Instruction: Generate impression based on findings.

Input: 50 year old man with history of hypertension and severe chest pain. He is referred to rule out aortic dissection since his renal disease prevents CTA as a test. Left VentricleLeft ventricular hypertrophy is noted. LV systolic function could not be assessed. Left AtriumModerate to severe left atrial dilation. Right VentricleGrossly normal in size and systolic function. Right AtriumModerate right atrial dilation. AortaThere is a left sided aortic arch with a pseudobovine brachiocephalic branching pattern. No aortic dissection noted to the level of the renal arteries. Normal ascending aortic and aortic arch size. Mild dilation of the proximal portion portion of the descending thoracic aorta (30mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe inferior vena cava is dilated suggesting increased right atrial pressure. PericardiumSmall pericardial effusion is noted. Extracardiac FindingsSmall bilateral pleural effusions. Bilateral lung opacities seen. Several lymph nodes (largest 1.3cm) noted in right-sided pretracheal location. 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. Within the limitations of a non-contrast cardiac MRI/ MRA examination, no thoracic or abdominal aortic dissection noted down to level of the renal arteries. Mild dilation of the proximal portion of descending thoracic aorta. 2. Significant left ventricular hypertrophy.3. Moderate biatrial dilation. 4. Grossly normal RV size and systolic function.5. Small pericardial effusion.6. Multiple large lymph nodes noted as above. Small bilateral pleural effusions. A significant amount of bilateral lung opacity is noted which could represent pulmonary edema or interstitial lung disease. Correlation with chest CT (ILD protocol) suggested.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of cerebral meningesClinical question: no fiducials. Preop planning for tumor removalsSigns and Symptoms: visual defect There is a 21 x 21 mm axial dimension enhancing mass centered in the right cavernous sinus the broad-based towards the dura. It displaces the pituitary gland towards the left side. It impresses upon and extends into the right Meckel's cave. In general it has not changed significantly since the prior examNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a right cavernous sinus mass present which appears stable in dimensions compared to the prior exam. It is suspected to represent a meningioma. It displaces the pituitary gland towards the left and occupies the majority of the right cavernous sinus and extends into the anterior aspect of the right Meckel's cave. The right trigeminal nerve appears to be thickened adjacent to it.


Instruction: Generate impression based on findings.

Input: Reason: lateral meniscus tear History: knee pain. MENISCI: Blunting of the free of the anterior horn of the lateral meniscus. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. Bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Blunting of the free edge of the anterior horn of the lateral meniscus compatible with tear. 2.Small joint effusion.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, syrinx and tethered cord, six-month follow-up Extensive postoperative findings are again seen in the lumbar spine related to lipomyelomeningocele repair and cord detethering. Mild syringohydromyelia of the distal spinal cord spanning from approximately T12 to L2 is unchanged in caliber and extent. At its widest point it measures approximately 5 x 3 mm. Cord parenchymal volume loss is also noted.The distal spinal cord remains closely apposed to the posterior aspect of the spinal canal. No change in distal cord position is seen on prone imaging although there is ventral motion of the lower thoracic cord.The distal lumbar spinal canal is ectatic with septations in the thecal sac as seen before. Partial nonsegmentation of the posterior aspects of the L4 and L5 vertebral bodies is again seen. Dysplastic posterior elements again seen.There is prominence of the thoracic kyphosis which can be better assessed with standing radiographs. Vertebral body heights are preserved. No marrow replacement or marrow edema is detected. Again seen are mild degenerative changes including a left paracentral disc extrusion at the T12-L1 level and to a milder degree at the T11-T12 level which are present previously.Again seen is marked fatty atrophy of the lower lumbar paraspinal musculature. Small left renal cysts again seen.

Output: Postoperative changes related to lipomyelomeningocele repair and cord untethering. There is no significant change in small syrinx involving the distal spinal cord. No significant change in position of the distal cord which does not demonstrate ventral motion on the prone sequence and may represent re-tethering in the appropriate clinical setting. Distal thoracic cord does demonstrate ventral motion on the prone sequences.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out PML. Signs and symptoms: New onset of bilateral upper extremity weakness. Nonenhanced brain MRI:No acute intracranial process and no evidence of acute ischemic stroke.Examination to demonstrate multiple small foci of flair hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres consistent with patient's diagnosis of demyelinating disease. Compared to prior exam however there are a few small new lesions in the subcortical white matter of bilateral cerebral hemispheres. There are two small lesions in the right frontal on axial flair series 701 image 20 and two small new lesion in the left anterior temporal on flair T2 3701 image was 9 and 10 Surgicel of mild progression of disease since prior exam from 2013.Cortical sulci and the lateral ventricles appear slightly prominent for patient's stated age however without change since prior exam.The signal right major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and calvarium.

Output: 1.No acute intracranial process.2.Mild interval progression of demyelinating disease evident by at least four small new lesions in the subcortical white matter of right frontal and left anterior temporal lobes since prior exam from 2013.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness. History of multiple sclerosis, with reportedly previous MRI showing characteristic Dawson's fingers.IMAGE ACQUISITIONS: 5-mm contiguous axial CT sections of the brain without contrast infusion. No acute intracranial hemorrhage, mass effect or shift of midline structures. As on the previous head CT, there is multifocal white matter low attenuation, compatible with history of multiple sclerosis. There has likely been some interval progression compared to the previous CT scan, although the previous scan was somewhat degraded by patient motion and part of the apparent difference could be due to higher diagnostic quality of the current scan. There is no hydrocephalus. There are no subdural fluid collections.Some of the lesions in the left hemisphere are orientated anterior to posterior, which can be found with borderzone infarction, and the lesions are more prominent in the left hemisphere. It is not possible to definitively exclude superimposed ischemic lesions. If there is clinical concern for recent infarction or acute worsening of multiple sclerosis, MRI would be more sensitive.

Output: 1. No acute intracranial hemorrhage.2. slight interval worsening of white matter disease versus greater conspicuity of lesions due to motion artifact on the previous CT scan. Follow-up as indicated clinically.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB: 7/6/1949)Reason: trauma while lifting suitcase 4 weeks ago. Persistent pain in C3-C5. No radiation, on right side. Weakness and increased reflexes in biceps. History: trauma while lifting suitcase 4 weeks ago. Persistent pain in C3-C5. No radiation, on right side. Weakness and increased reflexes in biceps.PROVIDER/ATTENDING NAME: MARK SIEGLER MARK SIEGLER The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge and disc desiccation at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is some left-sided facet hypertrophy at this level.At C4-5 there is no significant compromise to the spinal canal. There are right-sided uncovertebral osteophytes present at this level associated with disc material which is associated with encroachment of the right-sided exiting nerve roots.At C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present this level associated with narrowing of the neural foramina. There is mild encroachment of exiting nerve roots within the neural foramina at this level which is somewhat worse on the right compared to the left side. There is disc desiccation at this level.At C6-7 there is no significant compromise to the spinal canal. There is some loss of disc space height, disc bulge and endplate and uncovertebral osteophyte formation associated with narrowing of the neural foramina and some encroachment of exiting nerve roots bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine mainly in the form of endplate and uncovertebral osteophyte formation. This associated with encroachment of right-sided exiting nerve roots at C4-5 and and bilateral exiting nerve roots at C6-7.2.No intrinsic spinal cord lesion is appreciated. There is no cervical spinal canal stenosis appreciated.


Instruction: Generate impression based on findings.

Input: Female 42 years old Reason: mvc, midline tenderness around t 10, low back pain, knee pain Thoracic spine: No acute fracture or malalignment. The vertebral body heights and disc spaces are maintained. Evaluation of T1 is somewhat limited secondary to overlying anatomy.Lumbar spine: Vertebral body heights maintained. Alignment is within normal limits. Mild to moderate degenerative disc disease at L5-S1, unchanged from MRI 8/3/2015. Right knee: Triangular appearing ossific density overlying the anterior tibial plateau, near the midline may represent a loose body or a fracture fragment, however no donor site or fracture line is identified. Fabella is present posterior to the knee and minimal osteoarthritis affects the right knee. Joint effusion is present.

Output: 1.Ossific density within the right knee joint space may represent a loose body, or fracture fragment, however no donor site or fracture line is identified. CT or MRI may be performed to determine acuity and/or origin of this fragment, if clinically warranted.2.Normal radiograph of the thoracic spine.3.Degenerative disc disease affects L5-S1.


Instruction: Generate impression based on findings.

Input: Evaluate anterior cruciate ligament. Status post graft MENISCI: There is complete loss of the posterior horn of the medial meniscus. The anterior horn is intact. The lateral meniscus is intact..ARTICULAR CARTILAGE AND BONE: The patellar cartilage is slightly thinned but no focal defects are seenThere are bone contusions at the lateral femoral condyle and posterior lateral tibial plateau. This pattern of bone contusion is typical of anterior cruciate ligament tearsLIGAMENTS: Posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral complex are intact.. There is disruption of the superior aspect of the anterior cruciate ligament graft. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Anterior cruciate ligament tear with typical bone contusions. Complete loss of the posterior horn of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: 52 year old female with a history of pancreatitis being treated for autoimmune pancreatitis with prednisone. MRI MRCP to evaluate biliary system, and pancreas. ABDOMEN:LIVER, BILIARY TRACT: Incidental note is made of pacreatic divisum. No evidence of intra-or extrahepatic biliary ductal dilation. There is stenosis/narrowing of the distal 2 cm of the common bile duct. No focal mass lesions are identified. No gallstones. No common duct stones are identified. SPLEEN: No significant abnormality noted.PANCREAS: Note is made of pancreatic divisum. There is a normal response to secretin augmentation. There is faint peripheral enhancement along the margins of the pancreas, which is nonspecific, however, correlation with IgG4 levels recommended to exclude the possibility of autoimmune pancreatitis. There is a focus on T1 and T2 prolongation in the uncinate process with associated patchy restricted diffusion and faint enhancement on post contrast images which is suspicious for focal evolving pancreatitis although a focal mass lesion is not entirely excluded. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There is questionable faint peripheral enhancement along the margins of the pancreas as well as narrowing of the distal common bile duct, which is nonspecific, but can be seen in autoimmune pancreatitis. Correlation with IgG4 levels could be considered if clinically indicated. 2.Focus of enhancing signal abnormality affecting an enlarged uncinate process of the pancreas is nonspecific. While an evolving focal pancreatitis is favored, a follow up examination in 6-12 months is recommended to establish resolution.3.Pancreatic divisum.


Instruction: Generate impression based on findings.

Input: Clinical question: Stenosis causing left flank pain? Signs and symptoms: Left flank pain. Unenhanced thoracic MRI:There is normal anatomical alignment of vertebral column.There is no the distal central spinal stenosis at any level.There is extensive expected post operative changes of posterior laminectomy and anterior fusion including placement of metallic fixating screws extending from T10 inferiorly to T2 level however without evidence of spinal stenosis or neural foraminal compromise. There is normal signal intensity and caliber all thoracic cord. The paraspinal soft tissues demonstrate no abnormalities.Nonenhanced MRI of lumbar spine:There is normal anatomical alignment of the vertebral column.There is no evidence of central spinal stenosis at any level.There is no evidence of neural foraminal compromise at any level. The visualization of the above described postoperative changes of posterior laminectomy and anterior fusion and placement of metallic hardware in the vertebral bodies extending from T10 inferiorly through L2 levels. The signal intensity and morphology the conus and the cauda equina demonstrate no abnormalities. There is mild degenerative changes of posterior elements at the L4 -- L5 and L5 -- S1 levels without appreciable significant degenerative disk disease. No spinal stenosis or neural foraminal compromise. A tiny linear focus of T2 increased signal intensity within the annulus of the disk on the right (axial T2 series 18 image 29 and sagittal T2 series 13 image 4) is consistent with a tiny annular fissure. There are no prior exams for comparison.There is a well-demarcated CSF signal intensity expansile lesion within the spinal canal at S2 level with associative mild bony remodeling consistent with a Tarlov cyst. Remote possibility of an arachnoid cannot be entirely excluded.

Output: 1.Nonenhanced MRI of thoracic and lumbar spine demonstrate expected extensive postoperative changes of posterior laminectomy and anterior fusion extending from T10 to L2 levels without spinal stenosis or neural foraminal compromise.2.Mild degenerative changes of posterior elements in the lower lumbar spine and a tiny a right far lateral L4 -- L5 annular fissure as detailed.3.Expansile CSF signal intensity finding within the spinal canal at S2 is believed to represent a Tarlov cyst.4.Essentially unremarkable nonenhanced examination otherwise.


Instruction: Generate impression based on findings.

Input: Clinical question: 72-year-old female with spine surgery with low back pain. Evaluate for progression of disease. Signs and symptoms: Low back pain. Pre-and post-enhanced lumbar MRI:T11 -- T12 is unremarkable.T12 -- L1 demonstrate minimal degenerative changes and unremarkable otherwise.L1 -- L2 demonstrate mild disk disease, mild bilateral (left greater than right) facets and ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise. Incidental note is made of a single large left renal cyst measuring at approximately 43 mm in transaxial dimensions.L2 -- L3 demonstrate mild disk desiccation, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is resultant mild central spinal stenosis at this level which appears to be primarily secondary to hypertrophic changes of posterior elements/ligamentum flavum. No neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, mild grade 1 anterolisthesis, chronic postoperative changes at this level are also noted. There is no spinal stenosis. There is compromise of bilateral neural foraminal with mass effect on the exiting nerve roots best appreciated on sagittal images.L4 -- L5 demonstrate moderate to advanced disk disease, significant loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild (left greater than right) facets hypertrophic changes. There is a large broad-based central and to the right disk protrusion at this level. Constellation of above findings results in moderate central spinal stenosis and significant lateral recess compromise bilaterally. No significant neural foraminal compromise.L5 -- S1 demonstrate mild disk desiccation moderate bilateral ligamentum flavum hypertrophy and minimal facet disease. No spinal stenosis or appreciable neural foraminal compromise. There is however compromise of the lateral recess of the canal at this level bilaterally (left greater than right). Post enhanced images demonstrate expected enhancement of degenerative changes of the articulating facets in particular at L2 -- L3 level and is unremarkable otherwise.

Output: 1.Degenerative changes at L2 -- L3 in particular of the ligamentum flavum results in mild central spinal stenosis.2.Degenerative changes at the L3 -- L4 and including mild grade 1 anterolisthesis without spinal stenosis however with compromise of bilateral neural foramina as detailed.3.Extensive degenerative changes at L4 -- L5 and a broad-based disk protrusion results in central spinal stenosis and lateral recess compromise bilaterally as detailed.4.Degenerative changes at L5 -- S1 with resultant lateral recess compromise bilaterally.5.Post enhanced images are unremarkable.


Instruction: Generate impression based on findings.

Input: Type ii or unspecified type diabetes mellitus without mention of complication, not stated as uncontrolledMemory lossClinical question: memory issues The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the maxillary sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for acute ischemic cerebral infarction


Instruction: Generate impression based on findings.

Input: Neoplasm related pain (acute) (chronic) [G89.3], Reason for Study: ^Reason: metastatic prostate cancer with bone lesions History: metastatic prostate cancer with bone lesions 68 years Male (DOB:6/9/1948)Reason: metastatic prostate cancer with bone lesions History: metastatic prostate cancer with bone lesionsPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU MAGDALENA ANITESCU For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multifocal mixed lytic and sclerotic metastatic lesions involving thoracolumbar spine, sacrum as well as bilateral ilium.In particular, there is about 5% compression fracture of L3 vertebral body with the bone marrow edema.In addition, soft tissue extension through the anterior epidural space from T12 vertebral body is also seen which suggest possible tumor extension.The spine alignment is anatomic. The signal of the visualized cord is normal. The conus medullaris terminates at the T12.Degenerative changes are specified by the intervertebral level as follows: T12-L1: Complete replacement of normal fatty marrow of T12 vertebral body indicate metastatic lesion. Anterior epidural space extension of soft tissue lesion from the T12 vertebral body metastasis. The soft tissues about the thecal sac and extends through bilateral neural foramen results minimal to mild neural foraminal stenosis. L1-L2: There is a sclerotic metastatic lesion on the right anterior aspect of the L1 vertebral body, however, other portion of the vertebral bodies are osteophytic lesion. No neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse metastasis lesion involvement of L2 vertebral body. No neuroforaminal narrowing or spinal stenosis. L3-L4: There is relatively well circumscribed metastatic lesion on the left anterior aspect of L3 vertebral body with a sclerotic margin. Diffuse bulging of disc with bilateral ligamentum flavum thickening results minimal to mild spinal canal stenosis. L4-L5: May new sclerotic metastatic lesion on the left side of vertebral body of L4 with associated osteolytic lesion. Diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L5-S1: Several nodular osteolytic metastatic lesion involving L5 vertebral body as well as left posterior lamina. Diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Multifocal vertebral body metastatic lesions including thoracic, lumbar and sacral vertebrae, as well as bilateral iliac bones.2. Epidural extension of metastatic lesion is seen at the level of T12 vertebral body.3. Minimal to mild spinal canal stenosis due to degenerative changes of lumbar spine.4. Spinal cord signal intensity is normal.


Instruction: Generate impression based on findings.

Input: Pain. Question of internal derangement. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is 9 x 6 mm full thickness chondral defect of the superior patellar articular cartilage with underlying bone marrow edema. There is fraying of the surrounding cartilage. The articular cartilage of the lateral and medial compartments is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Full thickness chondral defect of the superior patellar cartilage with underlying bone marrow edema.


Instruction: Generate impression based on findings.

Input: 74 year old male with a history of nonischemic cardiomyopathy s/p pacemaker, PVC ablation, atrial flutter referred for cardiac MRI. Left VentricleThe left ventricle is severely dilated with moderately reduced function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 136 ml/m2 (normal range: 74+/-15), the LVEDV is 293 ml (normal range 142+/-34), the LV end systolic volume index is 91 ml/m2 (normal range 25+/-9), the LVESV is 197 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 117 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is epicardial late gadolinium enhancement in the basal inferior and inferolateral walls which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is additionally evidence of a patch of late gadolinium enhancement with a "necrotic" core involving the most basal aspect of the anterior wall (aka the LV summit); this finding is likely secondary to the recent ablation procedure. The pattern is not typical for prior myocardial infarction. No evidence of myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 262 ml (normal range 142+/-31), the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9), and the RVESV is 121 ml (normal range 54+/-17). Pacemaker lead in RV. Right AtriumThe right atrium is mildly dilated. Pacemaker lead in the RA. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 FindingsA pacemaker can is noted in left upper chest. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severely dilated left ventricle with moderately reduced systolic function (LVEF 33%).2. Mildly dilated right ventricle with mildly reduced systolic function (RVEF 46%)3. There is evidence of epicardial late gadolinium enhancement involving the basal inferior and inferolateral walls which suggest the presence of an underlying fibrosing inflammatory infiltrative or inflammatory process. There is additionally evidence of a patch of late gadolinium enhancement with a "necrotic" core/ microvascular obstruction involving the most basal aspect of the anterior wall (aka the "LV summit"); this finding is likely secondary to the recent ablation procedure. No evidence of prior myocardial infarction. 4. Left atrium is moderately dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: Headaches and hypertension Nonenhanced CT of brain:There is no definitive evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal. Follow-up with an MRI is recommended if clinical concern for stroke in our system. Non-infused CT can this area also the small strokes.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are unremarkable.

Output: No definitive evidence of abnormality. Follow-up with an MRI is recommended if clinical concern for stroke persists.


Instruction: Generate impression based on findings.

Input: Lung cancer with known metastatic disease, please evaluate known sacral lesion. PELVIS: Internal pelvic contents are unchanged and remain grossly unremarkable in this limited evaluation. Specifically only minimal effacement of the presacral fat is observed. No evidence of additional pelvic floor abnormalities, specifically vascular structures appear intact and unremarkable.BONES, SOFT TISSUES: A large and markedly enlarged since October centrally necrotic enhancing sacral mass is again observed extending from the superior margin inferiorly with mild extension into the right sacral notch. The mass measures 7.8 x 5.1 cm axially (image 22 series 1/1/2001) and abuts the right SI joint along the posterior margin and extends to within 2 cm of the left SI articulation.Of particular note is neural foraminal narrowing with essentially complete occlusion with nerve encasement of the right S2 foramina and marked narrowing of the right S1 and left S2 foramina. More minimal involvement of the S3 foramina bilaterally.Additional focal lesion measuring 2.1 cm in the right iliac wing (image 22 series 501) with cortical destruction, homogeneous enhancement and extension with minimal fat effacement under the overlying gluteus minimus.OTHER: The surrounding and overlying soft tissues and external muscular compartments are otherwise unremarkable.

Output: 1.Large necrotic sacral mass, more pronounced and extensive when compared to prior exam from October. Measurements and extent including sacral nerve encasement described.2.Additional enhancing metastatic focus observed in right iliac wing


Instruction: Generate impression based on findings.

Input: 37-year-old female has peri-umbilical bulge. Rule out ventral hernia. History of uterine fibroids. ABDOMEN:LUNG BASES: Mild bibasilar dependent atelectatic changes. No acute infiltrates or effusions.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a bowel-containing supraumbilical right sided paramedian ventral hernia with neck measuring approximately 3.9 cm diameter.PELVIS:UTERUS, ADNEXAE: Two masses within the uterus were found on the prior MRI exam, one consistent with fibroid, and one which represents either fibroid or focal adenomyoma. Scarring in the uterus and anterior abdominal wall with suggestion of adhesion. Nabothian cysts. Right lower quadrant cyst, likely paraovarian cyst or duplication cyst has a thickened wall and measures approximately 3 cm in diameter at axial image 104/148 of series 4.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bowel-containing nonobstructing supraumbilical right sided ventral hernia. Left adnexal cyst.


Instruction: Generate impression based on findings.

Input: 34-year-old male with a left upper extremity soft tissue mass in the biceps. Note is made of a lobulated irregular mass along the lateral aspect of the deltoid and biceps muscles, with associated heterogeneous T1 and T2 prolongation and heterogeneous enhancement on postcontrast sequences, measuring approximately 4.2 x 1.4 x 3.8 cm (TR x AP x CC) as seen on image 23 of series 13 and image 8 of series 14. There is a vitamin E capsule in the overlying area presumably corresponding to the patient's palpable area of concern. There is no definitive evidence to suggest invasion into the surrounding musculature or erosion/destruction of the adjacent bone, although the mass abuts the fascia along the lateral aspect of the deltoid and biceps muscles. Additionally, there are scattered foci of increased bone marrow signal abnormality which become confluent proximally within the anterior humeral head and are associated with enhancement on postcontrast sequences. An intramedullary process such as metastatic disease should be considered in the setting of a primary neoplasm. There is no cortical destruction. The imaged musculature otherwise appears normal.

Output: 1. Nonspecific heterogeneous enhancing mass in the subcutaneous soft tissues along the lateral aspect of the deltoid muscle suspicious for a primary malignancy. 2. Enhancing bone marrow signal abnormality in the proximal left humerus. An intramedullary process such as metastatic disease should be considered in the setting of a primary neoplasm.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with history of Merkel cell carcinoma now presenting with altered mental status, confusion. CT head at an outside hospital concerning for subependymal nodules within the periventricular regions. Extensive enhancing ependymal nodularity is seen involving the entire ventricular system, particularly the lateral ventricles. Marked T2 hyperintensity is also seen within the periventricular regions. The ventricles themselves are mildly enlarged. Some of the ependymal nodules demonstrate faint susceptibility effect, but no definite evidence of acute intracranial hemorrhage is seen. No abnormal fluid collections are detected. The basal cisterns remain patent.

Output: Diffuse ependymal nodularity is seen most likely representing metastatic disease. The parenchyma surrounding the ventricles is edematous, and the ventricles and sulci are mildly enlarged.


Instruction: Generate impression based on findings.

Input: Patient with an acute hemoglobin drop and right lower extremity sarcoma. Please evaluate for hematoma.IMAGE ACQUISITIONS: CT of the right thigh without contrast enhancement; transverse, coronal, and sagittal views are provided CT of the right thigh without contrast enhancement again shows a large heterogeneous mass within the posterior thigh, which appears comparable to that seen on the MRI from June. Centrally, the mass is of prominently low density, which likely represents a combination of blood, fluid and/or necrosis. The periphery of the mass is isodense to muscle. Although the previous MRI showed findings consistent with internal hemorrhage, there are no specific findings on this exam showing new hemorrhage or hematoma. However, acute extravasation cannot be assessed in the absence of contrast enhancement. The right sacroiliac joint is fused as seen previously.

Output: There is a large soft tissue sarcoma which is comparable in appearance to the previous MRI study. The heterogeneous appearance may be due to internal hemorrhage as seen on the previous MRI; however, the possibility of acute extravasation cannot be determined in the absence of contrast.


Instruction: Generate impression based on findings.

Input: 55-year-old woman with history of parotid carcinoma, now with severe back pain. There are multiple enhancing, T2 hyperintense, and T1 hypointense lesions within the vertebral bodies of T1, T2, T6, T8, T10, and T12 along with the posterior elements of T4 and T9. There is no loss of vertebral body height and the thoracic spine is in normal alignment. Of these lesions, a T9 left laminar lesion (901/17) erodes through the cortex into the surrounding soft tissues and indents the posterior thecal sac. The spinal cord is of normal caliber and signal and there is no spinal canal or neural foraminal compromise. The intervertebral disk heights are well-maintained. A right pleural effusion, pleural based nodule, and bilateral nodular adrenal thickening are noted, better characterized on recent CT.LUMBAR SPINE

Output: 1.Multiple enhancing osseous metastases throughout the thoracic and lumbar spine. Specifically, there is cortical destruction of the left T9 lamina with slight tumor extension into the paraspinal musculature and minimally compression of the thecal sac.2.Multilevel lumbar spine degenerative changes without significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 90 year-old female with altered mental status, evaluate for bleed. There is no evidence of intracranial hemorrhage or mass. Multiple scattered hypoattenuating foci in the left frontal, right occipital, and right temporal lobe consistent with cortical infarcts of indeterminate age. If there is clinical concern for an acute infarct, MRI may be obtained. Numerous hypoattenuating foci within the subcortical, deep, and periventricular white matter consistent with ischemic small vessel disease of indeterminate age. The ventricles and basal cisterns are prominent compatible with age-appropriate volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Multiple areas of cortical and subcortical infarcts, age indeterminate. If there is clinical concern for acute infarction, MRI may be obtained.


Instruction: Generate impression based on findings.

Input: 21 year old male with diagnosis of hypertrophic cardiomyopathy who presents for cardiac MRI for further evaluation of function, morphology, and fibrosis Left VentricleThe left ventricle is normal in size and systolic function. There is asymmetric hypertrophy of the left ventricle. The maximum thickness involving the basal to mid inferior and septal walls (15-16mm); the remainder of the myocardium is approximately 7-8mm thick. There is mild evidence of turbulent flow in the outflow tract secondary to systolic anterior motion of the mitral valve. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 209 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 88 g/m2 (normal range 85+/-15), and the LV mass is 202 g (normal range 164+/-36). There are no regional wall motion abnormalities present on cine imaging; however, based on myocardial tagging, the hypertrophied segments have reduced myocardial deformation. There is a small amount of subtle late gadolinium enhancement involving the basal inferior and inferolateral walls to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 102 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is systolic anterior motion of the anterior mitral leaflet and associated mild mitral regurgitation and flow acceleration in the left ventricular outflow tract.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 69%). There is asymmetric hypertrophy of the left ventricle consistent with the diagnosis of hypertrophic cardiomyopathy. There is a small amount of subtle late gadolinium enhancement involving the basal inferior and inferolateral walls to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. 2. The right ventricle is normal in size and systolic function (RVEF 51%).3. Systolic anterior motion of the anterior mitral leaflet with mild mitral regurgitation and mild flow acceleration in the left ventricular outflow tract.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Bladder cancer ABDOMEN:LIVER, BILIARY TRACT: Scattered T2 hyperintense cysts. Probable left hepatic lobe hemangioma is unchanged. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. IVC filter.BOWEL, MESENTERY: Right lower quadrant ileal conduit.BONES, SOFT TISSUES: Chronic L1 compression deformity.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Distention of the right iliopsoas bursa consistent with bursitis.

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


Instruction: Generate impression based on findings.

Input: 43 years Male (DOB:1/10/1973)Reason: assess for stenosis History: low back and leg painPROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH JAVAD HEKMATPANAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, mild disc desiccation and a minor disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are mild degenerative changes present in the lower lumbar spine but compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer to lung. Evaluate disease. CT of the soft tissues of the neck:Images through the skull base including cavernous sinuses remain within normal limits. Paranasal sinuses and mastoid air cells are unremarkable. Images through the rest of soft tissues of the neck demonstrate no evidence of a mass or pathologic adenopathy. No residual enhancing thyroid tissue is seen.A lytic soft tissue lesion erodes the spinous process of the C6 vertebra, measuring 20 x 19 mm, previously 13 x 11 mm. This lesion lesion appears to narrow spinal canal. MRI of the cervical spine could be obtained for further evaluation. Degenerative disk disease most severely affects C5-6 and C6-7, with uncovertebral osteophytes at these levels. Limited images of the apices of the lungs again demonstrate scattered pulmonary nodules. Please review dedicated report of CT of chest for details. CT of brain with infusion.No evidence of metastatic lesion to the brain, leptomeninges or the calvarium is detected. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Lytic lesion affecting the C6 spinous process may narrow the spinal canal. Cervical spine MRI can be obtained for further evaluation if indicated.2. Partial visualization of multiple pulmonary nodules. Please refer to chest CT scan day for further detail.


Instruction: Generate impression based on findings.

Input: Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified [R93.0] / Transient alteration of awareness [R40.4] / Headache [R51], Reason for Study: ^Reason: evaluate for demyelinating or ischemic lesions History: headaches, prior abnormal MRI. Previously demonstrated FLAIR high signal intensity lesions on the left inferior frontal lobe and vermis appear to be stable, no change in size, extent and signal intensity suggesting likely to be chronic ischemic lesion but again cannot completely exclude possibility of demyelinating lesion.There is no other lesion seen on this scan.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cyst on the right side of the sphenoid sinus.

Output: 1. No change of left inferior frontal lobe and vermis FLAIR high signal intensity lesion since prior scan. No new lesion is seen. Thus, those lesions may represent chronic ischemic lesion but again cannot completely exclude the possibility of demyelinating lesion. 2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: History of gallstone pancreatitis and choledocholithiasis. ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. The liver is normal in morphology, size, and enhancement. No focal suspicious lesion. Status post cholecystectomy. The common bile duct appears to narrow at the ampulla suggesting a benign stricture at the ampulla. The common bile duct measures up to 10 mm which may be in part due to post cholecystectomy state.The vasculature is patent.SPLEEN: The spleen is normal in morphology size and intensity.PANCREAS: The pancreas is normal in morphology, signal intensity and enhancement. The main pancreatic duct is normal in caliber. No peripancreatic inflammatory changes.Following secretin administration there appears to be an adequate excretory response of the pancreas. No side branch ectasia.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Fatty liver.2.No significant stigmata of acute or chronic pancreatitis.3.Possible benign appearing stricture at the level of the ampulla with mild common bile duct prominence which may be in part due to post cholecystectomy state.


Instruction: Generate impression based on findings.

Input: 21 year-old woman with history of right shoulder pain. ROTATOR CUFF: The rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. We see no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The anterosuperior labrum is separated from the underlying glenoid from the 2 o'clock to 3 o'clock positions, likely representing a normal variant sublabral foramen. There is a small, 3-4 mm collection of fluid signal intensity at the capsular insertion along the inferior aspect of the labrum which may represent a small cyst, but we see no associated labral tear. The anterior bundle of the inferior glenohumeral ligament can be followed from the glenoid to the humerus. Additional contrast tracking along the medial aspect of the proximal humeral diaphysis may represent a rent in the capsule.BICEPS TENDON: The long head of biceps tendon is intact. ADDITIONAL

Output: Normal appearing rotator cuff and labrum without specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with multiple myeloma and multiple compression fractures, presenting with new mid and lower back pain. Please note that an abridged examination was performed to accommodate the patient's discomfort during scanning.Severe compression deformities are evident at T5 and T7-T9, all showing evidence of prior kyphoplasty. The compression at T9 appears to have progressed slightly when compared to the prior MRI examination although the others are not significantly changed. There is mild retropulsion at the T5 level, similar to prior, which results in effacement of the ventral thecal sac but no significant spinal canal stenosis.Moderate to severe compression deformities are also evident at the T12-L5 vertebral bodies, all of which show evidence of prior kyphoplasty. There has been no significant change in the severity of these compressions. At the L4 level, there may be some degree of retropulsion which, combined with anterolisthesis of L3 relative to L4, results in a moderate generalized spinal canal stenosis with crowding of the cauda equina.Marrow signal characteristics are generally slightly heterogeneous. There are, in addition, several scattered focal areas of marrow replacement throughout the spine, some of which demonstrate corresponding enhancement. The largest focal enhancing lesion is found in the left sacrum.Multilevel disc osteophyte formation is seen in the cervical spine. This results in mild to moderate spinal canal narrowing from C3-4 through C5-6. Significant foraminal narrowing is evident on the left at C4-5.In the lumbar spine, disc uncovering at L3-4 with some component of L4 retropulsion, in combination with marked facet arthropathy and ligamentum flavum thickening, results in a moderately severe spinal canal stenosis. Milder disc degeneration is seen at other lumbar levels though the posterior elements are significantly degenerated at lower lumbar levels. The lumbar neural foramina are mildly to moderately narrowed.

Output: 1.Redemonstration of multiple compression deformities including at T5, T7-T9, and T12-L5. All demonstrate evidence of prior kyphoplasty.2.No new compression deformities are seen. The compression deformity at T9 has progressed slightly. The remaining compression deformities appear similar to prior examinations.3.Several scattered foci of marrow replacement are seen which may represent areas of active myelomatous disease. The largest such lesion is found in the left sacrum.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, brain metastases status post right cerebellar lesion resection and RT and AP26113 therapy. There are postoperative findings in the posterior fossa without evidence of right cerebellar tumor recurrence. There is an unchanged subcentimeter partially cystic and partially enhancing lesion with mild surrounding T2 hyperintensity in the right middle frontal gyrus. There is also an unchanged punctate intrinsically T1 hyperintense lesion in the left superior frontal gyrus. There is no evidence of new intracranial lesions. There is no evidence of intracranial hemorrhage or acute infarct. 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, and scalp soft tissues are unchanged. There is moderate mucosal thickening in the bilateral maxillary sinuses and a retention cyst in the right sphenoid sinus.

Output: 1. Unchanged postoperative findings in the posterior fossa without evidence of right cerebellar tumor recurrence. 2. Unchanged small bilateral frontal lobe treated metastases.


Instruction: Generate impression based on findings.

Input: 28-year-old female with BRCA mutation and family history of breast cancer. History of benign MR guided biopsy of left breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.An enhancing focus, which is a proven benign lesion, is again seen at 2 o'clock position in the left breast. It is significantly smaller measuring 3 mm in maximum diameter, compared to the previous measurement of 7 mm. A marker clip is identified immediately medial to the focus.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 22-year-old female. Knee pain status post ACL reconstruction x 2. MENISCI: Medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Mild marrow edema in the posterior tibial plateau and the femoral condyles, likely representing contusions. New small area of femoral trochlea cartilage high signal abnormality and mild fraying without a full thickness defect. No full thickness cartilaginous defects are identified in the tibiofemoral compartment.LIGAMENTS: Post-surgical findings of ACL repair. Complete disruption of the graft consistent with a full thickness tear. PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Full thickness tear of the ACL graft. Large knee joint effusion.2. Small area of chondromalacia of the femoral trochlea cartilage with surface fraying.


Instruction: Generate impression based on findings.

Input: Multiple cerebral cavernous malformations. There is slight interval increase in size of a posterior right cerebellar hemisphere cavernous malformation with interval appearance of central T1 hyperintense components, with an adjacent small developmental venous anomaly. There is no appreciable interval change in the numerous other supratentorial and infratentorial cavernous malformations. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Slight interval increase in size of a posterior right cerebellar hemisphere cavernous malformation likely attributable to subacute hemorrhage. Otherwise, no appreciable interval change in the numerous supratentorial and infratentorial cavernous malformations.


Instruction: Generate impression based on findings.

Input: 45-year-old male with left shoulder pain and weakness, assess for rotator cuff tear ROTATOR CUFF: Increased signal within the supraspinatus at its insertion is suggestive of a mild tendinopathy, however no discrete tear is identified. The supraspinatus muscle is normal. The infraspinatus, subscapularis and teres minor tendons and muscles appear normal.SUPRASPINATUS OUTLET: An os acromiale is identified.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small subchondral cyst in the humeral head at the supraspinatus insertion, otherwise marrow signal is normal. The glenoid labrum is grossly intact.BICEPS TENDON: The biceps tendon is intact.ADDITIONAL

Output: 1.Mild tendinopathy of the supraspinatus without a discrete tear.2.Os acromiale.


Instruction: Generate impression based on findings.

Input: 39-year-old male with seizure status post a partial suprasellar mass resection. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. Right frontoparietal craniectomy with overlying skin staples and surgical drain with adjacent frontal and left temporal pneumocephalus consistent with postsurgical procedure. A small amount of hemorrhage is present in the subarachnoid space and overlying the left cerebellar hemisphere. This examination is nondiagnostic for evaluation of the pituitary sella; for evaluation of residual disease, MRI of the pituitary may be considered.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postsurgical changes as described above without acute abnormality.2. For evaluation of residual disease MRI of the pituitary may be considered.


Instruction: Generate impression based on findings.

Input: For purposes of numbering, there are 5 lumbar type vertebral bodies. There is loss of the normal lumbar lordosis and minimal anterolisthesis of L2 on L3, slightly increased as compared to prior exam. The vertebral body heights are preserved. There is fatty endplate changes and moderate to severe loss of intervertebral disc space height at the L2-L3, L3-L4, L4-L5, and L5-S1 intervals, which is slightly progressed as compared to prior exam on the L2-L3 level. There is edematous changes involving the L2-L3 endplates which is likely degenerative in etiology and new since remote study from 2005. Enhancing Schmorl nodes are noted at the inferior endplate of L2 and superior endplate of L5. The conus is normal in signal and morphology and terminates at L1-L2 level. Large left kidney cystic structure is again partially visualized.T12/L1: There is no significant disc disease or no spinal canal or neural foraminal stenosis.L1/2: There is mild facet joint arthropathy with no significant disc disease, or spinal canal or neural foraminal stenosis.L2/3: Diffuse disc bulge and advanced bilateral facet arthropathy as well as ligamentum flavum thickening resulting in up to moderate spinal canal stenosis, mild right neural foraminal stenosis, and moderate left foraminal stenosis, progressed as compared to prior exam from 2005.L3/4: Diffuse disc bulge with endplate osteophytes, ligamentum flavum thickening, and facet joint arthropathy resulting in moderate to severe left neural foraminal narrowing and mild to moderate right neural foraminal narrowing. Postsurgical changes of prior left-sided laminectomy are noted, with effacement of the left lateral recess but no significant thecal sac effacement. Caliber of the spinal canal is improved since the prior exam.L4/5: Patient status post left-sided laminectomy with improvement in spinal canal caliber and no significant spinal canal stenosis. Facet joint arthropathy with mild to moderate left neural foraminal stenosis and moderate to severe right neural foraminal stenosis are noted.L5/S1:Diffuse disc bulge with posterior osteophytes and partial effacement of the lateral recess, right greater than left, with no significant central canal stenosis. There is severe right neural foraminal and moderate left neural foraminal stenosis.

Output: 1.Multilevel degenerative changes throughout the lumbar spine, progressed at the L2-L3 level since remote prior study of 10/8/2005 with decompression of spinal canal at the L3-L4 and L4-L5 level in the interval.2.Multilevel neural foraminal stenoses, as detailed above.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42] / Unspecified abnormalities of gait and mobility [R26.9] / Abnormal results of other function studies of eye [R94.118], Reason for Study: ^Reason: Evaluate Brain History: Dizziness, Abnormal VNG Focal high signal intensity on diffusion-weighted imaging at the left frontal lobe precentral gyrus which is corresponding to high signal intensity lacunar infarct lesion on the T2 weighted image, therefore this lesion is more likely T2 shine through is a of acute ischemic infarct.There are multiple scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.There are multiple lacunar infarcts on bilateral cerebellar hemispheres.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening are seen on bilateral maxillary sinus, ethmoid sinus and sphenoid sinus. Especially the right maxillary sinus shows high signal intensity on diffusion-weighted imaging indicating thick mucus accumulation.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease with multifocal lacunar infarcts.3. Pansinusitis.


Instruction: Generate impression based on findings.

Input: Ms. Frekko is a 42 y/o woman with recent diagnosis of grade 2 DCIS in the left breast, status post wire localized excision with close margins DCIS present <1mm from the inked margin at Rush Hospital. The following studies from outside facility are submitted for review.1. Bilateral diagnostic mammogram, 4/23/20152. MRI of both breasts, 5/13/2015, which was reviewed separately.3. Ultrasound of the left breast, 5/18/2015.4. Post procedure mammogram of the left breast, 5/18/20155. Needle localization on the left and radiograph of the left lumpectomy specimen 7/28/2015For comparison, MRI of breast 4/4/2011 is available BILATERAL DIAGNOSTIC MAMMOGRAM, 4/23/20152 standard views of the both breasts were performed. The breast parenchyma is heterogeneously dense. The left breast is larger than the right breast. There is a small asymmetry is present in the central left breast, posterior depth, only seen on the CC view that persists with compression.ULTRASOUND OF THE LEFT BREAST, 5/18/2015MRI directed ultrasound was performed over the central left breast based on the recent MRI finding (separately dictated). In the left breast, 1:00 location, 6 cm from the nipple, there is a 3-4 mm circumscribed hypoechoic area that is probably benign in appearance. Incidental note are made of a few small cysts in the left breast, 1-2 o'clock location.POSTPROCEDURE MAMMOGRAM OF THE LEFT BREAST, 5/18/2015A stereotactic biopsy was performed as per clinic note. However, no imaging of the biopsy is provided.CC and MLO views of the left breast demonstrated a biopsy clip in the upper, central left breast, which correlates in location with the nonmass enhancement on the MRI breast dated 5/13/2015.NEEDLE LOCALIZATION AND RADIOGRAPH OF THE LEFT LUMPECTOMY SPECIMEN 7/28/2015Left breast mammograms show successful wire placement adjacent to the biopsy clip. The biopsy clip and the adjacent focal asymmetry are present in the specimen radiograph.

Output: Status post excision of the left breast clip from stereotactic biopsy. Correlation with surgical pathology is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female; 34 years old. Reason: history of perianal fistula, perirectal abscess. h/o Crohn's. f/u from 1/2015 History: abd pain, diarrhea ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate hiatal hernia, similar to prior study. Mild colonic wall thickening with increased enhancement at the junction of the descending colon and sigmoid colon (series 2201/91). Slight thickening of the wall of the terminal ileum is also seen (series 1501/1).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left transsphincteric perianal fistula is seen arising from the 6 o'clock position of the superior anus with complex fistulous tracts extending inferiorly toward of the skin surface at two sites in the left medial gluteal fold, similar to prior exam (series 2201/35).Increased enhancement due to granulation tissue associated with the fistula, particularly at the level of the anorectal junction, has increased (series 2201/42). BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Left transsphincteric perianal fistula is similar to prior exam, aside from increased associated granulation tissue.2. Thickening and enhancement of the descending/sigmoid colon.


Instruction: Generate impression based on findings.

Input: 73 old female with known lumbar stenosis; evaluate for stability of the spine. Flexion and extension views of the lumbar spine demonstrate significant disk space narrowing and anterospondylolisthesis of L5 on S1, which is not significantly change with flexion/extension.Spinal survey demonstrates scoliosis with a slight leftward convexity. There is anterior ossified formation at C5 and C6. There is a positive sagittal balance, measuring 5.2 cm. The lumbar spine demonstrates the aforementioned anterospondylolisthesis of L5 on S1.

Output: 1. Positive sagittal balance.2. Anterospondylolisthesis and significant disk space narrowing of L5 on S1.3. Anterior osteophyte formation at C5 and C6.


Instruction: Generate impression based on findings.

Input: Incidental liver mass seen on outside hospital CT. The study is suboptimal due to patient motion.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, contour and size measuring 18 cm in craniocaudal dimension. No intrahepatic or extrahepatic biliary ductal dilatation. The liver orientation is different from the outside hospital comparison CT. The right hepatic dome peripheral lesion appears to be at a different level relative to the gallbladder but this is felt to be likely due to positioning and liver orientation. Definite characterization of the lesion is limited due to extensive respiratory motion. The lesion demonstrates mild homogeneous T2 weighted hyperintensity, not the typical appearance of a hemangioma. On dynamic postcontrast imaging the lesion demonstrates arterial enhancement which persists on the portal venous and delayed imaging. The 1 hour delayed hepatobiliary phase demonstrates no retention of contrast, which would be expected in a typical FNH. The lesion demonstrates nonspecific mild restricted diffusion.SPLEEN: Mild splenomegaly measuring 14 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited study due to patient motion and respiration. The right hepatic dome lesion is difficult to see and definitively characterize. The features of the lesion are not that of a typical hemangioma or FNH. In the absence of a known hypervascular primary malignancy or risk factors for HCC the lesion is likely benign in etiology. However, given the suboptimal study, follow-up liver protocol CT (which will hopefully minimized motion) in 6 months is recommended. Borderline splenomegaly.


Instruction: Generate impression based on findings.

Input: 38 year old with history of systemic lupus erythmatosus presenting with worsening left ventricular dysfunction, chest pain and TTP. Left VentricleThe left ventricle is severely enlarged with mild to moderately reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 137 ml/m2 (normal range: 65+/-11), the LVEDV is 286 ml (normal range 109+/-23), the LV end systolic volume index is 96 ml/m2 (normal range 18+/-5), the LVESV is 200 ml (normal range 31+/-10), the LV mass index is 60 g/m2 (normal range 67+/-11), and the LV mass is 123 g (normal range 114+/-24). The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 105 ml/m2 (normal range 69+/-14), the RVEDV is 220 ml (normal range 110+/-24), the RV end systolic volume index is 62 ml/m2 (normal range 22+/-8), and the RVESV is 130 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly enlarged. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets are tethered and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern with a common origin of the left brachiocephalic and left common carotid. 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. There is a catheter in terminating at the SVC/RA junction. PericardiumThere is a small pericardial effusion. Thickening of the pericardium (5-6 mm) consistent with thickening inflammation and acute pericarditis.Extracardiac FindingsThere is a body piercing on bilateral breasts. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely enlarged with mild to moderately reduced systolic function. The overall LV ejection fraction is 30%. The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process (no evidence of myocarditis)2. The right ventricle is mildly dilated with mildly reduced systolic function (RVEF 41%)3. Thickening and inflammation of the pericardium consistent with pericarditis. Small circumferential pericardial effusion with no evidence of hemodynamic compromise. 4. Significant left atrial enlargement I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 45 years old evaluate renal mass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a nonenhancing 8 x 6 mm lesion with a single septation in the interpolar region of the left kidney which is intrinsically bright on T1 images and of low signal intensity on T2 images. This lesion previously measured 11 x 7 mm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable to slight decrease in size of the nonenhancing left renal lesion which remains most compatible with a complex proteinaceous or hemorrhagic cyst.


Instruction: Generate impression based on findings.

Input: 64-year-old male with pancreatic lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intra or extra hepatic biliary ductal dilatation. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Inferior-medial to the pancreatic head is a 4.5 x 1.3 cm lesion (series 14 image 128) that is mildly T2 hypointense, and the T1 hyperintense signal does not demonstrate loss of signal on the out- of-phase sequence (i.e. not fat). The size is stable to slightly decreased compared to the 1/21/2015 CT exam. Unfortunately, the lack of a precontrast T1 fat-saturated sequence limits evaluation for enhancement contrast. The lesion is located between the uncinate process and the mesenteric vessels and is favored to arise from the mesentery. The lesion margins are slightly infiltrated with the surrounding mesenteric fat (coronal series 8 image 21, series 13 image 50). No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mesenteric lesion as described above. Tiny hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.A T1 hyperintense / T2 hypointense lesion between the pancreatic uncinate process and mesenteric vessels is favored to originate from the mesentery and is stable to slightly decreased in size compared to the 1/21/2015 CT exam. The margins demonstrate a slightly infiltrative appearance. The lack of a precontrast T1 fat-saturated sequence limits evaluation for contrast enhancement. The imaging features are nonspecific, and the differential includes mesenteric carcinoid or fibrous tumor with a desmoplastic reaction.


Instruction: Generate impression based on findings.

Input: Tibial plateau fracture. Four views of the left knee appears similar to the prior radiographs, demonstrating no discrete fracture or malalignment. The osteochondral fracture seen on the prior MRI at the posterior aspect of the lateral tibial plateau is not well visualized on radiographs.

Output: Unchanged radiographic appearance of the left knee, without definite visualization of the osteochondral fracture seen on the prior MRI.


Instruction: Generate impression based on findings.

Input: Ms. Kerber is a 50 year old female with a personal history of benign right breast biopsy. She also has a history of a right thigh liposarcoma. She has a family history of breast cancer in her mother, two maternal aunts, and maternal grandmother. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Innumerable cysts are noted bilaterally, best seen on T2 images. No new or suspicious enhancement is seen in either breast. Previously noted enhancing lesions, including a benign-morphology mass in the right inner breast, benign morphology mass in the left inner breast and 3.8 cm area of non-mass-enhancement in the right lower inner breast are all stable.No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 3-year-old male status post intubation with recent fever; evaluate for cerebral edema. There is a focus of hypoattenuation in the right basal ganglia which is somewhat nonspecific on this nonenhanced CT scan. Additional hypoattenuating regions are seen in the bilateral posterior parietal/occipital lobes with extension to the cerebral cortex. Further imaging with MRI is recommended. There is no evidence of intracranial hemorrhage or midline shift. The gray-white matter differentiation appears somewhat indistinct. There is diffuse loss of the cortical sulci which can be seen as a normal variant in young patients; however this may also suggest diffuse cerebral edema.The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. There is partial opacification of the right mastoid air cells and middle ear cavity.

Output: 1. Findings suspicious for cerebral edema. 2. Nonspecific foci of hypoattenuation in the right thalamus and bilateral posterior parietal/occipital lobes. Further imaging with MRI is recommended. 3. Partial opacification of the right mastoid air cells and middle air cavity is nonspecific, but otomastoiditis cannot be excluded.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:2/19/1944)Reason: dysesthesias of lower extremities in pt with possible TIA in 2013 History: as abovePROVIDER/ATTENDING NAME: ANDREW M DAVIS ANDREW M DAVIS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No abnormal mass lesions are appreciated intracranially.


Instruction: Generate impression based on findings.

Input: Breast density study, exam for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not used for clinical purposes.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, with idiopathic scoliosis and café au lait macule. Assess for spinal cord abnormality. A moderate levoscoliosis of the lumbar spine is seen. In the sagittal plane, the vertebral bodies are well aligned with respect to each other.Fatty degenerative endplate signal alteration is seen at L2-3. Mild edematous endplate degenerative signal is demonstrated in the lower thoracic spine. Otherwise, no areas of significant or concerning marrow signal abnormality are detected.Mild right lateral wedging of the L2 vertebral body is seen related to the scoliotic curvature. Vertebral body height and morphology are otherwise unremarkable.The visualized spinal cord and conus are unremarkable. The conus tip terminates at the L2 level which is the lower boundary of normal. The nerve roots of cauda equina are unremarkable. No evidence of fatty filum or any intraspinal mass is seen.Loss of disk height and T2 signal are seen throughout the lumbar spine, probably most severely affecting the L2-3 level. Additional level specific findings are as follows:T11-12: Marked left facet hypertrophy. Bulging disk asymmetric to the left. Effacement of the left lateral thecal sac without cord impingement. Severe left foraminal narrowing.T12-L1: Facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.L1-2: Right greater than left facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Moderate right foraminal narrowing. L2-3: Right-sided facet hypertrophy. Bulging disk asymmetric to the right far lateral region. Mild narrowing of the right lateral recess. No significant generalized spinal canal stenosis. Severe right foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Severe bilateral facet hypertrophy with a prominent facet effusion on the right. Bulging disk asymmetric to the right foraminal region. Mild generalized spinal canal stenosis. Severe bilateral foraminal narrowing. L5-S1: Facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Moderate levoscoliosis.2.Superimposed degenerative findings which contribute to variable foraminal narrowing, severe at some levels as above, and scattered mild spinal canal stenosis.3.No abnormalities of the visualized spinal cord, conus or cauda equina are seen. No evidence of any intraspinal mass is detected.


Instruction: Generate impression based on findings.

Input: Female 11 years old Reason: eval for ligament or cartilage pathology History: persistent shoulder pain ROTATOR CUFF: A trace amount of fluid is present within the superior subscapularis recess. The muscles and tendons of the rotator cuff are intact and demonstrate normal signal and morphology.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Examination somewhat limited given lack of intra-articular gadolinium, given this limitation, no labral tear is evident.BICEPS TENDON: The biceps tendon is normally positioned within the bicipital groove. ADDITIONAL

Output: Findings suggestive of a subacromial/subdeltoid bursitis, but no tendinous or muscular injury is evident.


Instruction: Generate impression based on findings.

Input: Anaplastic astrocytoma, WHO grade III, treated with TMZ and radiation therapy. There are post-treatment findings unchanged cystic cavities in the left parietal lobe. However, there is interval increase in size and number of the enhancing lesions with susceptibility effect in the treatment bed region. For example, an enhancing lesion in the left periatrial white matter measures 10 x 18 mm, previously 8 x 14 mm. There appears to be increased blood volume associated with at least some of the lesions, although a few are too small to characterize on perfusion imaging. There is persistent surrounding confluent white matter T2 hyperintensity. There is an unchanged lesion with susceptibility effect and central T1 hyperintensity in the inferior pons, with an associated developmental venous anomaly, but no surrounding T2 hyperintensity. There is diffuse surrounding confluent T2 hyperintensity in the white matter, without associated mass effect. There is no midline shift or herniation. The orbits are unremarkable. There are bilateral maxillary sinus retention cysts.

Output: 1. Post-treatment findings in the left parietal region with interval increase in size and number of the treatment bed region, which may represent tumor progression.2. Subcentimeter pontine cavernous malformation with associated developmental venous anomaly, but no evidence of surrounding edema.


Instruction: Generate impression based on findings.

Input: This 53 old male status post liver transplant with a history of seizures and VZV meningitis as well as a history of intraventricular hemorrhage. Would like to rule out expansion/stroke. Again noted is trace blood in the bilateral lateral ventricles which was seen in the brain MRI dated 7/07/08.There is no evidence of new intracranial hemorrhage.There is asymmetric prominence of the lateral ventricles as well as mild prominence of the third ventricle. This may be due to mild/moderate volume loss. This prominence has increased slightly when compared with the CT scan dated 7/02/08.There are periventricular white matter changes indicative of small vessel disease. There is no evidence of intracranial mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Trace blood is again seen in the lateral ventricles. There is no evidence of new intracranial hemorrhage.2. There is prominence of the lateral and third ventricles which is slightly increased when compared to the prior CT scan dated 7/2/08.3. There is evidence of small vessel disease.


Instruction: Generate impression based on findings.

Input: 31-year-old male with right hip pain for 6 months, no improvement with conservative treatment, evaluate for labral tear ACETABULAR LABRUM: There is a tear of the anterosuperior acetabular labrum without labral detachment. There is a focal area of degeneration in the posterior labrum as well.ARTICULAR CARTILAGE AND BONE: There are no focal chondral abnormalities. There is an abnormal offset of the femoral head-neck junction, with an alpha angle measuring approximately 55 degrees.SOFT TISSUES: The visualized soft tissues are within normal limits.ADDITIONAL

Output: Anterosuperior labral tear and CAM type deformity of the right hip as described above.


Instruction: Generate impression based on findings.

Input: Male 70 years old Reason: H/o IVC sarcoma, resected 10/8/14 on f/u MRI done 2/19/15, some enhancing tissue along right diaphragmatic crus. Needs to evaluate for change May, 2015. ABDOMEN:LIVER, BILIARY TRACT: Left hepatic lobe hemangioma is stable in size measuring 1.1 cm (series 4, image 11). Again seen is a small enhancing focus in segment 8 measuring 7 mm (series 1002, image 67). This is unchanged in size but remains nonspecific. The previously described segment 5 T2 hyperintensity is not well seen on today's study.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: Persistent focus of diffusion restriction along the crus of the right hemidiaphragm measures 0.9 x 0.9 cm (series 8, image 69) and is unchanged compared to prior study. There is persistent mildly enhancing soft tissue surrounding this focus of diffusion restriction, along the crus, which has decreased in size compared to prior study. Low-density focus along the right posterolateral margin of the IVC is nonenhancing and likely represents postsurgical fluid. This is unchanged.Subcentimeter nonspecific retrocrural and retroperitoneal lymph nodes. These are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall.

Output: 1.Postsurgical changes related to IVC sarcoma resection, with mildly enhancing soft tissue along the right diaphragmatic crus with a small central focus of diffusion restriction. This has decreased in size compared to prior study.2.Nonenhancing collection along the right posterolateral margin of the IVC is unchanged and may represent postsurgical edema.3.Nonspecific arterially enhancing focus in segment 8 is unchanged.


Instruction: Generate impression based on findings.

Input: Shoulder instability ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a type II SLAP tear of the labrum which extends posterior to anterior.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Type II SLAP tear of the labrum. Otherwise no internal derangement of the left shoulder.


Instruction: Generate impression based on findings.

Input: Status post resection for atypical meningioma. There are postoperative findings related to parietal craniotomy for resection of a left parietal convexity meningioma. There is no evidence of gross residual tumor. However, there are bilateral frontal convexity fluid collections with areas of restricted diffusion and fluid-fluid levels on the left. The right fluid collection measures up to 12 mm in thickness and the left fluid collection measures up to 16 mm in thickness and there is associated mild mass effect upon the underlying brain parenchyma. However, there is no midline shift. There is persistent mild signal abnormality in the left frontoparietal brain parenchyma. The sulcal T2 hyperintensity in the region has resolved, however. There is mild mucosal thickening in the maxillary sinuses. The orbits are unremarkable.

Output: 1. Postoperative findings with residual bilateral frontal convexity extra-axial fluid collections that may represent seromas and less likely empyemas.2. No evidence of gross residual tumor, but persistent mild signal abnormality in the underlying brain parenchyma, which may represent gliosis or edema.


Instruction: Generate impression based on findings.

Input: Reason: Left posterior thigh soft tissue sarcoma, r/o recurrence History: above Metallic susceptibility artifact from the patient's right total hip arthroplasty and bilateral total knee arthroplasties limits evaluation of the surrounding soft tissues, particularly on the large field of view images. Again seen are postsurgical changes along the posteromedial aspect of the left thigh. The previously described elongated fluid collection along the posterior aspect of the thigh measures approximately 10 mm in diameter, previously 15 mm, likely representing a postoperative seroma. There is additional elongated fluid signal intensity extending superomedially to the level of the medial aspect of the upper thigh, appearing similar to the prior study, also likely representing seroma formation. There is a small amount of peritrochanteric inflammation which may be of no clinical significance.There is irregular curvilinear enhancing increased signal abnormality along the lateral aspect of the long head of the biceps femoris muscle at the level of the myotendinous junction which appears slightly more pronounced on today's examination when compared to the prior study (images 35 through 37; series 1201). There is no involvement of the underlying bone. While this may represent granulation tissue related to postsurgical change, the possibility of residual or recurrent tumor cannot be completely excluded. There is increased signal abnormality within the adductor musculature which is nonspecific. No bone marrow signal abnormality is identified.

Output: Slight interval increase in the irregular curvilinear enhancing signal abnormality along the posterolateral aspect of the long head of the biceps femoris muscle at the level of the myotendinous junction. While this may represent granulation tissue related to prior surgery, close interval follow-up examination is recommended to exclude the possibility of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Male; 8 months old. Reason: Tight anal sphincter with failure to pass stool. Question of perianal fistulas. Please assess further. Please also evaluate kidneys for malformations. Postcontrast sequences are limited by patient motion.PELVIS:PROSTATE/SEMINAL VESICLES: Not well visualized on today's study.BLADDER: The bladder is compressed by a dilated rectosigmoid colon as described below.LYMPH NODES: No significant pelvic lymphadenopathy. BOWEL, MESENTERY: Marked dilatation of the rectosigmoid colon to a diameter of 3.8 cm which compresses the bladder (series 1201, image 17). The distal 3 cm of rectum and anus are relatively narrowed. Stool is identified throughout the colon.BONES, SOFT TISSUES: No definite T2 hyperintense or enhancing tracts in the perianal region.OTHER: Normal kidneys and other visualized upper abdominal organs.

Output: 1.Stool filled colon and markedly dilated rectosigmoid colon which narrows distally. Findings are suggestive of Hirschsprung's disease or anal stenosis.2.No definite fistulous tracts identified in the perianal region.3.Normal kidneys.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 0:43

Output: Successful right hip arthrogram without immediate complication.


Instruction: Generate impression based on findings.

Input: Reported history of primary sclerosing cholangitis status post sphincterotomies also with history of Crohn's disease, evaluate pancreatic and biliary tree for cause of abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity and enhancement without suspicious focal lesions. There is mild irregularity and prominence of the central intrahepatic biliary ducts without dominant stricture or mass. The common bile duct measures up to 8 mm in diameter without stricture or mass.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal signal intensity and enhancement without focal lesions. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild prominence of the common bile duct and mild irregularity of the intrahepatic bile ducts without dominant stricture or mass.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: 6-12 mos R upper lip and bilateral heel numbness; hx migraines; evidence of MS? History: as above Multiple non enhancing scattered FLAIR high signal intensities on bilateral periventricular white matter and some on the left side deep white matter are seen which are non specific.Multiple converging linear enhancement on the callosal sulcus at the area of corpus callosum genu indicating developmental venous anomaly which is a normal variation. There is 16mm (CC) x 16.6mm (AP) x 5.4mm (RL) T1 high signal, T2 low signal without evidence of enhancement lesion on the left side falx which may indicate calcified meningioma or focal falx calcification.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Non specific multifocal white matter FLAIR high signal intensity lesions are seen.3. DVA on the right callosal sulcus.4. Possible calcified small meningioma or falx calcification.