Instruction: Generate impression based on findings.

Input: Cervicalgia. Posterior neck pain with left arm radiation. Outside order from Stroger hospital. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C5 on C6 and C6 and C7. Alignment is otherwise maintained.. Bone marrow signal is benign. T1 hyperintense lesion with enhancement involving the right T2 pedicle/transverse process junction is consistent with hemangioma. No suspicious enhancing lesions.The cervical spinal cord has normal signal characteristics and overall morphology.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: No significant compromise to the spinal canal or neural foramina.C4-5: Small central disc protrusion and ligamentum flavum thickening which partially efface the ventral and dorsal thecal sac. There is overall mild spinal canal stenosis at this level. Neural foramina are patent. C5-6: Small disc osteophyte complex. There is minimal narrowing of the spinal canal. Minimal narrowing of the bilateral neural foramina, left greater than right.C6-7: Small disc osteophyte complex and ligamentum flavum thickening. There is mild spinal canal stenosis. There is also mild left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy. Right neural foramen is patent. There is subtle asymmetric STIR hyperintensity as well as mild enhancement involving the proximal aspect of the left C7 nerve root. No appreciable underlying mass. 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: 1. Mild multilevel degenerative changes in the cervical spine with mild spinal canal stenosis at the C4-C5 and C6-C7 levels. There is also fairly mild neural foraminal narrowing at the C5-C6 and C6-C7 levels, left greater than right. 2. There is abnormal enhancement involving the proximal aspect of the left C7 nerve root which is nonspecific but may be secondary to the left C6-C7 neural foraminal stenosis and correspond to patient's radiculopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post metastatic spinal cord tumor resection. Signs and symptoms: Status post metastatic spinal cord tumor resection. Pre-and post-enhanced thoracic MRI:Examination demonstrate interval posterior laminectomy as well removal of the spinous processes for tumor resection at T8 and T9 levels. There are also post operative changes of posterior spinal fusion with placement of bilateral transpedicular screws at T7 and T10 levels. Postoperative changes at the levels of T8 laminectomy demonstrate mass effect on the thecal sac posteriorly and with effacement of subarachnoid space and displacement of the cord anteriorly. The signal intensity of the thoracic cord called to remains reading normal which can be assessed only on sagittal series. Axial images through the surgical sites are suboptimal due to excessive artifact from metallic hardware.Marrow signal replacement of the vertebral bodies of T7 T8 and T9 and including the left pedicle of T8 and T9 representing metastatic disease is again noted without convincing evidence of change. A focus of marrow signal replacement in the body of T7 vertebrae consistent with a metastatic disease demonstrating slight interval increased size.There is no detectable abnormal enhancement of the cord or the meninges.

Output: 1.Interval laminectomy and removal of the spinous processes of T8 and T9 for removal of tumor. Postoperative changes posteriorly results in mass effect on the thecal sac and with forward displacement of cord and effacement of subarachnoid space at T8 level.2.Interval fusion and placement of fixating transpedicular screws bilaterally at T7 and T10.3.Marrow signal changes of vertebral bodies and including the left pedicles at T8, T9 and T10 levels are again noted and are presenting tumor without change.4.Focus of metastatic lesion in the vertebral body of T11 which demonstrates minimal interval increased size.5.Normal signal intensity of the cord and without abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 40-year-old female with PVT. Please evaluate also for evidence of PSC. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in contour and morphology. Stable small cyst of the left hepatic lobe. No suspicious enhancing lesions.Chronic thrombosis of the portal vein with cavernous transmission including the large collateral periportal vessel formation.Stable mild irregularity of the biliary tree. No suspicious focal lesion or dominant stricture.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: Colon remains significantly distended with fluid, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable mild irregularity of the biliary tree. No suspicious lesion or dominant stricture.2.Stable cavernous transmission of the portal vein.3.Stable fluid distention of the visualized colon.


Instruction: Generate impression based on findings.

Input: 62-year-old male with acute shortness of breath and hemoptysis. Rule out PE. PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: Severe emphysema. Right hilar and peribronchial thickening with adjacent interstitial and air space disease concerning for with lymphangitic spread of diseaseMEDIASTINUM AND HILA: Bulky AP window lymph nodes, the largest of which measures 2 x 2.6-cm, (image 37, series 6). and moderate pericardial effusion. Right hilar mass has ill-defined borders but grossly measures 4.7 x 4.1cm (image 86, series 8) which sounds and narrows the right upper lobe bronchus and right upper pulmonary artery. The distal aspect of the right upper lobe bronchus is narrowed measuring approximately 4 mm (image 36, coronal series).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Right adrenal gland is incompletely imaged but has a bulky appearance which is nonspecific and may be further evaluated with dedicated adrenal CT or MRI if clinically indicated.

Output: 1. Bulky mediastinal lymphadenopathy and right hilar mass with adjacent interstitial and airspace disease concerning for primary neoplasm with local extension and lymphangitic spread.2. Bulky right adrenal gland as described above.


Instruction: Generate impression based on findings.

Input: Female, 18 months old, with seizures x2 (staring episodes). The septum pellucidum is absent with associated findings of flattening of the roof of the frontal horns and draping of the floor of the frontal horns around the forniceal columns. The corpus callosum is fully formed and intact. The posterior body may be slightly thinned but this can also be a normal variation for age. The fornices are present and within normal limits.The anterior pituitary gland demonstrates normal size and morphology. The posterior pituitary gland is normally positioned within the posterior aspect of the sella and is also within normal limits. The pituitary stalk is present and seems to be of normal caliber.The optic chiasm is present and probably within normal limits for size. The right optic nerve, however, appears to be slightly smaller than the left. The shape the globes is within normal limits.A small parenchymal defect is present along the right caudothalamic groove. No evidence of any cerebral clefting is seen. No definite ectopic cortex, cortical dysplasia or migrational anomaly is seen.No evidence of acute intracranial hemorrhage is seen. There are no abnormal extra-axial fluid collections.The degree of sulcation appears to be normal for age. The pattern of white matter myelination is appropriate for age. Mild T2 hyperintensity along the lateral ventricular atrium may represent the so-called terminal zones of myelination.

Output: 1.Constellation of findings including absence of the septum pellucidum, anomalous shape of the frontal horns, and questionable mild hypoplasia of the right optic nerve highly suggestive of septo-optic dysplasia.2.The corpus callosum and fornices are visualized and intact. No evidence of schizencephaly or any definite cortical heterotopia, dysplasia or migrational anomaly is seen.3.A small parenchymal defect is evident along the right caudothalamic groove. This could reflect the sequela of a remote, potentially prenatal or perinatal insult.


Instruction: Generate impression based on findings.

Input: Fever and pain with neck movement. Brain: There is encephalomalacia and hemosiderin in the right parietal lobe, left occipital lobe, and left posterior cingulate gyrus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift. There is mild diffuse cerebral volume loss with prominence of the ventricles and sulci. There is microcephaly.Face: There are secretions and mucosal thickening throughout the paranasal sinuses. There are numerous polypoid lesions in the nasal cavities. There appears to be thinning of the left frontal sinus posterior wall and there is a focal dehiscence in the right lateral sphenoid sinus wall. The orbital contents are unremarkable.

Output: 1. Sinonasal polyposis with widespread paranasal sinus secretions related to cystic fibrosis, with thinning of the left frontal sinus posterior wall and a focal dehiscence in the right lateral sphenoid sinus wall, but no evidence of intracranial collections. However, assessment for infectious processes is limited due to the lack of intravenous contrast.2. Encephalomalacia and hemosiderin in the right parietal lobe, left occipital lobe, and left posterior cingulate gyrus.3. Microcephaly.


Instruction: Generate impression based on findings.

Input: Lung cancer, balance deficits, questionable neurologic deficit, evaluate for brain tumor No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. Nonspecific T2/FLAIR hyperintense foci are seen throughout the periventricular and subcortical white matter. Given the patient's age, these are likely secondary to small vessel seen in disease. No mass lesion is seen within the brain. No abnormal areas of enhancement are seen. The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of a cavum septum pellucidum and cavum vergae, normal variants.Normal vascular flow voids are present in the major intracranial vasculature.The imaged portions of the paranasal sinuses are clear. Fluid is seen within the left mastoid air cells. The imaged portions of the orbits are intact.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: The patient is a 9-week-old male with history of apnea for two minutes. Rule out bleed or mass. There is no evidence of intracranial hemorrhage, mass or edema. The parenchyma of the cerebrum, cerebellum and brainstem is normal in attenuation and morphology.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: Normal brain CT.


Instruction: Generate impression based on findings.

Input: History of tethered cord. There are postoperative findings related to what appears to be prior dethetering surgery, including lumbosacral laminectomies. There is diffuse elongation and thinning of the spinal cord with a low lying conus medullaris at the L5 level. There is also a fat signal intensity mass that measures up to 21 mm associated with the cauda equina nerve roots at the L5-S1 level, abutting the posterior dura. There is also a subcentimeter globular area of low T1 and T2 signal to the right of the mass, which may represent clumped nerve roots and/or scar tissue. There is no appreciable translation of the spinal cord on prone versus supine positioning. The spinal cord signal is otherwise unremarkable. There are multiple intravertebral disc herniations, but there is no spinal canal or neural foraminal stenosis. The vertebral body heights are otherwise preserved and the bone marrow signal is unremarkable. The vertebral column alignment is anatomic.

Output: Postoperative findings in the lumbosacral region with a low lying conus medullaris at the L5 level and a lipomatous mass associated with the cauda equina nerve roots at the L5-S1 level, abutting the posterior dura. The constellation of findings suggests persistent tethered cord.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for bleed. Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrates multiple patchy areas of low attenuation in bilateral cerebral hemispheres. Some regions demonstrate mass effect evidence by effacement of adjacent cortical sulci. There is also a focus of low-attenuation with well-demarcated margin in the right mid temporal lobe that has the appearance of a cyst. There is no evidence of hemorrhage as clinically is questioned. The ventricular system are within normal range of size and not significantly changed since prior exam. Areas of low attenuation described above correspond with areas of peritumoral vasogenic edema noted on prior MRI examination from 2 -- 22 -- 11. There is however suggestion of interval increase in the amount of edema which may indicate further progression of disease. Recommend follow-up with an infused head CT or unenhanced MRI of brain. No evidence of abnormality of posterior fossa and stable since prior exam.

Output: Multiple large areas of peritumoral vasogenic edema with subtle associated mass-effect and with interval worsening since prior MRI examination from 2 -- 22 -- 11.


Instruction: Generate impression based on findings.

Input: Lifelong cervicofacial lymphatic malformation involving tongue, floor of mouth with possible macrocystic components: Submandibular swellings and bleeding from tongue component. There are non-enhancing cystic lesions involving multiple spaces of the head and neck, including the bilateral parotid, submandibular spaces, perhaps extending slightly into the parapharyngeal spaces, floor of mouth, oral tongue, tongue base, and submental region. Many of the cystic spaces are punctate. However, there are several larger cystic components as well, particularly in the left parotid and submandibular spaces, where these measure up to approximately 45 mm, in the right submandibular space, where these measure up to 20 mm, and root of tongue where these measure up to 15 mm. The orbits and imaged intracranial structures are grossly unremarkable.

Output: Extensive multispatial cervicofacial lymphatic malformation with both microcystic and macrocystic components.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with pain from calf to lateral foot, weakness of great toe dorsiflexion. Eval for L5 or S1 nerve root impingement. Assuming the vertebral body with rudimentary ribs to be T12, there are four fully lumbar vertebral bodies and a transitional L5. Spinal alignment is anatomic. Vertebral body heights are preserved. A 1 cm T2 hyperintense focus in the L3 vertebral body is favored to represent a benign process, perhaps an atypical hemangioma. The visualized distal spinal cord, conus and cauda equina are unremarkable. No epidural abnormalities are suspected. L1-2: Loss of disc T2 signal, but preserved disc height. Small left paracentral superiorly directed extrusion. No significant canal stenosis or nerve root impingement. No foraminal narrowing. L2-3: Unremarkable. L3-4: Small right subarticular disc protrusion which mildly contacts the descending right L4 nerve root. No significant canal stenosis. Mild right foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disc T2 signal and slight loss of disc height. Shallow central disc protrusion. No significant canal stenosis. Mild foraminal narrowing. L5-S1: Perineural root sleeve cyst along the right exiting L5 nerve root. No spinal canal or foraminal narrowing.

Output: Mild degenerative findings are seen. At L3-4, a small right subarticular disc protrusion contacts the descending right L4 nerve root. At L5-S1, note is made of a perineural root sleeve cyst along the exiting right L5 nerve root, though these cysts are a common incidental finding of questionable significance. No other significant spinal canal or foraminal encroachment is seen.


Instruction: Generate impression based on findings.

Input: Numb hands and chest pain. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No significant spinal canal or neural foraminal stenosis.2. No evidence of demyelinating lesions in the spinal cord.


Instruction: Generate impression based on findings.

Input: 72-year-old female with soft palate cancer. CT of the soft tissues of the neck:Images through the skull base and including cavernous sinuses are unremarkable. Mastoid air cells and paranasal sinuses are within normal limits. A mass with possible small area of necrosis is noted along the posterior lateral aspect of the soft palate on the left. The mass measures approximately 26.5 mm in AP axis and 14.6-mm in transverse axis measured on axial image 33. On coronal reformatted image 33 the tumor measures 28.6-mm in cranial cephalad axis and 16-mm in transverse axis. There is no definitive evidence of a pathologic lymph node in the neck. Increased vascularity immediately posterior to the mass in the left is noted (axial image 37 and 39).The vasculature of the neck is unremarkable. No evidence of osseous or cartilaginous erosion. Limited images of the apices of the lungs and mediastinum are negative however please review the dictated report of CT of chest which visualizes both these regions would better advantage. Extensive degenerative changes of the cervical spine is noted.CT of brain with infusion:Examination demonstrates a mass in the right anterior cranial fossa which is believed to be extra-axial in location the mass measures 18-mm in AP axis and 26.6-mm in transverse axis. The mass abuts the inner table of the skull a days the right frontal bone. There is a small amount of vasogenic edema surrounding the mass. There is uniform enhancement of the mass. The finding is believed to represent a meningioma the possibility of metastatic disease is considered significantly less likely however it cannot be entirely ruled out. Follow-up with an MRI is recommended. Minimal findings of a small vessel disease is noted. No evidence of any additional area of abnormal enhancement is detected. Calvarium is intact.50 CC of Omnipaque 350 was utilized for a bulbous studies.

Output: 1.Left-sided soft palate tumor with no associated pathologic adenopathy as detailed.2.Left frontal meningioma with associated area of vasogenic edema in the right anterior cranial fossa. Follow-up with an MRI is recommended.3.Minimal small vessel disease.


Instruction: Generate impression based on findings.

Input: Ms. Streicher is a 68 year old female with a personal history of left breast lumpectomy in 2011 for carcinoma. Patient received radiation therapy. Family history of breast cancer in sister (diagnosed at the age of 57) and four maternal cousins. She has no current breast complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable post lumpectomy changes are present in the left upper outer breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: The last rib bearing vertebral bodies T12. Five lumbar vertebral bodies were counted.The conus medullaris ends at the level of L1-L2. There is diffuse and uniform heterogenous marrow signal, likely due to chemotherapy oh chronic disease.There is multilevel small convex deformities of the endplates and mild chronic compression deformities of the vertebral bodies, likely due to osteopenia. There is no malalignment and no acute fracture.T12-L1: Minimal degenerative changes with no spinal stenosis and no neural foraminal stenosis.L1-L2: Minimal degenerative changes with no spinal stenosis and no neural foraminal stenosis.L2-L3: There is a broad-based far lateral disc protrusion on the right with no spinal stenosis. No neural foraminal stenosis.L3-L4: Mild degenerative changes with no neural foraminal stenosis. There is no spinal stenosis.L4-L5: Mild degenerative changes with no neural foraminal stenosis. There is no spinal stenosis.L5-S1: Mild degenerative changes with no neural foraminal stenosis. There is no spinal stenosis. In the left lateral aspect of the disc there is a tiny annular fissure.No abnormalities are seen in the paraspinal soft tissue.

Output: 1. Mild degenerative changes of the lumbar spine with no neural foraminal or spinal stenosis.2. At the level of L2-L3 there is a right far lateral broad-based disc protrusion.3. Mild convexities of the endplates from L1 to L5 with no marrow signal changes due to chronic vertebral body compression deformities.


Instruction: Generate impression based on findings.

Input: History of cirrhosis, hepatocellular carcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No suspicious focal enhancing lesions are identified. The hepatic vasculature appears patent. No biliary ductal dilatation. Cholelithiasis. SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing lesion within a lower thoracic vertebral body compatible with a benign hemangioma. Incompletely imaged degenerative changes of the spine as well as increased wedge compression deformities involving the lumbar spine. OTHER: Small amount of abdominopelvic ascites, increased from prior.

Output: 1.Cirrhotic liver without focal lesions suspicious for hepatocellular carcinoma. Small amount of abdominopelvic ascites, increased from prior. 2.Incompletely imaged degenerative changes of the spine as well as increased wedge compression deformities involving the lumbar spine. Dedicated spinal imaging can be considered as clinically warranted.3.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Achilles pain for 4 years. Evaluate for Achilles' tendon degenerative tear. TENDONS: Left ankle: The tendons of the ankle are intact, including the Achilles tendon. No evidence of tearing. Right ankle: The tendons of the ankle are intact, including the Achilles tendon. No evidence of tearing. LIGAMENTS: Left ankle: The ligaments of the ankle are intact.Right ankle: The tendons of the ankle are intact.ARTICULAR SURFACES AND BONE: Left ankle: There is a 6 x 6 mm low T1 and high T2 lesion within the posterosuperior aspect of the left calcaneus which may represent either a subchondral cyst or enchondroma; this is likely of no clinical significance. Bone marrow signal is otherwise within normal limits. A type II accessory navicular bone is noted.Right ankle: Bone marrow signal is within normal limits. A type II accessory navicular bone is noted.ADDITIONAL

Output: Intact Achilles tendons bilaterally.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (7/17/15), ultrasound images of right breast (7/17/15), images from right ultrasound guided biopsy and post-procedural right mammographic images (7/23/15), breast MRI (7/28/15) performed at Northshore University Healthsystem. DIGITAL MAMMOGRAPHIC IMAGES (7/17/15):The breast parenchyma is heterogeneously dense. A triangular marker is placed at anterior 12 o'clock position of right breast, denoting the area of palpable lump.A focal asymmetry with mild architectural distortions are present at the site of palpable lump, at 12:00 position in the right breast. There are scattered pleomorphic calcifications around the asymmetry.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (7/17/15):A lobulated mass with mixed hypo- and isoechoic lesion, measuring 19 x 7 mm is detected at the site of palpable lump.IMAGES FROM RIGHT ULTRASOUND GUIDED BIOPSY AND POST-PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (7/23/15):Ultrasound guided biopsy for the right breast mass was performed with appropriate needle placement. Post-procedural right mammographic images show a marker clip located at superior aspect of the abnormal asymmetry.Per outside radiology repost, the biopsy result was malignant.BREAST MRI (7/28/15):Breast MRI was performed with a protocol outlined in the outside radiology report.In the right breast, there is a segmental non-mass enhancement at 12:00 position measuring 37 x 23 x 39 mm (AP x LR x CC). The maximum diagonal measurement on the sagittal plane of the lesion is 54 mm. A marker clip artifact is present at the anterior superior aspect of the lesion.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven right breast cancer. Breast MRI demonstrated extensive enhancement. Pathology slide should be reviewed at University of Chicago.2. No mammographic or MRI evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 67 year old man with cardiomyopathy referred to rule out cardiac amyloid. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. Wall thickness is normal. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 132 ml/m2 (normal range: 74+/-15), the LVEDV is 293 ml (normal range 142+/-34), the LV end systolic volume index is 100 ml/m2 (normal range 25+/-9), the LVESV is 222 ml (normal range 47+/-19), the LV mass index is 70 g/m2 (normal range 85+/-15), and the LV mass is 156 g (normal range 164+/-36). There is global hypokinesis with regional wall variation present. There is an atypical pattern of late gadolinium enhancement which spares the endocardium and involves the basal inferolateral wall (epicardial pattern) and the basal to mid anteroseptum (mid-wall pattern) which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. It has been commonly described to represent old myocarditis and also fibrosis in dilated cardiomyopathy. No evidence of cardiac iron overload or cardiac amyloidosis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 163 ml/m2 (normal range 82+/-16), the RVEDV is 361 ml (normal range 142+/-31), the RV end systolic volume index is 117 ml/m2 (normal range 31+/-9), and the RVESV is 260 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated. The interatrial septum is aneurysmal and bows to the left suggesting increased right atrial pressures.Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to severe 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 a small pericardial effusion.Extracardiac FindingsLarge right pleural effusion, small left pleural effusion, left renal cyst. 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. Severe LV dilation with severely reduced systolic function (LVEF 24%).2. Severe RV dilation with severely reduced systolic function (RVEF 28%).3. There is mid-wall and epicardial late gadolinium enhancement involving the basal inferolateral wall and the basal to mid anteroseptum. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying fibrosis, inflammation or infiltration. The pattern has been commonly described in old myocarditis and in fibrotic stage dilated cardiomyopathy. There is no cardiac MRI evidence of myocardial iron overload or cardiac amyloid. 4. Severe biatrial dilation. 5. Moderate to severe tricuspid regurgitation. 6. Mild dilation of main pulmonary artery. 7. Mild to moderate aortic regurgitation. 8. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

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

Output: Unremarkable pre-treatment planning brain MRI.


Instruction: Generate impression based on findings.

Input: Female 57 years old with left shoulder pain and weakness. Evaluate for rotator cuff tear. Evaluation is somewhat limited secondary to artifact from prior surgical intervention.ROTATOR CUFF: A full-thickness tear of the anterior fibers of the supraspinatus tendon has decreased in size presumably due to prior repair. There is new full-thickness tearing of the posterior supraspinatus tendon fibers. There is mild to moderate tendinopathy and a small intrasubstance tear of the infraspinatus tendon. Mild tendinopathy of the subscapularis tendon with no evidence of tear. There is moderate fatty atrophy and volume loss of the supraspinatus and infraspinatus muscles.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is flattening of the humeral head compatible with a Hill-Sachs deformity.Moderate to pronounced osteoarthritis affects the glenohumeral and acromioclavicular joint. Bone marrow signal intensity is grossly intact.The glenoid labrum is grossly intact within the limits of a non-arthrogram exam. BICEPS TENDON: The intra-articular portion of biceps tendon is not well seen and moderate tendinopathy is suspected. ADDITIONAL

Output: 1.Full-thickness tears of the supraspinatus tendon, intrasubstance tear of the infraspinatus tendon and rotator cuff tendinopathy as described above.2.Glenohumeral and acromioclavicular joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: A 71 year old male with paroxysmal atrial fibrillation referred to cardiac MRI for further evaluation as a candidate for ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 95 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 92 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 121 g (normal range 164+/-36). There is a diverticulum at the basal segment of the inferior wall. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is increased signal intensity on LGE images noted in basal inferolateral wall which is likely partial volume artifact. No intracavitary thrombus was seen.Left AtriumThe left atrium is moderately dilated (129ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 180 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely with mitral valve prolapse and mid-systolic mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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 and are patent.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 54%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. Moderate biatrial enlargement. 4. The right ventricle is normal in size with normal systolic function, the RVEF is 52%. 5. There is mitral valve prolapse with mild to moderate mitral regurgitation.6. Moderate tricuspid regurgitation. 7. All four pulmonary veins drain normally into the left atrium and are patent.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 70 year old BRCA 2 mutation carrier. Personal history of stage III ovarian cancer diagnosed at the age of 41. History of breast carcinoma in paternal grandmother, uncle and cousins. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. The 5 mm enhancing foci in the posterior right breast is stable. No abnormal axillary lymph nodes are identified in either axillary region. Perineural root sleeve cysts are stable.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 51-year-old male with history of chronic pancreatitis and abdominal pain. The patient also has history of pancreatic pseudocyst, cyst drainage, and pancreatic stent placement. ABDOMEN:LIVER, BILIARY TRACT: Stable small right hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: Interval decreased inflammatory changes involving and anterior to the pancreatic body with resolution of previously seen perigastric loculated fluid collection. Previously seen smaller fluid collection at the level of the pancreatic body has decreased and measures up to 0.8 x 0.8 cm, previously 1.4 x 1.7 cm (series 15/31). Mild dilation of the pancreatic duct in the body and tail with abrupt transition point in the pancreatic body in the location of the the above-described inflammatory changes. Underlying stricturing is suspected. No focal, discrete mass is evident; however, occult neoplasm cannot be excluded. Stable mild atrophy of the pancreatic body and tail.Stable 1 x 1 cm cystic lesion in the pancreatic tail, suspicious for sidebranch IPMN (series 5/10); no mural nodularity or significant enhancement.Splenic vein at the level of the portal confluence is not well visualized, suggesting thrombosis. The distal superior mesenteric vein and main portal vein and its branches are patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Previously seen prominent upper abdominal mesenteric lymph nodes have decreased in size, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval decreased inflammatory changes at and anterior to pancreatic body with decreased peripancreatic fluid collections.2.Suspected pancreatic duct stricturing in the pancreatic body, though occult neoplasm cannot be excluded.3.Stable cystic lesion in the pancreatic tail, suspicious for sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: There are scattered foci of T2 hyperintensity within the white matter without associated restricted diffusion, mass effect, or susceptibility abnormality. There is diffuse volume loss without specific lobar predominant atrophy pattern. There are no findings of ventricular obstruction or hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially empty sella. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Degenerative changes of the upper cervical spine demonstrates some degree of central spinal stenosis at the level of C3/4.

Output: 1.Mild chronic small vessel ischemic disease.2.Mild diffuse volume loss.


Instruction: Generate impression based on findings.

Input: Reason: Occult fracture/bursitis History: pain ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified to suggest an acute fracture or stress reaction.SOFT TISSUES: There is a lobulated focus of fluid signal intensity along the posterior aspect of the left acetabulum which may represent a paralabral cyst suggesting a labral tear (image 28; series 3). There is diffuse fatty infiltration of the imaged musculature of the left hip particularly affecting the gluteal musculature. ADDITIONAL

Output: Findings indicating a left sided trochanteric bursitis. Probable left-sided acetabular labral tear as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Right knee pain after motor vehicle collision. Examination is suboptimal secondary to patient size and inability to use knee coil.MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the articular cartilage of the patella.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No significant bony or ligamentous injury. Generalized thinning of the articular cartilage of the patella.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer to brain; s/p SRS and WBRT: surveillance. There is interval decrease in size of an enhancing lesion in the left superior parietal lobe, which measures 2 mm in diameter, previously 4 mm. There are unchanged subcentimeter lesions with susceptibility effect in the superior portion of the right precentral gyrus and left inferior parietal lobule. Other previously demonstrated intracranial lesions are no longer identified, accounting for differences in technique. 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval decrease in size of a metastatic lesion in the left superior parietal lobe, which measures 2 mm in diameter, previously 4 mm, but unchanged subcentimeter metastatic lesions with susceptibility effect in the superior portion of the right precentral gyrus and left inferior parietal lobule. Other previously demonstrated intracranial lesions are no longer identified, accounting for differences in technique.


Instruction: Generate impression based on findings.

Input: 50-year-old male with history of phalloplasty and chronic UTI. PELVIS:UTERUS: Presumed atrophic uterus in left hemi-pelvis.BLADDER: Mild bladder wall thickening and trabeculation, nonspecific and may be due in part to underdistention.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postoperative changes from phalloplasty and penile prosthesis.OTHER: Small cystic structure adjacent to the right aspect of the proximal urethra may represent a small Skene's gland cyst.

Output: Mild bladder wall thickening and trabeculation, nonspecific and may be due in part to underdistention but correlation with patient's clinical history and urinalysis recommended to exclude a mild cystitis.


Instruction: Generate impression based on findings.

Input: 60-year-old male with metastatic bladder cancer with acute back and RUQ pain with CT A/P showing L2 compression fracture. Further assess L2 compression fracture seen on CT. Note this is a limited examination due to patient motion and lack of postcontrast sequences.There is compression deformity of L2 anteriorly with approximately 50% loss of vertebral body height anteriorly. There is no retropulsion or evidence of epidural disease extension. There might be a discrete lesion within the L2 vertebral body on the left, however the marrow is diffusely abnormal in signal intensity likely a combination of edema and marrow infiltration by tumor. Posterior to L2 vertebral body there is what likely represents a tumor deposit along the posterior paraspinal soft tissues on the left. There is an additional tumor deposit centered on the posterior arch of L3 vertebral body involving the laminae, spinous process and facet complexes with associated epidural extension posteriorly resulting in narrowing of the spinal canal and crowding of the cauda equina.The spinal cord itself is normal in signal intensity with no evidence of cord compression. There is facet arthropathy throughout the lumbar spine. Most levels show some degree of degenerative disk disease, most pronounced at L5-S1. No high grade stenosis is seen secondary to the degenerative findings. There is fairly significant retroperitoneal adenopathy as well as a cystic lesion in the left kidney.

Output: Limited examination due to patient motion and lack of postcontrast sequences.1. Pathologic compression fracture of L2 vertebral body without retropulsion or epidural disease extension. 2. Tumor deposit centered along the posterior arch of L3 does result in epidural extension, spinal canal narrowing and crowding of the cauda equina.3. Additional tumor deposit along the posterior paraspinal soft tissues at L2 is noted.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning for brain lesion. Signs and symptoms: Headache and memory loss. Pre- and post enhanced Stealth brain MRI:Examination demonstrates extensive vasogenic edema in the left anterior and mid temporal lobe with resultant extensive effacement of regional cortical sulci and trace midline shift to the right. There is a necrotic rim-enhancing lesion in the left anterior and mid temporal lobe projecting lateral to the left temporal horn of ventricle. The lesion measures 25 mm in AP axis, 7 mm in transverse axis and 10 mm in cranial cephalad. No additional foci of edema or abnormal parenchymal/meningeal enhancement. Ventricular system remains within normal size

Output: 1.A thin rim enhancing lesion in the left anterior and mid temporal lobe white matter measuring 25 x 7 x 10 mm in size. There is extensive surrounding vasogenic edema with resultant trace deviation of midline to the right.2.No additional foci of edema or parenchymal/meningeal enhancement.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with brain lesion. Selected sequences for surgical navigation purposes redemonstrate a lesion in the right frontal lobe with thick rim enhancement and extensive associated edema involving the frontal and parietal lobes as well as the basal ganglia and insula. The size and appearance of this lesion have not significantly changed from prior examination. The degree of mass effect is also stable. Large region of encephalomalacia is redemonstrated within the left parietal lobe compatible with remote infarction. Extensive patchy areas of T2 hyperintensity are also seen in the periventricular regions, basal ganglia and thalami, perhaps representing sequelae of prior ischemic injury. The left mastoid air cells remain significantly opacified.

Output: Redemonstration of a lesion in the right frontal lobe with thick rim enhancement and extensive associated edema.


Instruction: Generate impression based on findings.

Input: 80-year-old female with fecal incontinence, back pain, and back tenderness. There is partial fusion of the osseous structures of C2-C4, with what may represent associated segmentation anomalies. Moderate loss of disc height at C5, favored to be chronic. There are disc osteophyte complexes at C4-C5 and C5-C6 that cause moderate cervical spinal canal stenosis with an apparent punctate focus of increased T2 signal in the adjacent spinal cord. There is also bilateral moderate neural foraminal stenoses at C4-5 to C5-C6. There is loss of the normal cervical lordosis, but the rest of the vertebral column alignment is intact. There is mild anterior wedge deformity of the T6 vertebra that appears chronic in nature. The thoracic and lumbar spinal cord has normal signal characteristics and morphology. The conus terminates at the L2 level. The vertebral bone marrow signal is grossly unremarkable, aside from scattered areas of focal fat and endplate degenerative changes in the cervical spine. The paraspinous soft tissue structures appear unremarkable. However, there is a 5 mm wide lipoma associated with the left strap muscle overlying the thyroid cartilage.

Output: 1. Partial fusion of the osseous structures of C2-C4.2. Disc-osteophyte complexes at C4-C5 and C5-C6 result in moderate cervical spinal canal stenosis, perhaps with mild signal abnormality in the adjacent spinal cord. The degenerative changes may be associated with what may represent segmentation anomalies with fusion of C2 through C4. 3. Bilateral moderate neural foraminal stenoses at C4-5 to C5-C6. 4. Mild anterior wedge deformity at T6 is likely chronic.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58-year-old female with medial right knee pain. MENISCI: There is increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There is blunting and increased signal abnormality which extends to the femoral and tibial articular surfaces consistent with complex tearing of the posterior horn of the medial meniscus with a radial component. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial tibial plateau with underlying degenerative subchondral signal abnormality. There is subjective thickening of the articular cartilage of the lateral tibiofemoral compartment. There is thinning of the articular cartilage along the medial facet of the patella. There is tricompartmental osteophyte formation.LIGAMENTS: The ACL and PCL appear intact. The LCL appears intact. There is thickening of the proximal fibers of the superficial band of the MCL which may represent prior injury/sprain. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe degenerative osteoarthritic changes of the knee, most pronounced along the medial tibiofemoral compartment with associated full-thickness articular cartilage degeneration.2. Complex tearing of the medial meniscus with a radial component as described above.


Instruction: Generate impression based on findings.

Input: 59-year-old male with paresthesias upper extremity when arms overhead. Assess for spinal stenosis. Cervical spine alignment is maintained. No acute fracture or subluxation. The ligamentous structures are intact. No appreciable abnormal signal of the spinal cord noted with no evidence of spinal cord edema or hemorrhage. No abnormal marrow signal. The craniocervical junction is maintained. Multilevel degenerative changes are seen, individual levels is below:At C2-C3 there is minimal disc bulge with no significant neural foraminal or spinal canal stenosis.At C3-C4 there is minimal disc bulge and uncovertebral hypertrophy without significant spinal canal or neural foraminal stenosis.At C4-C5 there is minimal disc bulge with no significant neural foraminal or spinal canal stenosis.At C5-C6 there is mild disc bulge and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis. At C6-C7 there is mild disc bulge and mild uncovertebral hypertrophy. There is no significant spinal canal or neural foraminal stenosis. At C7-T1 there is no significant spinal canal or neural foraminal stenosis. There is left-sided facet arthropathy.

Output: Mild multilevel degenerative changes in the cervical spine without high-grade spinal canal or neural foraminal stenosis at any level. Please see additional details above.


Instruction: Generate impression based on findings.

Input: 79-year-old female with cirrhosis and HCC status post RFA/TACE x2 ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Ablation cavity in the left lobe of liver (segment 3) without peripheral enhancement evident. TIPS stent is again noted and appears patent. There is diminished intrahepatic portal venous flow, similar to prior. Cholelithiasis is unchanged.SPLEEN: Splenomegaly.PANCREAS: Tiny T2 hyperintense foci most likely sidebranch IPMN formation, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged T2 hyperintensities bilaterally compatible with benign cysts. Complex cyst are noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Varices noted in the left hemiabdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged left liver lobe ablation zone without evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: Episodes of unresponsiveness. Signs and symptoms: Unresponsive intermittently. No focal findings on exam. Pre and postcontrast enhanced brain MRI:No detectable acute intracranial process and in particular no evidence of acute ischemic stroke is present.Examination demonstrate extensive periventricular and to a lesser degree subcortical confluent foci of FLAIR hyperintensity in bilateral cerebral hemispheres. Minimal similar signal changes are also present in bilateral basal ganglia and minimally in bilateral thalami and pons without evidence of hemorrhagic changes. Findings are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of moderate degree. There is slight prominence of lateral ventricles likely within normal range and possibly partially secondary to extensive chronic small vessel ischemic stroke. There is no deviation of midline. Unremarkable cerebral cortex and cerebellum/vermis.There is no detectable abnormal parenchymal or left meningeal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses remain within normal and the normal pattern of enhancement.Unremarkable calvarium and orbits without abnormal enhancement.

Output: 1.No acute intracranial process.2.Chronic nonhemorrhagic small vessel ischemic strokes of moderate degree as detailed.3.Unremarkable pre and post enhanced brain MRI otherwise for stated age of 93.


Instruction: Generate impression based on findings.

Input: There is a small 9-mm AP by 10-mm craniocaudal by 5-mm transverse enhancing lesion with a broad dural base along the posterolateral-most aspect of the right temporal lobe (series 11 image 14, series 1401 image 31, series 14 image 137). There is no associated underlying parenchymal signal abnormality.There are scattered foci of T2 hyperintensity within the white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain parenchyma.

Output: 1.There is a small 9-mm AP by 10-mm craniocaudal by 5-mm transverse enhancing lesion with a broad dural base along the posterolateral-most aspect of the right temporal lobe (series 11 image 14, series 1401 image 31, series 14 image 137). There is no associated underlying parenchymal signal abnormality. Although the differential diagnosis would include a metastasis, lymphoma, or granulomatous disease, an incidental meningioma is more likely.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 58-year-old man with history of lymphoma and abnormality in liver enzymes. ABDOMEN:LIVER, BILIARY TRACT: Moderate intrahepatic biliary ductal dilatation is again seen to level of the hepatic hilum. There is diffuse infiltrative masslike T2 signal within the hepatic parenchyma distal to the biliary duct dilatation. The gallbladder wall is thickened.SPLEEN: The splenic capsule appears infiltrated with an ill-defined T2 hyperintense lesion which appears contiguous with the pancreatic tail and retroperitoneum.PANCREAS: The pancreatic duct is mildly dilated. The pancreatic tail is indistinguishable from the aforementioned lesion.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There are punctate renal cysts, otherwise the kidneys appear normal.RETROPERITONEUM, LYMPH NODES: The abdominal aorta is aneurysmal, better characterized on the recent CT. Additionally, there is T2 hypo and T1 hyperintense material in the lumen.BOWEL, MESENTERY: The stomach is distended as previously noted in the wall of the greater curvature appears infiltrated by this mass (series 4, image 20). An umbilical hernia containing fat is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Very limited study due to patient motion and lack of intravenous contrast.2.Infiltrative mass involving the greater curvature of the stomach, spleen, pancreas, and retroperitoneum. This finding is more likely to represent lymphoma than hematoma as previously questioned.3.Additional infiltrative mass within the liver causing biliary duct dilatation.


Instruction: Generate impression based on findings.

Input: Ms. Lichtenstein submitted outside studies for review.Submitted for review are:-Bilateral mammogram dated 9/13/2016 performed at Northwest Memorial Healthcare-Right breast ultrasound dated 9/13/2016 performed at Northwestern Memorial Healthcare.-Images from stereotactic core biopsy of the right breast including specimen radiograph and postprocedure mammogram dated 9/14/2016 performed at Northwestern Memorial Healthcare.-Bilateral breast MRI dated 9/27/2016 performed at Rush University Medical Center.For comparison, bilateral diagnostic mammogram dated 10/24/2014 and right breast ultrasound dated 3/18/2015 are available. BILATERAL MAMMOGRAM:Bilateral CC and MLO views; ML, MLO, and spot magnification views of the right breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C).There is a linear marker overlying a scar on the right breast. There are postsurgical changes from right lumpectomy, noting architectural distortion, increased density, and surgical clips in the upper inner right breast at posterior depth. There is a 12 mm cluster of calcifications along the anterolateral aspect of the lumpectomy site. There is a partially obscured mass in the upper outer right breast at posterior depth, similar to prior mammogram dated 10/24/2014. There is a partially obscured mass in the upper outer right breast at mid depth, similar to prior mammogram dated 10/24/2014.There are stable postsurgical changes of the left breast, noting architectural distortion, increased density, and surgical clips in the upper outer quadrant. No new mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in the left breast. Scattered benign calcifications are present.Benign appearing lymph nodes are projected over both axillae. There are surgical clips in the right axilla.RIGHT BREAST ULTRASOUND:Static images from targeted right breast ultrasound are submitted.In the right breast, 10:00, 6 cm from the nipple, there is a 0.8 x 0.6 x 0.7 cm hypoechoic mass, previously 0.7 x 0.8 x 0.7 cm on prior ultrasound dated 3/18/2015.In the right breast, 11:00, subareolar region, there is a 0.7 x 0.5 x 0.7 cm hypoechoic mass, previously 0.8 x 0.7 x 0.8 cm on prior ultrasound dated 3/18/2015.In the right breast, 12:30, 4 cm from the nipple, there is a 0.4 x 0.3 x 0.4 cm hypoechoic mass, previously 0.5 x 0.3 x 0.5 cm on prior ultrasound dated 3/18/2015.STEREOTACTIC CORE BIOPSY, RIGHT BREAST:Pre- and postfire images from stereotactic core biopsy of the right breast, specimen radiographs, and post procedure CC and LM views of the right breast were submitted.Calcifications in the upper inner quadrant of the right breast were targeted for biopsy. Targeting appears appropriate. Specimen radiographs demonstrate calcifications within the cores. Postprocedure mammograms demonstrate a dumbbell-shaped clip along the anterolateral aspect of the lumpectomy site. There are residual calcifications 7 mm posterior to the clip.BILATERAL BREAST MRI:Multiple enhanced MR sequences are submitted per outside institution's protocol.There is heterogeneous fibroglandular tissue. There is moderate background parenchymal enhancement.There are postsurgical changes in the upper inner quadrant of the right breast. There is a seroma in the right breast lumpectomy site, measuring 3.7 x 1.5 x 2.6 cm. Susceptibility artifact from surgical clips is seen along the anterior and posterior aspect of the seroma cavity. There is no abnormal enhancement around the seroma cavity or elsewhere in the right breast. There are scattered complicated cysts in the right breast, corresponding to the right breast masses seen on ultrasound. No right axillary or internal mammary lymphadenopathy.There are postsurgical changes in the upper outer quadrant of the left breast with susceptibility artifact from surgical clips. No abnormal enhancement in the left breast. Numerous scattered benign enhancing foci are present, but no focus is uniquely suspicious. No left axillary or internal mammary lymphadenopathy. There is a 2.6 x 2.2 x 2.5 cm hepatic cyst.OUTSIDE PATHOLOGY (per report):A. Right breast, upper inner, with calcifications, stereotactic needle core biopsy (BI-RADS 4A):Ductal carcinoma in situ (DCIS), nuclear grades 2 and 3, cribriform and solid types with apocrine features and focal necrosisLobular carcinoma in situ (LCIS), classic typeB. Right breast, upper inner, without calcifications, stereotactic needle core biopsy (BI-RADS 4A):Focal ductal carcinoma in situ (DCIS), nuclear grade 2, solid type

Output: 1. Biopsy-proven right breast DCIS along the anterolateral aspect of the lumpectomy site, for which no suspicious MR enhancement is seen. Continued surgical management is recommended.2. Previously described right breast sonographic masses are stable from 3/18/2015 and correspond to complicated cysts on the MRI.3. Stable postsurgical changes of the left breast. No mammographic or MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with visual field defect, status post tumor resection. Evidence of recent resection of the previously demonstrated left occipital lobe tumor is seen. The resection cavity contains air and mixed fluid and blood product as expected.On comparison with the preoperative examination, a majority of the dominant enhancing component of the lesion has been resected. There is, however, enhancement along the posterior margin of the resection cavity extending to the ependymal surface of the atrium and occipital horn which likely represents residual tumor. In addition, there are patchy areas of very ill-defined parenchymal enhancement above the level of the resection which were evident on the preoperative examination and which likely reflect additional sites of tumor.Patchy ill-defined and gyriform T2 hyperintensity is seen within the parenchyma surrounding the resection cavity, similar to the prior examination, which may represent a combination of edema and nonenhancing tumor. Regional mass effect is seen in the form of sulcal and ventricular effacement. However, no significant generalized mass effect or brain herniation is identified. The ventricular system is stable in size and morphology.

Output: Expected findings are seen status post resection of a left occipital lobe tumor. A majority of the dominant enhancing portion has been resected, though there is residual enhancing tumor along the deep aspect of the resection cavity, and in the parenchyma above the resection cavity. There may also be scattered areas of nonenhancing tumor in the surrounding parenchyma as well.


Instruction: Generate impression based on findings.

Input: Large left flank/sacral mass in girl with NF1. There is a partly imaged large mass in the left paraspinal region with a bag of worms appearance, which extends from the L1 level to the sacrococcygeal region. The tumor protrudes into the left L1-2 through S2-3 neural foramina, but does not enter the spinal canal. There is also an infiltrative mass with partial bag of worms appearance in the posterior lower back subcutaneous tissues that measures up to approximately 11.5 cm. There is scalloping of multiple lumbar and sacral vertebral bodies with widening of the spinal canal. There is exaggerated lumbar lordosis, but no spondylolisthesis. The imaged cauda equina nerve roots and spinal cord appear to be grossly unremarkable.

Output: 1. A partly imaged large mass in the left paraspinal region with a bag of worms appearance, which extends from the L1 level to the sacrococcygeal region likely represents a plexiform neurofibroma, although assessment is limited by the lack of contrast. The tumor protrudes into the left L1-2 through S2-3 neural foramina, but does not enter the spinal canal. Please refer to the separate pelvis MRI report for additional details.2. An infiltrative mass in the posterior lower back subcutaneous tissues that measures up to approximately 11.5 cm may represent a superficial neurofibroma combined with features of a plexiform neurofibroma.3. Multilevel posterior vertebral scalloping related to neurofibromatosis 1.


Instruction: Generate impression based on findings.

Input: Chronic subdural hematoma. Three-month follow-up. Evaluate for changes. The bilateral apical frontal subdural fluid collections are significantly smaller. The residual effusions are limited medially to the frontal parafalcine region and measures less than 5 mm in thickness. The associated susceptibility effect on the previous examination has nearly resolved. There is no mass-effect on the underlying brain. The posterior fossa subdural hematomas have resolved. There is focal parenchymal volume loss and T2 hyperintensity involving the right postcentral gyrus and to a lesser extent the anterior aspect of the superior parietal lobule. There are small patches of occipital and temporal white-matter T2 hyperintensity. The degree of myelination is otherwise appropriate for age. There is no mass-effect or midline shift. There is mild prominent of the subarachnoid spaces, particularly in the frontal regions. The ventricles are unchanged in size. There is no gross orbital abnormality. There is minimal left mastoid T2 hyperintensity, which is nonspecific.

Output: 1.Right parietal encephalomalacia is probably reflective of prior insult. Small patchy areas of high T2 signal in the white matter of the occipital and temporal lobes are non-specific and may represent terminal zones of myelination, for example.2.The cerebral convexity subdural effusions are much smaller and cause no significant mass-effect. The posterior fossa subdural hematomas have resolved.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Again seen is a slightly lobulated somewhat exophytic mass along the posterior aspect of the mesial right temporal lobe, abutting the right cerebral peduncle with mild localized mass-effect and flattening. The lesion demonstrates enhancement and measures 2.0 x 1.2 cm. Again seen is associated deformity of the adjacent right hippocampus. Adjacent vasculature courses along the margins, including the right posterior cerebral artery and the right superior cerebellar artery. The right posterior communicating artery is slightly deviated medially. The lesion extends to the superior margin of Meckel's Cave inferiorly without definite involvement. The ventricles and sulci are within normal limits, with the right lateral ventricle remaining slightly larger than the left. The basal cisterns remain patent. There is no midline shift. No extra-axial fluid is identified.

Output: Previously known right mesial temporal lobe lesion with exophytic pattern of growth demonstrate partial enhancement and suspicious for a neoplasm.


Instruction: Generate impression based on findings.

Input: Degenerative disc disease in the cervical spine with arm weakness. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is moderate loss of disc height at C5-C6, C6-C7, and C7-T1 as well as mild loss of disc height at C3-C4 with associated degenerative endplate changes. There is an area of increased T2 signal within the T1 vertebral body with associated mottled increased T1 signal suggestive of an atypical hemangioma. The spinal cord displays normal signal and morphology. At C2-C3, there is no significant spinal canal or neuroforaminal stenosis. At C3-C4, there is a posterior disc osteophyte complex, as well as ligamentum flavum hypertrophy resulting in moderate central canal stenosis and severe bilateral neuroforaminal stenosis. At C4-C5, there is a minimal posterior disc osteophyte complex, as well as left greater than right facet hypertrophy with mild right and moderate left neuroforaminal stenosis, but without significant spinal canal stenosis. At C5-C6, there is a mild posterior disc osteophyte complex, as well as facet hypertrophy and ligamentum flavum thickening resulting in mild spinal canal stenosis and mild bilateral neuroforaminal stenosis. At C6-C7, there is a posterior disc osteophyte complex, as well as facet hypertrophy resulting in mild spinal canal stenosis and moderate left and mild right neuroforaminal stenosis. At C7-T1, there is a small posterior disc osteophyte complex resulting in mild to moderate bilateral neuroforaminal stenosis and minimal spinal canal narrowing. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative cervical spondylosis most pronounced at C3-C4, where there is moderate central canal stenosis, but no associated spinal 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: Ovarian mass. PELVIS:UTERUS, ADNEXA: Anteflexed anteverted uterus. The endometrium is normal in thickness. The junctional zone is normal in thickness. No discrete uterine mass.The right ovary measures 4.2 x 2.4 cm. It contains a well-defined multilobulated 2.9 x 2.6 cm lesion demonstrating very low T2-weighted signal intensity and hypointense T1-weighted. There is minimal to no significant enhancement on postcontrast imaging as best demonstrated on the subtraction images. There is no macroscopic fat within the lesion.The left ovary measures 2.5 x 1.9 cm and is normal in morphology.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume of free pelvic fluid, within physiologic limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The 2.9 cm right ovarian lesion with imaging features suspicious for a fibrous stromal neoplasm (e.g. fibroma, fibrothecoma or Brenner tumor). It demonstrates no macroscopic fat to suggest a dermoid cyst.


Instruction: Generate impression based on findings.

Input: 34-year-old female with nocturnal diarrhea and abdominal pain. Past question of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No hepatic lesions. No intra or extrahepatic biliary ductal dilatation. Patent vasculature.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 bowel wall thickening, abnormal wall enhancement, fistulous connection, or drainable fluid collection. No bowel obstruction or ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Simple appearing 2.1 cm left adnexal cyst (series 10 image 30). Normal appearance of the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence for inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Thoracic spine pain. Compared to prior CT chest of 8/17/2011, there has been slight interval progression of diffuse metastatic disease involving the thoracic spine, from T1 to T8 levels. For example, there is increased lytic lesion at T2 level. There is involvement of both anterior and posterior columns. There is soft tissue mass component of the spine metastasis, with epidural components extending into the spinal canal and neural foramina, with likely impingement of spinal cord and exiting nerves. These findings can be further characterized with MRI.There is compression fracture of T6 and T4 levels, which appears unchanged. Endplate depression of T5 is also noted, and also appears unchanged.Rib metastasis is present.There is tortuous thoracic aorta, with atherosclerotic changes.

Output: 1. Progression of diffuse metastatic disease in the thoracic spine, with epidural components that likely result in spinal cord and nerve impingement. Correlation with MRI thoracic spine is recommended.2. Pathological compression fractures at T4, T5, and T6 levels, not significantly changed. No evidence of new fracture.3. Rib metastasis. Please correlate with CT chest.


Instruction: Generate impression based on findings.

Input: Clinical question: Upstroke. Signs and symptoms: Confusion, history of stroke. Nonenhanced brain MRI:There is no evidence an acute intracranial process and including acute stroke.There are subtle ill-defined foci of flair hyperintensity in the pons bilaterally. Findings are nonspecific however in the proper clinical setting this appearance could represent microvascular ischemic changes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination the brain otherwise.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium, soft tissues of the scalp, and orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Subtle ill-defined foci of flair hyperintensity in pons which could represent microvascular chronic ischemic change and unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Provided history of Crohn's disease. Evaluate extent of disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No suspicious focal lesion. No biliary ductal dilatation or vascular abnormality. Normal gallbladder.SPLEEN: The spleen is normal in morphology and size without a focal lesion.PANCREAS: Normal in morphology, signal intensity and enhancement. Normal pancreatic duct caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is abnormal post-contrast enhancement of approximately 8 mm of the terminal ileum. Approximately 2 cm proximal to the terminal ileum, there is mild circumferential wall thickening and narrowing of the ileum measuring approximately 3.5 cm in length with restricted diffusion and arterial enhancement. Immediately proximal to this region is a 2 cm region of similar bowel abnormality. The more proximal small bowel is minimally prominent. There are no fluid collections. There is fibrofatty proliferation in the right lower quadrant.Small hiatal hernia. Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Several right lower quadrant prominent lymph nodes are nonspecific but likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Active inflammation involving the terminal and distal ileum as described.


Instruction: Generate impression based on findings.

Input: 60 years Female (DOB:1/31/1956)Reason: r/o vasculitis or other abnormality History: encephalopathyPROVIDER/ATTENDING NAME: TRISHA V SHETH FERNANDO D. GOLDENBERG MRI of the brainThere are multiple foci of diffusion restriction present. One located in the right temporal lobe centered along the midportion of the right temporal lobe measures 27 x 38 mm axial dimensions and is associated with T1 signal hyperintensity and susceptibility effect. One extends from the trigone of the left lateral ventricle to the watershed between parietal and occipital lobes measuring approximately 21 x 29 mm. There are multiple smaller lesions in the periventricular white matter as well as a splenium of the corpus callosum. Compared to the prior exam diffusion restriction in some of the lesions previously seen has regressed indicating continued evolution. There is no clear-cut new lesion appreciated.There are multiple foci of susceptibility effect scattered throughout the brain including subcortical white matter, basal ganglia, thalami, brainstem, cerebellum and corpus callosum. These were also present on the previous exam and have evolved but do not appear to have changed significantly specifically the right temporal lobe lesion which was earlier subacute stage a few weeks ago is now a later subacute stage.There is gyriform enhancement present along the left occipital and parietal lobes. This corresponds to area of a early subacute infarction on the 5/24 exam.The visualized portions of the paranasal sinuses demonstrate large mucous retention cyst in the right maxillary sinus and mucosal thickening within the paranasal sinuses. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The intracranial distal vasculature appears attenuated. There are stenosis present along the right p3 segment of the right posterior cerebral artery. There also appear to be multiple foci of dilation and narrowing of the intracranial cerebral vasculature. Similarly there appears to be stenoses along the pericallosal and callosomarginal arteries at the A3, a4 and a5 segments as well as the middle cerebral arteries distally at the M2, M3 and M4 segments. This appearance has not changed significantly compared to the previous exam.The anterior communicating artery is identified. The right posterior communicating artery is medium-sized. The left posterior communicating artery is very small. Anterior communicating artery is also very small.

Output: 1.There are multiple ischemic infarctions within the supratentorial brain and the multiple hemorrhagic infarctions scattered throughout the brain. These continue to evolve relative to prior exams. No new ischemic or hemorrhagic lesions are appreciated.2.MR angiography demonstrates distal intracranial cerebrovascular occlusive disease. One possibility is that this is related to vasculitis or vasculopathy another possibility is that this represents atherosclerotic intracranial small vessel occlusive disease. Given the patient's clinical history, small vessel intracranial atherosclerotic vasculopathy is favored over vasculitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Chiari decompression several years ago, syrinx, no follow-up since 2010. Patient with new symptoms, evaluate for change, performed CSF flow study. Signs and symptoms: Headache, neck and middle back pain. Nonenhanced brain MRI: Negative diffusion weighted series.Examination demonstrates stable post operative changes of Chiari decompression. There is expansion of subarachnoid space at the surgical site however there is inferior sagging of the cerebellar into the expanded subarachnoid space which remains identical to prior study from 2010.The anatomical morphology of the brain is otherwise within normal limits and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain margination. No evidence of any new finding since prior exam.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical spine MRI:Stable expected postoperative changes Chiari decompression since prior exam. Mild dorsiflexion of the dens is again noted. Normal signal intensity and caliber of the cervical cord without evidence of syrinx. Normal signal intensity and alignment the vertebral column without spinal canal or neural foraminal compromise at any level. Unremarkable perispinal soft tissues. CSF flow study demonstrate presence of biphasic flow through the foramen magnum both anteriorly and posteriorly. There is also detectable biphasic flow through the fourth ventricle and the aqueduct.Nonenhanced thoracic spine MRI:The signal intensity in the alignment the vertebral column is unremarkable.The signal intensity and caliber of thoracic cord is unremarkable.There is no evidence of spinal canal or neural foraminal compromise at any level.There is termination of the cord at mid L1 level.Nonenhanced lumbar MRI:There is normal anatomical development, signal intensity and alignment of vertebral column.There is normal signal intensity and morphology of cauda equina.There is no detectable perispinal soft tissue abnormalities.

Output: 1.Nonenhanced brain MRI demonstrate no evidence of new finding since prior exam. Stable postoperative changes of Chiari decompression as detailed. Unremarkable brain MRI otherwise.2.Unremarkable nonenhanced MRI of the cervical, thoracic and lumbosacral spine as detailed. 3.CSF flow study demonstrate presence of biphasic flow through the foramen magnum anteriorly and posteriorly as well as the fourth ventricle and the aqueduct.


Instruction: Generate impression based on findings.

Input: Status post liver transplant, evaluate for incisional hernia ABDOMEN:LUNG BASES: UnremarkableLIVER, BILIARY TRACT: Status post liver transplant. No focal lesions on this noncontrast CT.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large left-sided anterior abdominal wall hernia containing nonobstructing small bowel segments and mesenteric fat is not significantly changed from previous MRI.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive degenerative changes involving bilateral hip joints.OTHER: No significant abnormality noted

Output: No significant change in the large anterior wall hernia containing nonobstructive bowel segments on the left side of the abdomen.


Instruction: Generate impression based on findings.

Input: Preoperative planning for meningioma. There are postoperative findings related to posterior parafalcine meningioma resection. There is interval increase in size of a heterogeneously enhancing mass in the surgical bed along the bilateral aspects of the posterior falx cerebri with invasion of the superior sagittal sinus and extension into the overlying subgaleal space, which measures up to at least 6 cm. There is extensive vasogenic edema in the underlying brain parenchyma. There is unchanged patchy nonspecific scattered cerebral white matter T2 hyperintensity beyond the region of the surgical bed. There is no midline shift or herniation. There are bilateral lens implants. There are persistent secretions in the left frontal sinus.

Output: Postoperative findings related to posterior parafalcine meningioma resection with interval increase in size of the tumor in the treatment bed and overlying subgaleal space, as well as extensive vasogenic edema in the adjacent brain parenchyma.


Instruction: Generate impression based on findings.

Input: 39-year-old female with meniscal symptoms. MENISCI: The lateral and medial menisci appear intact without significant abnormality.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the patellofemoral articulation. However, the articular cartilage of the femur, tibia and patella are without defect. LIGAMENTS: The ACL, PCL, MCL, and LCL complex remain intact. EXTENSOR MECHANISM: The extensor mechanism appears within normal limits.ADDITIONAL

Output: Minimal joint effusion and minimal thinning of the patellofemoral articulation, however otherwise unremarkable examination of the left knee.


Instruction: Generate impression based on findings.

Input: 40-year-old female with right knee pain, buckling and instability with fall MENISCI: There is a complete radial tear at the junction of the body and posterior horn of the lateral meniscus with lateral extrusion of the body of the lateral meniscus. There is marked attenuation and signal abnormality of the anterior horn lateral meniscus indicating additional extensive tearing. There is a horizontal undersurface tear of the anterior horn of the medial meniscus and perhaps mild fraying along the undersurface of the posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is diffuse full-thickness loss of articular cartilage within the lateral compartment. Signal heterogeneity of the articular cartilage along the medial and central aspects of the femoral trochlea indicate relatively mild degeneration. The patellar cartilage is intact. The medial compartment cartilage is intact. Tricompartmental osteophytes are present. There is an ossicle at the proximal tibiofibular articulation with edema type signal, which is of uncertain clinical significance.LIGAMENTS: Increased signal intensity within the ACL likely represents mucoid degeneration. The PCL, MCL and lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Severe osteoarthritis of the lateral tibiofemoral compartment with extensive tearing and extrusion of the lateral meniscus. Relatively mild osteoarthritis affects the patellofemoral and medial compartments.2.Degenerative undersurface tearing/fraying of the medial meniscus.3.Small ossicle at the proximal tibiofibular articulation containing edema-type signal is of uncertain significance.4.Mucoid degeneration of the ACL and other findings as described above.


Instruction: Generate impression based on findings.

Input: Left carotid plaque irregularity with bilateral frontal and left parietal acute ischemic infarction indicating possible symptomatic plaque. Initially TOF survey scan was performed, the target area of the left CCA bifurcation was selected.There is eccentric carotid plaque on the left carotid bifurcation and proximal extracranial left ICA.The plaque is best seen on series #801, image 23/30.The plaque shows relatively homogenous high signal intensity on T1 black blood images and low signal intensity on T2 weighted images indicating lipid fibrous core.On series 801, image 15 to 22/30 and series 1401 image 4 to 17/17 show focal crescentic shaped low signal intensity lesion on the surface of the plaque may suggest ulceration of plaque inhomogeneity of plaque (mixed intermediate signal intensity with high signal intensity of plaque) may indicate possible complex plaque, in other words, intra plaque hemorrhage (high signal intensity portion can suggest possible intra plaque hemorrhage).The right carotid bulb also demonstrated carotid plaque with high signal intensity on T1 and T2 weighted images indicating lipid core.Otherwise no remarkable finding.

Output: 1. Demonstration of bilateral CCA bifurcation atheromatous plaques, left side is more prominent and irregular than right.2. Mixed signal intensities of the left carotid bulb plaque may indicate complex plaque (intra plaque hemorrhage).3. Bilateral carotid bifurcation plaques (lipid core) were seen.


Instruction: Generate impression based on findings.

Input: Septic joint, shoulder pain Exam is limited by poor fat saturation and patient motion.ROTATOR CUFF: There is full-thickness tear of the supraspinatus muscle with approximately 1.5 cm retraction and muscle atrophy (series 13 image 10). There is fluid in the subacromial/subdeltoid bursa. Infraspinatus tendon is intact. Thickening of the subscapularis tendon suggestive of tendinosis with partial-thickness interstitial tear (series 15 image 10). Teres minor tendon is intact. There is diffuse muscle edema.SUPRASPINATUS OUTLET: Mild degenerative change of the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The osseous alignment is within normal limits. There is mild joint space narrowing and osteophyte formation of the humeral head. There is definite cortical destruction or bone marrow signal abnormality to confirm osteomyelitis. The glenoid labrum appears globally degenerated. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Large joint effusion without definite osteomyelitis.2. Rotator cuff tear as above.


Instruction: Generate impression based on findings.

Input: 31 year old male patient with no significant past medical history presenting for evaluation of recent diagnosis of heart failure, etiology unclear. Left VentricleThe left ventricle is severely dilated with severly decreased global function. The overall LV ejection fraction is 16%. The LVEDV is 413 ml (normal range 142+/-34), the LV end diastolic volume index is 167 ml/m2 (normal range: 74+/-15), the LVESV is 347 ml (normal range 47+/-19) and the LV end systolic volume index is 140 ml/m2 (normal range 25+/-9). The LV mass is 312 g (normal range 164+/-36) and the LV mass index is 126 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. Late gadolinium images are limited by increased noise in images, however no late gadolinium enhancement is noted to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is [1037]ms. These values are within normal limits, suggestive of no underlying diffuse fibrosis or infiltration.There is [no]myocardial iron overload. There is [no]LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is dilated with decreased function. The overall RV ejection fraction is 17%. The RVEDV is 315 ml (normal range 142+/-31), RV end diastolic volume index is 127 ml/m2 (normal range 82+/-16), the RVESV is 263 ml (normal range 54+/-17), and the RV end systolic volume index is 106 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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 moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is presence of a T1 hyperdense lesion measuring 1.6cm in the left lower lobe of the lung, likely representing a calcified granuloma. Further correlation is recommended with CT imaging. Bilateral pleural effusions, right greater than left. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severely dilated left ventricle with severely decreased ejection fraction at 16%2. Dilated right ventricle with severely decreased ejection fraction at 17%3. Mild mitral regurgitation, moderate tricuspid regurgitation.4. No late gadolinium enhancement noted in ventricular myocardium.4. No LV thrombus noted.5. T1 hyperdense lesion measuring 1.6cm in the left lower lobe of the lung, likely representing a calcified granuloma. Further correlation is recommended with CT imaging. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Severe headaches with semiology consistent with migraine with aura and suspicion of autoimmune disease: bilateral nystagmus and peripheral neuropathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several, at least 15, punctate foci of high T2 signal in the white matter of the bilateral frontal lobes, which may have progressed slightly since 2011. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter left posterior nasopharyngeal retention cyst. There are partially imaged postoperative findings in the cervical spine.

Output: Punctate foci of T2 hyperintensity in the bilateral frontal lobe white matter are nonspecific, but may represent sequela of migraine, autoimmune, or chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: New daily headache and dizziness. Some of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial mass or acute infarction.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with right lateral thigh pain status post L4-5 TLIF and PSF. Findings are seen compatible with posterior instrumented fusion from L4 to L5. Also noted is right-sided laminotomy for placement of interbody bone graft at L4-5. Within the laminotomy defect, there is a fluid collection measuring 27 x 23 x 23 mm which is T2 hyperintense and T1 hypointense. This collection appears to extend slightly into the discectomy defect. This collection encroaches upon the spinal canal causing effacement of the right aspect of the thecal sac and the right L4-5 neural foramen. The soft tissues surrounding this collection are not particularly edematous or inflamed.Spinal alignment is anatomic on this examination. Vertebral body height and morphology are within normal limits. Apart from mild degenerative endplate signal changes at L4 and L5, and a Schmorl's node superiorly at L2, no significant marrow signal abnormality or edema is detected.As above, there is a moderate narrowing of the spinal canal at L4-5 with moderate narrowing of the right neural foramen. Elsewhere, no significant spinal canal or neuroforaminal compromise is seen.

Output: Findings are redemonstrated compatible with posterior instrumented fusion and interbody fusion at L4-5.Within the right L4-5 laminotomy defect, a fluid collection has developed causing encroachment on the spinal canal and neural foramen. This collection is favored to represent a seroma, with pure hematoma and CSF pseudomeningocele considered less likely possibilities. Lack of surrounding inflammation would argue against an infected collection.


Instruction: Generate impression based on findings.

Input: 59-year-old female with low back pain, history of lumbar fusion. Evaluate hardware and sagittal balance 2 views of the cervical spine reveal mild anterior osteophyte formation of the lower cervical spine, otherwise alignment is anatomic and the disc spaces are preserved.2 views of the thoracic spine show mild multilevel degenerative disc disease with anterior osteophyte formation.2 views of the lumbar spine reveal posterior stabilization rod and pedicle screws for L5/S1 fusion. There is minimal anterolisthesis of L5 on S1. Mild anterior osteophyte formation of the lower lumbar spine is noted, otherwise alignment is anatomic with preservation of the disc spaces.There is 5 mm positive sagittal balance and 0 mm coronal balance.

Output: Postoperative and mild degenerative arthritic changes as described above.


Instruction: Generate impression based on findings.

Input: Female 46 years old with mass in uterus, cystic on CT, solid on ultrasound and a new diagnosis of choriocarcinoma. PELVIS:UTERUS, ADNEXA: There is a 6.0 x 5.8 cm x 9.0 mass within the anterior right lateral myometrium (series 501, image 28 and series 701, image 17). The mass has peripheral T1 hyperintensity and heterogeneous T2 hyperintensity centrally indicating complex content. There is some rim enhancement but no internal enhancement. The adnexa appear normal.BLADDER: No significant abnormality noted.LYMPH NODES: There are multiple enlarged lymph nodes along both pelvic sidewalls. For reference, a left pelvic sidewall lymph node measures 12 x 9 mm (series 1004, image 379).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enhancing lesions are seen in the bilateral iliac bones and sacrum. The largest is in the right sacrum and measures 13 x 8 mm (series 1004, image 519).OTHER: There is a moderate amount of pelvic free fluid.

Output: 1.Large uterine lesion for which the differential includes choriocarcinoma and degenerating fibroid. 2.Bilateral pelvic lymphadenopathy is concerning to metastatic disease.3.Enhancing lesions in the sacrum and iliac bones may represent metastases. Correlate with bone scan as clinically warranted.