: Interval decrease in size of the right iliac wing lesion, consistent with treatment response. No new sites of disease.


Instruction: Generate impression based on findings.

Input: 65-year-old female with suspicious left breast mass at 2:00 position, and left abnormal axillary lymph node detected on the recent mammographic and ultrasound workup. The patient underwent breast MRI earlier today, which demonstrated additional mass in the left breast at 5:00 position. Ultrasound-guided biopsy of these lesions has been scheduled. MR directed ultrasound study is performed for the mass seen on the today's MRI at 5:00 position in the left breast. Detected is an irregularly-shaped hypoechoic mass with increased blood flow measuring 8 x 5 mm at 5:00 position, 2 cm from nipple in the left breast. Left ultrasound re-identified the mass at 2:00 position, 2 cm from the nipple measuring 6 x 6 mm, and the abnormal lymph node in the left axilla measuring 10 x 6 mm. PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. 1. Left breast mass at 5:00 position:Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. 2. Left breast mass at 2:00 position:Local anesthesia was obtained using 1% lidocaine with 1:100,000 epinephrine at depth. Using the same skin entry as the prior biopsy, continuous ultrasound guidance and a inferolateral to superomedial approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Using continuous ultrasound-guidance a Bard ribbon clip was placed into the lesion in the usual manner. 3. Left axillary lymph node:Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, three 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged very good. All specimens partially sank in the prefilled container of 10% formalin. Specimen quality was judged very good. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Specimens were sent to Pathology with an accompanying history sheet. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed Hydromark clip to be in the expected location at 5:00 position in the left breast, and at left axilla, and ribbon clip within the mass at upper outer quadrant in the left breast. Distance between two clips in the left breast is 45 mm on MLO view and 43 mm on CC view. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.

Output: Successful ultrasound-guided core biopsy of the left breast two masses and left axillary lymph node with clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 80 years old, restaging examination for metastatic lung cancer. No focal edema, mass effect or pathologic intracranial enhancement is seen. The previously mentioned focus of apparent enhancement in the left parietal lobe is clearly an artifact on today's examination. Extensive, nearly confluent periventricular white matter T2 hyperintensity is redemonstrated appearing similar to the prior examination. No restricted diffusion is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles remain normal in size and morphology. Bone marrow signal characteristics are within normal limits.

Output: 1.No evidence of active metastatic disease in the brain.2.Redemonstration of extensive white matter signal abnormality which may represent a combination of treatment effect and small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 29-year-old man with spontaneous rupture of the flexor tendons of the left leg. Evaluate for re-rupture of the Achilles tendon. TENDONS: There is a globular focus of decreased signal in the area of the previously identified achilles tendon rupture, most likely representing fibrous scar tissue. The tendon is disrupted and retracted. There is marked swelling of the proximal achilles. The remaining tendons of the ankle appear intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: The achilles tendon is torn and retracted, with a globular focus of fibrotic scar tissue in the area of the tear.


Instruction: Generate impression based on findings.

Input: Worsening chronic headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. 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, and scalp soft tissues are grossly unremarkable. There is minimal diffuse ethmoid sinus mucosal thickening.

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


Instruction: Generate impression based on findings.

Input: Reason: HCV cirrhosis, HCC s/p TACE/RFA 7/2016: follow up imaging for treatment effect. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology including left hepatic lobe and caudate lobe hypertrophy as well as fissural prominence.In hepatic segment 5 at the site of the previously seen focal lesion compatible with HCC, there is a new ablation cavity which measures 1.7 x 3.7 cm and demonstrates some intrinsic T1 hyperintensity compatible with blood products. There is no definite associated marginal or nodular arterial enhancement with washout to suggest residual disease or recurrence. There is a new area of arterial enhancement in segment 5/6 (series 9, image 31) which measures 0.9 x 1.3 cm and lacks washout on more delayed images. This is nonspecific but may reflect a transient hepatic intensity difference. Status post cholecystectomy with prominence of the common bile duct up to 11 mm, not significantly changed. No evidence of choledocholithiasis.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: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology. 2.Interval ablation of segment 5 lesion without specific evidence of marginal residual disease or recurrence.3.New small area of arterial enhancement in segment 5/6 without washout which is favored to represent a transient hepatic intensity difference but should be followed on subsequent examinations.


Instruction: Generate impression based on findings.

Input: L5-S1 microdiscectomy, evaluate for re-herniation. Recurrent lumbar radiculopathy down left lower extremity. Compared to 3/28/2015, interval postsurgical changes of microdiscectomy at the left L5-S1 level is seen via left-sided L5 laminotomy. Previously identified left paracentral disc extrusion at L5-S1 is no longer present. There remains moderate narrowing of the left L5-S1 neural foramen related to facet arthropathy, disc bulge, and endplate spur.There is unchanged mild retrolisthesis of L5 on S1 measuring approximately 5 mm. The vertebral body heights are well-maintained. There is disc desiccation of L3-L4, L4-L5 and L5-S1, which is unchanged. There is mild loss of disc height at L3-L4 and L4-L5 and moderate loss of disc height at L5-S1, which are similar to prior. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. Fatty filum is again demonstrated which measures less than 3 mm in thickness similar to prior.Individual levels as below: T12/L1: Bilateral facet degeneration, but no significant disc bulge, spinal canal or neural foraminal stenosis.L1/2: Bilateral facet degeneration, but no significant disc bulge, spinal canal or neural foraminal stenosis.L2/3: Bilateral facet degeneration, but no significant disc bulge, spinal canal or neural foraminal stenosis.L3/4: Mild disc bulge similar to prior, bilateral facet degeneration and ligamentum flavum thickening, but no significant spinal canal or neural foraminal stenosis.L4/5: Mild disc bulge, bilateral facet degeneration and ligamentum flavum thickening, contributing to mild spinal canal stenosis. No significant neural foraminal stenosisL5/S1: Postsurgical changes as described above. Previously seen left paracentral disc extrusion has been resected. There remains mild right and moderate left neural foraminal stenosis. Bilateral facet arthropathyPostsurgical changes involving the paraspinous soft tissues at L5-S1 without fluid collections. Paraspinous soft tissues are otherwise unremarkable.

Output: Interval postsurgical changes of microdiscectomy with previously seen left paracentral disc extrusion at L5-S1 no longer present. No recurrent disc herniation in this location is evident. Again seen is moderate left-sided neural foraminal stenosis at L5-S1 related to facet arthropathy, disc bulge, and endplate spur with contact of the exiting left L5 nerve root. Additional levels as above.


Instruction: Generate impression based on findings.

Input: A 40 year old male with Crohn's disease, s/p collectomy, atrial flutter after ablation and after cardiac arrest post-cardioversion. Now presents with new onset biventricular heart failure and referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with moderate to severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 255 ml (normal range 142+/-34), the LV end systolic volume index is 66 ml/m2 (normal range 25+/-9), the LVESV is 165 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 138 g (normal range 164+/-36). There is hypokinesis of the entire septum and inferior wall at the base, middle and apical segments, there is hypokinesis of the anterior wall at the middle and apical segments. There is late gadolinium enhancement sparing the endocardium in the entire septum and inferior wall at the base, middle and apical segments, and in the anterior wall at the middle and apical segments. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process and are atypical for myocardial infarction. The T1-mapping times are normal.There is no myocardial iron overload.There is no intracavitary thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 108 ml/m2 (normal range 82+/-16), the RVEDV is 271 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 199 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with moderate to severely reduced systolic function, the LVEF is 36%, though this has improved since previous study. There is hypokinesis of the entire septum and inferior wall at the base, middle and apical segments, there is hypokinesis of the anterior wall at the middle and apical segments. 2. There is late gadolinium enhancement sparing the endocardium in the entire septum and inferior wall at the base, middle and apical segments, and in the anterior wall at the middle and apical segments, similar in distribution to previous study. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process and are atypical for myocardial infarction. The T1-mapping times are normal. There is no myocardial iron overload. There is no intracavitary thrombus.3. The right ventricle is normal in size with severely reduced systolic function, the RVEF is 27%, though improved from previous study. 4. The right atrium is mildly dilated, improved from previous study.5. The main pulmonary artery is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69 year old man with history of anterior wall MI with chronic LAD occlusion, LV thrombus and LV dysfunction with worsening angina; referred for cardiac MRI to evaluate ischemic and scar burden.MEDICATIONS: aspirin, atorvastatin, lopressor, warfarin, lisinopril First Pass PerfusionDuring hyperemia, extensive amount of the myocardium had evidence of a perfusion defect. The mid ventricle and apex had a perfusion defect, as did the basal anterior and anteroseptal walls. Viability/ Myocardial ScarThere is a very large, nearly transmural infarction involving the basal anterior and anteroseptal walls remainder of the myocardium is viable. Left VentricleThe left ventricle is moderate to severely dilated with moderately reduced systolic dysfunction. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 134 ml/m2 (normal range: 74+/-15), the LVEDV is 292 ml (normal range 142+/-34), the LV end systolic volume index is 86 ml/m2 (normal range 25+/-9), the LVESV is 187 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 125 g (normal range 164+/-36). There is thinning of the entirely of the apical segments with associated aneurysmal formation. There is laminated thrombus within the aneurysm. There is additionally mild hypokinesis of the basal inferolateral wall. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with hyperdynamic systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 176 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. A large burden of the myocardium has evidence of perfusion defects during hyperemia, which corresponds to multi-vessel coronary artery diease. The perfusion defect in the LAD territory is associated with a large myocardial infarction which involves 40-50% of the wall thickness. This territory has a low to intermediate probability of viability. The RCA and LCx territories also have evidence of perfusion defect/ "ischemia"; however, these territories have no associated myocardial infarction and are highly likely to be viable. 2. The left ventricle is moderate to severely dilated with moderately reduced systolic dysfunction (EF 36%). There is a large apical aneurysm with evidence of a laminated thrombus. 3. The right ventricle is normal in size with hyperdynamic systolic function (EF 63%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Acute mental status changes x 1 week There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Areas of subcortical and periventricular white matter hypodensity indicate small vessel ischemic disease of indeterminate age. If there is concern for an acute stroke, an MRI may be considered for further evaluation.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: Small vessel ischemic disease of indeterminate age. No acute intracranial findings.


Instruction: Generate impression based on findings.

Input: Ms. Walker is a 67 year old female with a personal history of left breast lumpectomy in 2013 for pleomorphic/classic type LCIS and right breast mastectomy in 1992 for breast cancer. She is currently on Aromasin. There is scattered fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted in the left breast.The patient is status post right breast mastectomy with stable appearance of the right implant based reconstruction. Stable postoperative changes are identified in the left breast, at site of prior left breast lumpectomy. Subcentimeter enhancing mass is seen in the left inner breast, stable on MRI and mammogram since 2014. There is no new abnormal enhancement seen in either the left breast or the right reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. No significant interval change since prior MRI.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 35 years old, history of ependymoma of the spine status post resection with supratentorial lesions. Brain:A punctate focus of cortical enhancement is seen along the left precentral sulcus (image 128 series 37). The immediate prior examination was performed without contrast, but when compared to the next prior examination, the size of the enhancement has decreased. T2 hyperintensity which extends from this lesion and spreads mildly into the adjacent white matter is unchanged relative to the immediate prior study, but more prominent than that seen on the older study.An enhancing lesion seen previously in the right occipital lobe has decreased in size and now presents as a faint ill-defined blush (image 79 series 37). A punctate focus of enhancement in the left occipital lobe (image 77 series 37) was not clearly evident on the prior contrast enhanced exam although image quality in that study was poor.No evidence of significant parenchymal edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricles are normal in size and morphology.Spine:Motion artifact significantly degrades image quality in the spine.Redemonstrated is evidence of laminectomy from C6 through T2. The soft tissues of the operative bed are diffusely enhancing compatible with scar. No fluid collections are seen.Redemonstrated is evidence of tumor resection from the lower cervical/upper thoracic spinal cord. The cord is thinned from C7 through T2, and in this region, the cord does enhance diffusely but to a lesser degree than was seen on the prior contrast enhanced study. As before, the inferior margin of this enhancement appears to stop at a hemosiderin cap.Syringohydromyelia of the cord above the level of resection is unchanged. Within the limitations of degraded image quality, no other lesions are suspected in the visualized spinal canal.A small left pleural effusion is evident.

Output: 1. Two of the intracranial enhancing lesions seen on the prior examination have decreased in size. This includes a lesion along the left precentral sulcus. T2 hyperintensity which extends from this lesion into the adjacent white matter is unchanged relative to the immediate prior examination, but more prominent when compared to older studies. These changes would be compatible with evolution of a benign process, perhaps embolic or septic-embolic disease. However the possibility of metastasis has not been entirely excluded and continued follow-up of these lesions is recommended.2. A single punctate lesion in the left occipital lobe visualized on the present study was not clearly seen on the prior contrast enhanced examination. It is possible that this lesion was present and simply not seen due to significant artifact on the prior study, though it could have developed in the interval. There is no associated T2 hyperintensity or edema. The significance of this finding is uncertain.3. Redemonstration of postoperative findings in the spine compatible with resection of ependymoma from the lower cervical and upper thoracic spinal cord. The cord remains thinned through this region and diffusely enhancing. However, the intensity of enhancement is reduced relative to the prior study. No definite evidence of any new cord lesion is seen within the limits of significant artifact.


Instruction: Generate impression based on findings.

Input: 66-year-old female with newly diagnosed cirrhosis who presents for MRI of the liver for pretransplant evaluation. ABDOMEN:LIVER, BILIARY TRACT: Severe cirrhotic morphology. Within the limitation of noncontrast examination, no gross T2 hyperintense lesion. Motion artifact limits evaluation of vasculature.SPLEEN: Splenomegaly.PANCREAS: Previously noted 12 x 9 x 9 mm lesion on the ultrasound examination is not visualized on the T2 or diffusion-weighted images.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume ascites. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right and moderate left pleural effusions.

Output: 1.Limited nonenhanced examination. Cirrhotic hepatic morphology. This exam is nondiagnostic for evaluation for hepatic lesions without contrast.2.Previously noted pancreatic head lesion is not visualized on the T2 or diffusion-weighted images. This may have been an adjacent duct on the previous sonogram.3.Large volume ascites.4.Small right and moderate left pleural effusions.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for subluxation or ligamentous injury History: neck pain, intermittent bilateral hand paresthesias, Ehlers Danlos syndrome, fell forward 2 days ago at playground, neck pain for 4 days Alignment is anatomic. There is no fracture or subluxation. The marrow signal is benign. Vertebral body heights are maintained. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Spinal cord has a smooth contour and is without focal atrophy, edema, myelomalacia. No intraspinal hematoma or mass. The visualized paraspinal contents are unremarkable. Major cervical vasculatures with normal flow voids. There are no MRI findings of ligamentous injury.

Output: No evidence of fracture, subluxation, or ligamentous injury.


Instruction: Generate impression based on findings.

Input: 78 yo with Afib, SVT and dilated Ao Left VentricleThe left ventricle is normal . The overall LV ejection fraction is 60%, the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVEDV is 157 ml (normal range 142+/-34), the LV end systolic volume index is 31 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.Left AtriumThe left atrium is upper normal in size. Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 169 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 67 ml (normal range 54+/-17).Right AtriumThe right atrium is normal . Dilated coronary sinus.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Dilated aortic root.SOV 45 mmAsc Ao 40-41 mmMid Ao arch 34Desc 27-28 mmPulmonary 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. There is a persistent left SVC.PericardiumThere is no obvious pericardial disease.Extracardiac Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function2, Normal RV size and systolic function3. Persistent L SVC4. Dilated aortic root (measurements above).5. No evidence for delayed enhancement.


Instruction: Generate impression based on findings.

Input: No findings to suggest acute cord compression. Post-operative changes of sub-occipital craniectomy for Chiari decompression. There is exaggerated kyphosis of the thoracic spine at T8 through 10 level as well as exaggerated lordosis of the lumbar spine. There are no acute fractures or subluxations. The marrow signal is benign. The spinal cord is normal in signal. The conus is normal in signal and morphology and terminates at an appropriate level. Multilevel disk height loss without significant central spinal canal stenosis or neural foraminal narrowing. The visualized paraspinal contents are unremarkable.

Output: No findings to suggest acute cord compression.


Instruction: Generate impression based on findings.

Input: Redemonstrated are multiple foci of susceptibility abnormality consistent with multiple cerebral cavernous malformations. A lesion along the anterior surface of the left pons has increased in size, however without change of central intensity characteristics and with no perilesional edema. Other supratentorial and infratentorial lesions are not significantly changed. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is an unchanged 12 mm wide extra-axial CSF space overlying the medial right cerebellar hemisphere, which may represent an arachnoid cyst versus minimally prominent cisterna magna, unchanged in appearance. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Redemonstrated are multiple foci of susceptibility abnormality consistent with multiple cerebral cavernous malformations. A lesion along the anterior surface of the left pons has increased in size, however without change of central intensity characteristics and with no perilesional edema. Other supratentorial and infratentorial lesions are not significantly changed.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer. Passed out last night, need to evaluate possible CNS disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of T2 hyperintensity in the cerebral white matter, which are nonspecific. There is also a nonspecific non-enhancing punctate focus of susceptibility effect in the right middle frontal gyrus. 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, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses.

Output: Nonspecific non-enhancing punctate focus of susceptibility effect in the right middle frontal gyrus. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 48-year-old man status post right meniscectomy with history of knee pain. MENISCI: The lateral meniscus is unremarkable. There is a horizontal tear of the posterior horn of the medial meniscus (series 7, image 16) extending to the femoral articular surface. Additionally, the posterior horn of the medial meniscus is diminutive and there is slight medial extrusion of the body.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of both patellofemoral and tibiofemoral compartments. There is also focal fissuring of the cartilage overlying the posteromedial femoral condyle with underlying reactive marrow change and subchondral cyst formation (series 5, image 24).LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. The popliteus muscle and tendon are intact. EXTENSOR MECHANISM: The patella and extensor mechanism are unremarkable.ADDITIONAL

Output: 1.Complex tear involving the posterior horn of the medial meniscus with mild extrusion.2.Diffuse chondromalacia with focal chondral fissuring over the medial femoral condyle and underlying subchondral cyst.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1] / Other specified disorders of muscle [M62.89] / Slurred speech [R47.81] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke History: Right facial droop dysarthria Brain MRIThere is focal restricted diffusion on the left internal capsule posterior rim indicating acute ischemic stroke.There is no evidence of hemorrhagic lesion.Multifocal encephalomalacia involving left parieto-temporo-occipital lobes, right cerebellar hemisphere, bilateral frontal lobes (left more than right), left basal ganglia and left thalamus are seen indicating chronic ischemic infarction. The left midbrain and pons show Wallerian degeneration.Susceptibility lesions on bilateral parietal lobes associated with encephalomalacia lesions described above indicating chronic hemorrhages likely related to prior ischemic stroke.The ventricles, sulci and cisterns are symmetric and show exvacuo changes, but overall unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate slightly irregular but normal ICAs, MCAs, ACAs and vertebrobasilar system. No arterial occlusion. No aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous but normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Left internal capsule posterior limb acute ischemic stroke without evidence of hemorrhagic conversion.2. Multifocal chronic ischemic infarctions with prior hemorrhagic conversion lesions as described above.3. No evidence of major intracranial or extracranial arterial occlusion or stenosis.4. No intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: ovarian cancer. mullerian duct. evaluate for metastases. 22 years old female. The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine. The known lesions in the cervical spine identified on MRI exam from a couple days ago are not detected on the CT scan.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.

Output: 1.No fractures are identified in the cervical spine.2.The patient's metastases cannot be detected on the CT of the cervical spine.


Instruction: Generate impression based on findings.

Input: Reason: assess for L hip osteo History: pain, pressure ulcer There is a band of low signal intensity extending from the left lower buttock through the subcutaneous fat to the inferior margin of the left ischium, presumably representing ulceration with a sinus tract. The sinus tract itself is predominantly low signal intensity with minimal enhancement, although a small amount of increased signal intensity is seen within the tract on T2-weighted images adjacent to the ischium where there is also mild enhancement. There is slight irregularity of the cortical margin of the adjacent ischium that likely represents early cortical erosion. There is minimal increased signal intensity of the underlying marrow on fat-suppressed T2-weighted images and minimal enhancement following contrast administration, but the T1 signal intensity of the medullary bone is relatively preserved. This pattern supports reactive osteitis rather than medullary osteomyelitis. An additional small focus of abnormal signal intensity and enhancement is noted immediately distal to the terminal coccyx, which likely represents an additional small phlegmon that communicates with the skin surface. We see no drainable fluid collection and the marrow signal of the adjacent coccyx is normal. The remaining bone marrow signal intensity is unremarkable. There is atrophy of the musculature. A Foley catheter is noted in the bladder. A small amount of fluid is seen within both hip joints but there is no effusion. The sacroiliac joints are normal. There is mild degenerative disc disease at L5-S1.

Output: Ulceration with sinus tract leading to the left ischium. Although there appears to be early erosion of the cortical margin of the bone, the signal intensity pattern of the underlying medullary bone suggests reactive osteitis rather than medullary osteomyelitis. A second small sinus is noted extending to the coccyx with no associated marrow signal abnormality.


Instruction: Generate impression based on findings.

Input: 59 year old with history of stem cell transplant for MDS, HTN, atrial fibrillation and admission for heart failure presenting for ischemic evaluation. MEDICATIONS: ASA, lisinopril, metoprolol, lasix, diltiazem First Pass PerfusionDuring hyperemia, no perfusion defect is noted. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%; however, the ejection fraction measurement is limited by atrial fibrillation. The LV end diastolic volume index is 146 ml/m2 (normal range: 74+/-15), the LVEDV is 250 ml (normal range 142+/-34), the LV end systolic volume index is 79 ml/m2 (normal range 25+/-9), the LVESV is 135 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 129 g. The LV dysfunction is global. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 213 ml (normal range 142+/-31), the RV end systolic volume index is 61 ml/m2 (normal range 31+/-9), and the RVESV is 104 ml (normal range 54+/-17).Right AtriumThe right atrium is mild to moderately 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small to moderate size pericardial effusion present along the posterior aspect of the LV and also over the right atrium. The pericardial effusion is not hemodynamically significant. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No evidence of perfusion defect during hyperemia/ "ischemia"2. No prior myocardial infarction. The entire myocardium is viable.3. Moderately dilated left ventricle with mildly reduced systolic function (LVEF 46%).4. Mildly dilated RV size with normal systolic function (RVEF 51%).5. Small to moderate sized, posteriorly located pericardial effusion, without evidence of hemodynamic significance.


Instruction: Generate impression based on findings.

Input: There is a 4 mm transverse x 3 mm craniocaudal focus of relative hypoenhancement within the right pituitary gland correlating with the smaller focus of T2 hyperintensity, matching previous abnormality identified on the MRI from 2003 and consistent with microadenoma. Although it appears to be larger, a portion of this is secondary to changes in technical acquisition including dynamic contrast imaging and also interval increase in conspicuity. The infundibulum remains in the midline. There are no suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally.

Output: There is a 4 mm transverse x 3 mm craniocaudal focus of relative hypoenhancement within the right pituitary gland correlating with the smaller focus of T2 hyperintensity, matching previous abnormality identified on the MRI from 2003 and consistent with microadenoma.


Instruction: Generate impression based on findings.

Input: 58-year-old female with pancreatic cancer with increasing liver enzymes and bilirubin. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: Moderate new intrahepatic and extrahepatic biliary ductal dilatation to the level of the hepaticojejunostomy. Additionally, there is evidence of periductal enhancement.Suboptimal arterial phase. There are nonspecific subcentimeter arterially enhancing scattered hepatic foci without evidence of washout, specifically in the right hepatic lobe (series 701, image 31). Segment 2 hepatic cyst again noted. Artifact from metallic clip at the hilum limits evaluation of the main portal vein.SPLEEN: No significant abnormality noted.PANCREAS: Postoperative changes involving the pancreas again noted. Persistent ductal dilatation in the residual pancreas without evidence of a mass. The soft tissue density surrounding the metallic surgical clip on the previous CT scan is not well appreciated given blooming artifact from the hardware. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The biliary jejunal loop is dilated measuring up to 4.4 cm with evidence of an abrupt transition which is not well evaluated on the MR examination (series 401, image 13)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dilatation of the biliary jejunal loop up to 4.4cm with an abrupt transition point as above, suggestive of obstruction, but which is not well evaluated on MRI examination. CT examination may be considered for further evaluation if indicated2.Biliary ductal dilatation to the level of the hepaticojejunostomy with findings raising concern for cholangitis; this may be secondary to the aforementioned dilatation of the biliary jejunal loop. 3.Postoperative changes involving the pancreas with persistent dilation of the pancreatic duct.4.Ill-defined soft tissue encasing the metallic surgical clip is better appreciated on the CT examination given blooming artifact on MRI.5.Arterial enhancing subcentimeter lesions without evidence of washout on the suboptimal arterial phase is likely perfusional in etiology; however, attention on subsequent examination is recommended.


Instruction: Generate impression based on findings.

Input: Evaluate for possible right sided submandibular gland mass/tumor: right submandibular enlargement. There is diffuse mild enlargement of the right submandibular gland, while the left submandibular gland appears to be atrophic. However, there is no evidence of mass lesions or significant cervical lymphadenopathy. The parotid glands and thyroid gland are unremarkable. The major cervical flow voids are intact. There is lack of the usual cervical kyphosis and mild multilevel degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable.

Output: Diffuse mild enlargement of the right submandibular gland may be compensatory to apparent atrophy of the left submandibular gland, without evidence of underlying mass lesions or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: evaluation of white matter abnormality History: AMS There are bihemispheric periventricular white matter confluent high signal intensity lesions on FLAIR/T2 weighted images or on the posterior aspect without evidence of restricted diffusion or associated edema. The high signal intensity lesions are extended toward right cerebral peduncle, pons and medullar. Differential diagnosis include HIV encephalopathy and the differential diagnosis include PML.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Constellation of above MR findings with clinical history indicate possible diagnosis of HIV encephalopathy and the differential diagnosis include PML.


Instruction: Generate impression based on findings.

Input: Reason: Eval cervical radiculopathy History: Shooting arm pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits.The cervical spinal cord has normal signal characteristics and overall morphology.Multilevel degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy. No significant compromise to the spinal canal. Mild left and minimal right neural foraminal narrowing.C4-5: Small disc osteophyte complex. No significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing.C5-6: Small disc osteophyte complex. No significant compromise to the spinal canal. Mild left and minimal right neural foraminal narrowing.C6-7: Small disc osteophyte complex. No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine with mild multilevel neural foraminal narrowing as described above. No significant spinal canal stenosis or cord signal abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is reversal of the upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Grade 1 anterolisthesis C2 on C3, posterior osteophyte disc complex, ligamentum flavum thickening, and facet hypertrophy. There is mild central and moderate to severe bilateral neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is moderate central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is moderate central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is moderate left neural foraminal and moderate to severe right neural foraminal stenosis.Degenerative changes of the upper cervical spine result in moderate neural foraminal stenosis at T1/2 and mild neural foraminal stenosis at T2/3.Lumbar spine:There are no fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: Asymmetric bulge to the left, ligamentum flavum thickening, mild bilateral facet hypertrophy, a tiny synovial cyst along the left anteromedial facet joint, and a small left facet effusion. There is moderate left neural foraminal and mild right neural foraminal stenosis.L3/4: Diffuse annular disc bulge, ligamentum flavum thickening, mild-to-moderate bilateral facet hypertrophy, and a moderate left facet effusion. There is mild central and mild bilateral neural foraminal stenosis.L4/5: Grade 1 anterolisthesis of L4 on L5, diffuse annular disc bulge, ligamentum flavum thickening, severe bilateral facet hypertrophy, and mild to moderate bilateral facet effusions. There is moderate to severe central, severe bilateral lateral recess, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.L5/S1:Mild disc bulge and minimal bilateral facet hypertrophy. Bilateral S1 nerve root sheath origins are blunted and flattened without displacement.

Output: 1.C2/3: Mild central and moderate to severe bilateral neural foraminal stenosis.2.C3/4: Mild central and severe bilateral neural foraminal stenosis.3.C4/5: Moderate central and severe bilateral neural foraminal stenosis.4.C5/6: Moderate central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.5.C6/7: Mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.6.C7/T1: Moderate left neural foraminal and moderate to severe right neural foraminal stenosis.7.Degenerative changes of the upper cervical spine result in moderate neural foraminal stenosis at T1/2 and mild neural foraminal stenosis at T2/3.8.L2/3: Moderate left neural foraminal and mild right neural foraminal stenosis.9.L3/4: Mild central and mild bilateral neural foraminal stenosis.10.L4/5: Moderate to severe central, severe bilateral lateral recess, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.11.L5/S1:Bilateral S1 nerve root sheath origins are blunted and flattened without displacement.


Instruction: Generate impression based on findings.

Input: History of ADEM with right lower extremity hyperreflexia. Follow up acute demyelinating encephalomyelitis. Redemonstrated are scattered periatrial T2 hyperintense white matter lesions bilaterally, which are not significantly changed from the prior examination. Scattered punctate hyperintense white matter lesions is also redemonstrated within the corona radiata and centrum semiovale. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. 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 interval progression in diffuse paranasal sinus mucosal thickening.

Output: 1. Nonspecific scattered bilateral white matter lesions, which are without significant interval change.2. Interval progression of diffuse paranasal sinus disease.


Instruction: Generate impression based on findings.

Input: 70-year-old male with history of severe pancreatitis, now with a large pseudocyst. Evaluate pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is a T2 heterogeneous with components of T1 hyperintensity, which are consistent with proteinaceous versus blood products, pancreatic and peripancreatic collection measuring 16.7 x 7.9 cm (series 4, image 16). This collection encases the splenic artery without evidence of a pseudoaneurysm. These findings are unchanged compared to the outside CT examination. Peripherally, the collection demonstrates contrast enhancement. The majority of the collection is non-liquefied.There is residual normal-appearing pancreatic head and uncinate process.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: Predominantly non-liquefied pancreatic/peripancreatic complex collection as above; findings most consistent with a large WON, walled off necrosis; superimposed infection not excluded.


Instruction: Generate impression based on findings.

Input: 45-year-old male with history of prostate cancer status post focal laser ablation. PROSTATE:Prostate Size: 4.6 x 3.1 x 2.6 cm, TR x AP x CCPeripheral Zone: There is a focal enhancing lesion in the left apex which demonstrates low T2 and ADC signal and measures 1.3 x 0.6 cm (series 703, image 144). T2 hyperintense post-ablation changes are noted within the right base and mid gland.Central Gland: Prostatic hypertrophy without focal lesion. Please see measurements above.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Enhancing lesion in the left apex abuts and appears to extend past the prostatic capsule, most pronounced on post-contrast images. BLADDER: No significant abnormality noted.LYMPH NODES: No suspicious pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enhancing, T2 hypointense lesion in the left apex that appears to abut/extend across the capsule. Findings are suspicious for neoplasm at this site. 2.Post-ablation changes in the right base as described above.


Instruction: Generate impression based on findings.

Input: Rheumatoid arthritis and neck pain. There is 6 mm anterior subluxation of the left C1 inferior facet relative to the C2 superior facet, which is unchanged compared to prior MRI. Alignment of the rest of the cervical spine is within normal limits. Again noted is mild superior subluxation of the tip of the dens superiorly. There is no evidence of significant change when compared to prior MRI study. The tip of the odontoid is above the Wackenheim line, which is abnormal. However, the odontoid tip is inferior to the McRae foramen magnum line, and intersect with the Chamberlain line, which is still within normal limits. There is impression of the dens on the ventral aspect of the cervicomedullary junction, which was best seen on the prior MRI study. Accounting for technical differences, there is no evidence of interval change. The atlantodental distance is slightly increased, measuring 5.5 mm. The spinal canal at the C1 level is slightly narrowed to 9 mm. The rest of the cervical spine demonstrates mild arthritic changes of the facet joints seen at multiple levels, but there is no spinal canal or neuro-foraminal compromise.This a hypodense nodule in the right thyroid gland, measuring 1.2 x 1.7 ccm approximately. There is no associated calcification.

Output: 1. Arthritic changes at C1-C2 level, with mild superior subluxation of the dens and narrowing of the spinal canal, resulting in impression on the cervicomedullary junction. No significant interval change compared to the prior MRI study. 2. Right thyroid nodule. Please correlate with other clinical parameters.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right frontal craniotomy with no significant change in the area of confluent T2 hyperintensity within the right superior frontal gyrus surrounding the surgical cavity. However, there is no evidence of associated abnormal intraparenchymal enhancement. The ventricles and sulci are stable. There is no midline shift or mass effect. There is no evidence of acute infarct. The skull and extracranial soft tissues appear to be unchanged.

Output: Post-treatment findings involving the right frontal lobe without evidence of interval tumor progression.