Instruction: Generate impression based on findings.

Input: Male, 71 years old, history of esophageal cancer and brain metastases, status post drainage of cyst, status post radiosurgery. A left posterior parietal burr hole is redemonstrated. Subjacent to this, there remains an ill-defined heterogeneous lesion at the site of prior rim enhancement. Accurate sizing of this lesion is not possible given lack of IV contrast. However, the degree of surrounding parenchymal T2 hyperintensity has increased, now covering a wider geographic area involving the left parietal and occipital lobes, and with a greater degree of associated sulcal effacement.The known small right cerebellar lesion is vaguely identified as a region of ill-defined T2 hyperintensity. No other significant interval changes are detected. The ventricular size and morphology are approximately unchanged.

Output: 1.Limited precontrast examination of the brain. 2.Although accurate sizing of the dominant left parieto-occipital lesion is not possible, the degree of edema surrounding this lesion has increased. 3.A small lesion in the right cerebellum is vaguely discernible.


Instruction: Generate impression based on findings.

Input: 45 years, Female, Reason: hx of Crohn's disease , on ct with new ileal inflammation History: hx of Crohn's disease , on ct with new ileal inflammation. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a left lower quadrant colostomy. At the 12 o'clock position, 2.1 cm superior to the ostomy, there is a colocutaneous fistula which communicates with the colon at the abdominal wall. The colon proximal to the ostomy to the splenic flexure has wall thickening, enhancement and diffusion restriction compatible with active inflammation. There is mild distention of colon proximal to this segment measuring up to 4.6 cm in diameter. There is a separate segment of inflammatory changes in the neoterminal ileum, immediately proximal to the ileocecectomy, extending approximately 13 cm with wall thickening, enhancement and diffusion restriction compatible with active disease.No abscesses identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A suprasphincteric fistulous track is again visualized arising from the rectum at the 3 o'clock position and traversing the intra-sphincteric space and levator ani, entering the left ileoanal fossa and forming multiple branches, one of which terminates posteroinferiorly in the left gluteal cleft. This is similar in distribution to the prior exam although, less inflammation and edema is noted. There is a sinus tract which travels posteriorly from the rectum at the same level which is unchanged. Multiple abscesses seen previously have resolved. Evaluation of fistulous seen on the prior exam more inferiorly within the perineum are not within the field of viewBONES, SOFT TISSUES: Hemangioma within a lower vertebral body.OTHER: Small fluid in the pelvis.

Output: 1.Two segments of active Crohn's disease involving the neoterminal ileum and distal colon immediately proximal to the ostomy2.Colocutaneous fistula adjacent to the ostomy.3.Complex perianal fistulas appear slightly improved from the prior exam but are incompletely visualized and suboptimally evaluated on this study..


Instruction: Generate impression based on findings.

Input: 51-year-old female patient with history of Crohn's disease status post multiple small bowel resections presents with obstructive symptoms. ABDOMEN:LIVER, BILIARY TRACT: Layering gallbladder stones and sludge noted in the gallbladder. No intra or extra hepatic biliary ductal dilatation. No liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an approximately 8 cm segment of ileum with acute inflammatory changes in the midabdomen (series 18 image 80) and fibrofatty proliferation. There is mild small bowel dilatation proximal to this segment.There is also distal circumferential rectal wall inflammation and thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Minor contrast extravasation as described above.2.Long segment inflammatory changes the ileum in the midabdomen with mild proximal dilatation, compatible with mild obstruction.3.Distal rectal wall inflammatory changes.


Instruction: Generate impression based on findings.

Input: A 44 year old female with history of heart surgery as an infant ?ASD repair. ECG showed WPW. Referred to cardiac MRI for further evaluation and to rule out ASD. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 190 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 99 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracavitary thrombus was seen.AtriaThe left atrium is normal in size. The LA volume is 71 ml.The right atrium is normal in size. The RA volume is 69 ml. No shunt was noted, no atrial septal defect.Qp:Qs normal (1.08).Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 106 ml/m2 (normal range 69+/-14), the RVEDV is 243 ml (normal range 110+/-24), the RV end systolic volume index is 54 ml/m2 (normal range 22+/-8), and the RVESV is 125 ml (normal range 35+/-13). Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (32 mm).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 pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 55%. There is no late gadolinium enhancement.2. The right ventricle is mildly dilated with mildly reduced systolic function, the RVEF is 48%. 3. The left and right atria are normal in size.4. No hemodynamically significant atrial septal defect appreciated on this study. Qp:Qs normal (1.08).5. There is mild to moderate tricuspid regurgitation.


Instruction: Generate impression based on findings.

Input: 67-year-old man status post Roux-en-Y for pancreatic transection with increased JP output with high fluid amylase and fistula formation noted on recent fluoroscopic drainage. ABDOMEN:LIVER, BILIARY TRACT: There is mild to moderate intrahepatic biliary duct dilatation, the liver is otherwise unremarkable. The biliary-enteric anastomosis appears patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is atrophic. The proximal and distal pancreatic ducts are visualized, however the midportion of the duct is not seen. The visualized pancreatic duct is normal in caliber.Of note, there is a thin tract of T2 signal extending from the pancreatic duct in the neck into a portion of the abdominal fluid collection (series 701, images 79-90).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are noted. The kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Patient is status post Billroth II and has percutaneous gastrostomy. An abdominal drain is seen crossing the midline with pigtail anterior to the pancreatic head and the volume of fluid in the lesser sac has decreased from the CT on 10/23/2015.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There are bilateral small pleural effusions.

Output: 1.Probable thin communication between the pancreatic duct in the neck of the pancreas to the abdominal fluid collection.2.Abdominal drain in place with decreased fluid.


Instruction: Generate impression based on findings.

Input: 76 years, Male, tremor, weakness. Concern for stroke. Brain parenchyma appears within normal limits for age. There is mild global parenchymal volume loss. No restricted diffusion to suggest acute ischemia. No significant parenchymal T2 signal abnormality. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. However, there is artifact involving the right anterior globe which may be related to foreign body within or anterior to the globe. Left maxillary sinus mucus retention cyst. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is within normal limits for age. No evidence of infarct.


Instruction: Generate impression based on findings.

Input: Worsening right sided weakness. There is an area of restricted diffusion and high T2 signal in the left corona radiata, which is similar in size as on the prior CT, but larger than on the prior MRI. There are a few scattered foci of nonspecific cerebral white matter T2 hyperintensity, but no evidence of additional areas of restricted diffusion in the brain. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: A subacute infarct in the left corona radiata is similar in size as on the prior CT, but larger than on the prior MRI. There is no evidence of hemorrhagic transformation.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: eval for acute abnormalities History: facial droop, weakness Brain MRISignificant metallic artifacts especially right side degraded image quality especially right side posterior fossa.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.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. 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.No evidence of intracranial arterial aneurysm or significant stenosis.The left lens is not seen indicating postoperative status.

Output: 1. Normal brain MRI.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Reason: possible UCL avulsion injury of R thumb History: pain LIGAMENTS: There is disruption of the distal fibers of the ulnar collateral ligament just proximal to their insertion on the base of the proximal phalanx of the thumb. Portions of the proximal fibers of the ulnar collateral ligament appear to be retracted with some fibers deep to the adductor aponeurosis . The radial collateral ligament appears intact.TENDONS: The flexor and extensor tendons appear intact.BONES: There is decreased linear signal abnormality within the ulnar aspect of the base of the proximal phalanx at the level of the insertion of the ulnar collateral ligament indicating a small minimally displaced avulsion fracture. There is bone marrow edema in the surrounding area. There is asymmetry of the MCP joint with slight ulnar subluxation of the proximal phalanx. There is a small amount of fluid within the first MCP joint.

Output: Avulsion of the ulnar collateral ligament as well as a small Salter-Harris III/avulsion fracture of the base of the proximal phalanx of the thumb.


Instruction: Generate impression based on findings.

Input: Yearly follow up after resection of an anterior clinoidal meningioma. There are postoperative findings related to right pterional craniotomy with a small amount of unchanged encephalomalacia of the anterior right temporal lobe and the inferior right frontal gyrus and minimal dural enhancement along the superior aspect of the right anterior clinoid process. Otherwise, there is no evidence of measurable tumor in the treatment bed. There is no evidence of intracranial hemorrhage or acute infarct. There are a few unchanged nonspecific scattered small foci of cerebral white matter T2 hyperintensity. 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 are grossly unremarkable. There are small retention cysts in the left sphenoid and maxillary sinuses.

Output: Postoperative findings without evidence of recurrent anterior clinoid region meningioma.


Instruction: Generate impression based on findings.

Input: Tinnitus left ear and headaches. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several unchanged non-enhancing scattered T2 hyperintense cerebral white matter lesions. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of retrocochlear or inner ear lesions. A head CTA and temporal bone CT may be useful for further evaluation.2. Unchanged cerebral white matter lesions, which may represent multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 56 year old woman with history of peripheral arterial disease, diabetes who is referred for cardiac stress MRI for further evaluation of chest pain.MEDICATIONS: ASA, Lipitor, HCTZ, Xarelto, Metformin. First Pass PerfusionDuring hyperemia, there is a moderate severity perfusion defect involving the basal inferolateral wall. A subtle perfusion defect in the mid to apical inferior and inferoseptal walls can not be excluded.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), the LVEDV is 128 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 63 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 61 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall axillary (<1mm) lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a moderate severity perfusion defect/ "ischemia" in the basal inferolateral wall. A second subtle perfusion defect involving the mid to apical inferior and inferoseptal walls can not be excluded.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and schwannomatosis ROTATOR CUFF: There is increased signal intensity of the supraspinatus fibers near its just proximal to its attachment on the greater tuberosity representing tendinopathy. There is perhaps mild undersurface fraying of the supraspinatus as well but no discrete full-thickness tear. The rotator cuff tendinopathy extends posteriorly to involve the anterior fibers of the infraspinatus as well but again there is no evidence of a full-thickness tear. The supraspinatus and infraspinatus muscles are normal in caliber. The teres minor and subscapularis tendons and muscles are normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild degenerative tearing of the superior labrum but within the limits of a nonarthrographic study, the labrum is otherwise grossly intact. Glenohumeral joint alignment is normal. There is no effusion. Mild cystic changes are identified near the insertion of the rotator cuff.BICEPS TENDON: There is perhaps mild degenerative tearing of the intra-articular portion of the biceps tendon but the extra-articular portion appears intact.ADDITIONAL

Output: Rotator cuff tendinopathy without evidence of full-thickness tear. Additional mild age-related changes described above but there is no evidence of abnormal enhancement or mass following contrast administration.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type I. History of plexiform neurofibroma of the neck/brachial plexus and left arm. The infiltrative, nodular mass along/following the left brachial plexus and extending into the supraclavicular region, which is compatible with plexiform neurofibroma, is not significantly changed since the January 2014 examination. It is also not significantly changed in size compared to the more remote examination from 2012 though appears slightly less confluent. For example, the component of the lesion which is posterior to the left common carotid artery measures coronally 2.0 cm x 1.7 cm (series #501, image #20) compared to 1.9 cm x 1.8 cm in 2012. The plexiform neurofibroma is associated with denervation changes in the left subscapularis muscle.A well-circumscribed T2-hyperintense lesion anterior to the left scapula measures up to 1.7 cm axial and is not significantly changed since the previous examination done is not appropriately covered in all 3 imaging planes. Numerous smaller nodules are present on both sides of the neck without significant change. Some of them probably represent neurofibromas while others represent small lymph nodes.The airway is preserved. Cervical carotid flow voids are preserved.There is an incompletely imaged infiltrative mass involving the anterior right temporal region extending lateral to the right orbit, which has progressed since the previous examination, now measuring up to 1.7 cm in thickness compared to 0.7 cm on the 2012 examination. This is associated with a small questioned defect involving the lateral wall of the right orbit but no definite intraorbital extension of the mass.Signal abnormality involving the deep gray nuclei and the brainstem is only partly included on the current examination.

Output: 1.The component of the left plexiform neurofibroma in the neck and supraclavicular region has not significantly changed since January 2014 or January 2012 examinations. Please refer to the report of the MRI of the left upper extremity for details regarding the remainder of the plexiform neurofibroma.2.The incompletely imaged infiltrative mass involving the anterior right temporal region has increased since 2012 examination, likely an additional plexiform neurofibroma. Signal abnormality involving the deep gray nuclei and the brainstem also incompletely imaged on the current examination. Dedicated brain and orbits MRI can provide additional details regarding these findings.


Instruction: Generate impression based on findings.

Input: Examination is limited to post contrast sequences. Precontrast images were obtained on 1/12/2016. Partially imaged posterior fossa demonstrates prominent enhancement along the surface of the pons, medulla, and cerebellum. There is also abnormal leptomeningeal enhancement involving the surface of the cervical cord and to a lesser degree the thoracic cord. There is minimal if any abnormal enhancement involving the leptomeninges within the lumbar spinal canal.No discrete mass or nodular lesion within the spinal canal is appreciated.There is enhancement involving the lumbar paraspinous soft tissues which is likely related to combination of facet arthropathy, with possible component more superiorly related to recent lumbar punctures.

Output: 1. Abnormal leptomeningeal enhancement involving the partially imaged posterior fossa as seen on recent brain MRI studies. There is less prominent leptomeningeal enhancement involving the surfaces of the cervical cord and to an even lesser degree in the thoracic cord. No discrete enhancing nodule or masses are seen within the spinal canal.2. This examination is limited to post contrast sequences only; please refer to recent complete spine without contrast report from 1/12/2016 for additional findings.


Instruction: Generate impression based on findings.

Input: Reason: adrenal insufficiency History: short gut, TPN dependence, poor growth, normal GLT stim test and central adrenal insufficiency MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images, predominantly on the left side.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.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: 1.No abnormal lesion is identified in the pituitary gland. The pituitary is normal in overall size and morphologic appearance.2.Punctate periventricular white matter lesions of a mild degree are present which are nonspecific. Given the patient's past medical history, they are most likely are perinatal in origin.


Instruction: Generate impression based on findings.

Input: 62 year old man referred for cardiac MRI prior to atrial fibrillation ablation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 239 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 137 ml (normal range 47+/-19). LV 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 dilated. The LA volume is 182ml.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 247 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 139 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated. The RA volume is 173ml.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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. Dimensions as below:RUPV: 21mm x 20mmRLPV: 23mm x 22mmLUPV: 17mm x 24mmLLPV: 12mm x 22mmPulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is trace pericardial effusion.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. Mildly reduced bi-ventricular systolic function2. Severe biatrial enlargement3. No LV delayed enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: tremor, numbness and tingling. History of lupus. MRI brain:There is increased central T2 signal within the pons without associated diffusion restriction, mass effect, or susceptibility. No other parenchymal signal abnormalities are appreciated. There is no evidence of intracranial hemorrhage or acute infarct. An 8 mm pineal cyst is incidentally noted without mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.MRI lumbar spine:Vertebral body heights are within normal limits. Alignment is maintained. Bone marrow signal is benign. No abnormal signal within the cord or conus, which ends at L1. Disks are intact. T12-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1.Increased T2 signal within the central pons which may be related to prior osmotic demyelination. No abnormal signal in the basal ganglia is appreciated. Prior ischemia is also possible but less likely given the absence of significant white matter signal abnormality elsewhere in the brain. Remainder of the brain is unremarkable.2.Unremarkable lumbar spine MRI without significant spinal canal or neural foraminal stenosis.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: History of meningioma status post resection. Signs and symptoms: Surveillance. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates chronic postoperative changes upper left parietal craniotomy. There is a focus of encephalomalacia and gliosis under the craniotomy flap.Post enhanced images demonstrate minimal enhancing epidural thickening at the craniotomy site however without convincing evidence of residual or recurrence of tumor. Further follow-up however these needed.Multiple periventricular and subcortical foci of flair hyperintensity without interval change since prior exam are identified. The findings are nonspecific however possibilities of demyelinating disease and small vessel ischemic strokes should be considered. Some of the lesions have a perpendicular course to the ventricular system which could represent demyelinating plaques. Correlate with history and risk factors.

Output: 1.Chronic changes of left parietal craniotomy without evidence of residual or recurrent soft tumor. Further follow-up is recommended.2.Negative diffusion weighted series.3.Stable multiple foci of flair hyperintensity in the periventricular and subcortical white matter without enhancement. Some of the lesions appear perpendicular to the ventricular wall and could represent demyelinating disease. Small vessel ischemic strokes cannot be entirely excluded


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with horizontal metastatic with left-sided numbness. Assess for multiple sclerosis flareup. Numerous T2 hyperintense lesions are again seen within the cerebral hemispheres and to a lesser extent in the brainstem and cerebellum. Several lesions which were previously round or oval and relatively active appearing have evolved into a more chronic morphology. However, there are multiple new lesions. Likewise, some lesions which previously enhanced no longer do so, while a number of lesions show new enhancement. The dominant, tumefactive lesion in the left centrum semiovale contains a small focus of enhancement but is otherwise unchanged. No evidence of significant generalized edema or mass effect is seen. Brain parenchymal volume is preserved. Ventricular size and morphology are stable and within normal limits.

Output: Continued progression of disease with multiple newly developed lesions, some of which enhance.


Instruction: Generate impression based on findings.

Input: Preoperative planning for craniotomy and cystic demonstration. History of headache. This is a limited examination performed for preoperative planning. There are changes of previous right hemispherectomy. The complex extra-axial fluid collection and the right frontal parietal craniectomy is not significantly changed. Also, the complex fluid collection underneath the dural graft at the site of hemispherectomy is unchanged. Extensive T2-hyperintensity involving the left cerebral hemispheric white-matter is unchanged. The cystic compartment involving the left lateral ventricle have not significantly changed. The largest component in the posterior body measures up to 2 cm, for example. There are skin based fiducial markers.

Output: No significant interval change in the postoperative findings related to right hemispherectomy and appearance of the cystic compartment involving the left lateral ventricle.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, 59 years old, with transient right arm weakness and vertigo. Scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres without significant interval change. No restricted diffusion is evident. No significant edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: 1.No evidence of acute ischemia.2.Scattered foci of T2 hyperintensity are redemonstrated, a nonspecific finding which may reflect chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: History of HCV cirrhosis. Hepatocellular carcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.Demonstrated again in the right hepatic lobe segment 6 is a 6 mm lesion which is mildly T2 hyperintense and demonstrates early arterial phase enhancement and remains hyperintense on the portal venous and delayed imaging, unchanged.Additional punctate arterial phase enhancing foci likely represent perfusional anomalies and are similar to the prior.No vascular abnormality. No biliary ductal dilatation. Cholelithiasis within a normally distended gallbladder.SPLEEN: Mild splenomegaly measuring 13 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal inferior pole simple cyst.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: Cirrhotic liver morphology without new suspicious lesion.


Instruction: Generate impression based on findings.

Input: History of adrenomyeloneuropathy. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The orbits, skull, and scalp soft tissues are grossly unremarkable. A subcentimeter mucus retention cyst is noted within the right maxillary sinus.

Output: Brain within normal limits without parenchymal signal abnormality.


Instruction: Generate impression based on findings.

Input: Left shoulder pain and impingement signs for three month status post injection and physical therapy with no improvement. Years of subtle shoulder pain. Assess for massive rotator cuff tear. Evaluation of the shoulder on some sequences is limited by patient motion artifact.ROTATOR CUFF: The distal 2 cm of the supraspinatus tendon are of increased signal intensity with irregularity of both the bursal and articular surfaces indicating tendinosis and surface fraying/tearing. A poorly defined focus of increased signal intensity traversing the tendon at the 12-1-o'clock position approximately 2 cm proximal to its insertion on the greater tuberosity may represent a focal full-thickness tear, but I see no fluid-filled gap. There is mild fatty infiltration along the myotendinous junction of the supraspinatus muscle which otherwise appears normal. The infraspinatus muscle and tendon appear normal for age. The teres minor muscle and tendon appear normal for age. Increased signal intensity within the distal fibers of the subscapularis tendon suggests tendinosis, but I see no tear, and the muscle appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a moderate amount of fluid within the subacromial/subdeltoid bursa indicating a bursitis containing multiple foci of intermediate signal intensity likely representing a combination of synovitis, debris, and perhaps also blood products.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small glenohumeral joint effusion. There is perhaps minimal osteoarthritis which is essentially within normal limits considering the patient's age. The superior labrum appears attenuated, likely reflecting chronic attritional tearing. There is also mild blunting of the anterior labrum likely representing degeneration.BICEPS TENDON: The tendon of the long head of the biceps appears normal for age.

Output: 1.Degenerated supraspinatus tendon with surface fraying/tearing and probable focal full-thickness defect, but I see no fluid-filled gap or massive cuff tear.2.Subacromial/subdeltoid bursitis as described above.3.Acromioclavicular osteoarthritis and other degenerative findings as described above.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. Evaluate perianal disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: The urinary bladder is decompressed with a Foley catheter balloon. Note is made of mucosal enhancement which may be iatrogenic.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are numerous communicating peripherally enhancing fluid collections nearly entirely encasing the distal rectum predominantly within the ischiorectal fossa, compatible with multiple abscesses. One of the locules extends through the right lateral levator ani musculature measuring 2.5 x 1.9 cm. The largest component stems to the presacral space measuring 2.6 x 2.0 cm (series 7/33).One of the locules extends anteriorly towards along the right aspect of the levator ani musculature (series 7/46).There is a drainage device terminating in an abscess adjacent to the right anterolateral distal rectum in the intersphincteric space appears to traverse the 6 o'clock position of the rectum. The collection appears to have a small communicating channel with the other perirectal fluid collections described above.There is a suspected distal rectal intramural abscess measuring 6 mm (series 7/41).There are multiple mucosal abnormalities/sinus tracts of the rectum including the 8 o'clock position (series 7,image 68) and 2 o'clock position (series 7, image 62).BONES, SOFT TISSUES: Within the pelvis tracking along the right iliopsoas muscle is a 6.4 x 1.8 cm peripherally enhancing fluid collection (series 1401/47).Small locule of fluid in the gluteal cleft.There is extensive subcutaneous and muscular inflammatory/edematous signal intensity of the pelvic soft tissues without a discrete drainable fluid collection.Large bowel containing ventral hernia is partially imaged. OTHER: No significant abnormality noted.

Output: 1. Numerous interconnected peri-rectal abscesses and rectal fistulae/sinus tracts as described above. Small suspected intramural abscess in the left lateral wall of the rectum.2. Right peri-iliopsoas abscess appearing similar to prior CT.3. Extensive soft tissue edema/inflammation of the pelvis.4. Urinary bladder mucosal thickening may be iatrogenic; correlate for cystitis.


Instruction: Generate impression based on findings.

Input: Reason: evaluate non vascularize structure on RLE History: RLE abnormality A skin marker was placed along the posterior aspect of the right leg presumably corresponding to the patient's palpable area of concern. Note is made of a 3.1 x 2.4 cm mass within the lateral head of the gastrocnemius at the level of the myotendinous junction which corresponds to the findings on recent ultrasound examination. There is heterogeneous but predominantly low signal intensity on T1-weighted images with heterogeneous intermediate and increased signal intensity on T2-weighted images. There is apparent restricted diffusion within this lesion on diffusion-weighted images although some of this may, in part, represent T2 shine through. The tendon of the lateral head of the gastrocnemius appears intact. There is diffuse nonspecific subcutaneous edema most pronounced along the posterior, medial, and lateral aspect of the leg. There is also fluid signal intensity extending from the region of an apparent Baker's cyst which may represent the sequela of leakage or rupture of a Baker's cyst.

Output: Nonspecific 3.1 cm mass in the lateral head of the gastrocnemius at the level of the myotendinous junction. There is associated restricted diffusion on diffusion-weighted images. This is incompletely characterized on this noncontrast examination, and could represent a soft tissue neoplasm, although hematoma formation and abscess remain as differential considerations.


Instruction: Generate impression based on findings.

Input: History of 2 liver lesions. History of cirrhosis. The study is slightly limited due to metal artifact obscuring portions of the left hepatic lobe.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with particular T2-weighted signal intensity compatible with fibrosis. Recanalized umbilical vein.1.4 x 1.3 cm arterial enhancing focus in the inferior aspect of the right hepatic lobe (series 9/23) has no associated washout. There is mild associated restricted diffusion and mild T2 weighted hyperintensity. The lesion bulges the capsule.Stable nonspecific arterial enhancing segment 8 subcentimeter focus (series 9/52) without washout. Additional punctate arterial enhancing foci without wash-out, likely representing perfusional abnormalities.No suspicious arterial enhancing lesion is identified.Trace perihepatic fluid. Contracted gallbladder with gallbladder wall thickening is nonspecific in the setting of portal hypertension and chronic liver disease.No biliary ductal dilatation.SPLEEN: The spleen measures 14 cm in craniocaudal dimension without a focal lesion. Sequela of a small splenic infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cysts. Left proteinaceous/hemorrhagic cyst. No hydroureteronephrosis. Mild cortical scarring.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace left pleural effusion.

Output: 1.Cirrhotic liver with fibrosis. Stable arterial enhancing 1.4 lesion in segment 5 with associated T2-weighted hyperintensity and restricted diffusion. The lesion does not meet specific imaging criteria for HCC. Stable non-specific segment 8 arterial enhancing lesion. No new suspicious lesions.2.Mild splenomegaly, trace perihepatic ascites and recanalized umbilical vein.


Instruction: Generate impression based on findings.

Input: Ms. Ware is a 61-year-old woman with history of left breast ILC grade 2 with left axillary micrometastases status post left mastectomy in 2013. Family history of breast cancer in her paternal aunts. There is heterogeneous amount of fibroglandular tissue in the right breast. The patient is status post left mastectomy.Moderate parenchymal enhancement is noted in the right breast. A few high T2 signal cysts are present.No abnormal enhancement is seen in the right breast or left chest wall. No abnormal lymph nodes are identified in either axillary region. Post surgical change is noted in the left axilla.

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


Instruction: Generate impression based on findings.

Input: Malignant solitary fibrous tumor of the pelvis. PELVIS:UTERUS, ADNEXA: Anteflexed uterus. The endometrial thickness is normal. Endomyometrium/junctional zone is normal in thickness. No discrete uterine mass.BLADDER: The bladder is normally distended without a focal abnormality.LYMPH NODES: Nonspecific mildly prominent benign morphology inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post-surgical changes extending from the left piriformis towards the left aspect of the vagina. The right piriformis muscle appears atrophic relative to the left. The focus of enhancement in the left piriformis muscle measures 12 x 8 mm (series 1202/262), unchanged. No additional foci of abnormal enhancement.OTHER: No significant abnormality noted.

Output: 1. Stable 1.2 cm focus of enhancement in the left piriformis muscle, likely of vascular origin.2. Stable right piriformis atrophy.


Instruction: Generate impression based on findings.

Input: Male, full-term 21 days old infant, with increasing head circumference and bulging fontanelle. Evaluate for aqueduct stenosis/hydrocephalus. The lateral ventricles are markedly dilated, right side greater than left, with moderate dilatation of the third ventricles. The fourth ventricle is normal in caliber.Subacute blood clot is evident dangling within the right lateral ventricle. Subacute subdural blood product is also seen along the left anterior temporal lobe and along the posterior cerebellum. On susceptibility weighted imaging, however, there is a much more extensive pattern of chronic hemosiderin staining along the ependymal surface of the ventricles, the choroid plexi, and the surface of the brainstem and the cerebellum.Marked ventriculomegaly causes deformation of the brain parenchyma and periventricular white matter thinning. The corpus callosum appears to be present but is severely thinned. No areas of acute ischemia or significant parenchymal edema are detected.The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The cerebral aqueduct is patent. The posterior aspect of the right thalamus is smaller than that of the left and there is signal abnormality suggesting gliosis. The pattern of white matter myelination is otherwise appropriate for age.

Output: 1.Marked supratentorial ventriculomegaly.2.Subacute blood clot within the right lateral ventricle and in the subdural spaces along the left anterior temporal lobe and the posterior cerebellum.3.Superficial hemosiderin staining along the ependymal surface of the ventricles as well as the surface of the brainstem and cerebellum indicating a fairly extensive prior hemorrhagic event.4.Volume loss and gliosis of the right posterior thalamus are seen possibly suggesting prior injury or insult.5.The cerebral aqueduct is patent.


Instruction: Generate impression based on findings.

Input: There is a 7-mm focus of restricted diffusion with matching ADC hypointensity and T2 hyperintensity, without enhancement or susceptibility abnormality, involving the right cerebellar tonsil.There are a few scattered foci of T2 hyperintensity within the white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. There is enhancement within the distal right IAC which extends into the labyrinthine section of the facial nerve, to the geniculate ganglian, involving the horizontal facial segment, terminating at the descending portion of the facial nerve.The remainder of the right IAC components, as well as the left IAC components, are unremarkable.

Output: 1.7-mm focus of acute ischemia involving the right cerebellar tonsil of uncertain etiology or significance.2.Mild chronic small vessel ischemic disease.3.Asymmetric and abnormal enhancement the right facial nerve extending from the distal IAC to its descending segment.4.Findings were discussed with Dr. Kelly on 4/11/2015 at approximately 11:05 a.m.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense foci. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Nonspecific mild scattered cerebral white matter T2 hyperintense foci may represent chronic small vessel ischemic disease or stigmata of migrainous disease.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with extensive sinusitis and left-sided vision loss. Evidence of extensive pansinus infection/inflammation is seen with severe bilateral mucoperiosteal thickening. The sinus cavities are filled with very heterogeneous material which on MR sequences is particularly hypointense, a finding which suggests fungal elements. There is evidence of prior endoscopic sinus surgery.Sphenoid region inflammation extends superiorly, apparently eroding through the planum sphenoidale completely or nearly completely. As a result, this abnormal presumably infected tissue extends essentially to the margin of the gyri recti (see image 20 series 401 and image 16 series 901). No evidence of frank intracranial fluid collection or any brain parenchymal edema is seen. There may be other smaller areas of inflammatory penetration through the adjacent skull base. In addition, it appears that the floor of the sella is at least partially eroded by this process.The ethmoid air cell region is expanded bilaterally secondary to chronic inflammation. Abnormal enhancing tissue approaches very close to both optic nerves as they exit the optic nerve canals. The left optic nerve canal is significantly narrowed relative to the right, a finding which is better appreciated on the prior sinus CT, and which is secondary to sclerosis of the adjacent bone. The cisternal left optic nerve may even be somewhat smaller than the right suggesting a degree of atrophy. The intraorbital and cisternal segments of the optic nerves show no convincing evidence of enhancement or signal abnormality. Both nerves may potentially enhance mildly as they pass through the optic nerve canals but this could also be artifactual.The left pterygopalatine fossa is at least narrowed and possibly infiltrated by adjacent inflammation from the maxillary and sphenoid sinuses. No frank inflammatory extension is evident into the orbital apices.Limited intracranial views demonstrate multiple areas of periventricular and subcortical T2 hyperintensity. The hypothalamic region also seems to be affected by symmetric bilateral hyperintensity.

Output: Findings are seen compatible with an aggressive, possibly fungal pansinus infection. This process has eroded through the anterior skull base at the level of the planum sphenoidale in at least one location but probably in several. The process extends as far as the margin of the gyri recti. No definite evidence of any intracranial abscess or parenchymal edema is seen at this point. The floor of the sella is also partially eroded and there are likely additional areas of more subtle anterior skull base erosion.The left optic nerve canal is significantly more narrowed than the right, a finding which is better seen on prior CT and secondary to sclerosis and chronic thickening of the adjacent bony structures. The cisternal left optic nerve appears slightly smaller than the right which may reflect a component of atrophy. The cisternal and orbital portions of the optic nerve show no clear evidence of pathologic enhancement or signal abnormality. As the optic nerves pass through the optic nerve canals, they approach very closely to the infectious/inflammatory process in the adjacent sinuses and there may be some mild nerve enhancement though this could be artifactual.


Instruction: Generate impression based on findings.

Input: Clinical question: 52-year-old with continued altered mental status, potential right arm paralysis. Signs and symptoms: Altered mental status Nonenhanced head CT:There is no 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.Calvarium, visualized paranasal sinuses and mastoid air cells are unremarkable. Considering provided clinical information and prior negative CT from 3 -- 3 -- 2011 recommend further follow-up with an MRI.

Output: Negative nonenhanced CT brain.


Instruction: Generate impression based on findings.

Input: Cirrhotic liver. Evaluate new liver lesion. Evaluation is limited due to respiratory motion.ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with cirrhotic morphology. Within segment 5, there is an arterial enhancing lesion, with washout on delayed imaging measures 2.2 x 1.6 cm (series 12, image 50), characteristic of hepatocellular carcinoma. Within segment 7, there are additional peripheral enhancing foci, that do not meet washout criteria for hepatocellular carcinoma. The hepatic and portal veins are patent.SPLEEN: Splenomegaly measuring up to 13.8 cm in the coronal plane.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: Moderate volume abdominal ascites. Unremarkable bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large right pleural effusion.

Output: 1.2.2cm segment 5 arterial enhancing lesion with washout, in patient with cirrhosis, characteristic of hepatocellular carcinoma.2.Moderate abdominal ascites and large right pleural effusion possibly from a hepatic hydrothorax.3.Splenomegaly.


Instruction: Generate impression based on findings.

Input: Reason: 43 year old G1P0 (31w3d gestation) otherwise healthy female who presents today with newly diagnosed desmoid tumor of the lower left abd. Questions: Does it invade uterus? Can we map edges? History: abdominal pain/pressure PELVIS:UTERUS, ADNEXA: Gravid uterus. Please note that this exam is not optimized for fetal evaluation. Multiple T2 hypointense subserosal, intramural, and submucosal fibroids are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a large, homogeneous, well-circumscribed mass arising anterior to the abdominal wall in the subcutaneous soft tissues aerated measures approximately 1.7 x 1.1 x 1.3 cm (series 5, image 23; series 20, image 40), compatible with stated history of desmoid tumor. There is thinning and loss of homogeneous T2 signal in the subjacent musculature of the anterior abdominal/pelvic wall and uterine serosa, best seen on series 6, image 38, concerning for invasion. This spans approximately 9 cm as seen on axial sequences. Small amount of fluid is seen in the rectus sheath superior to the lesion.OTHER: Bartholin's gland cyst is noted.

Output: 1.Gravid uterus. Exam is not optimized for fetal evaluation, and no diagnostic assessment regarding the fetus is made.2.Mass arising from the anterior subcutaneous soft tissues of the pelvis is compatible with stated history of desmoid tumor, with possible focal invasion of underlying uterus, see discussion above.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of right lumpectomy for ADH in 2014. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Linear scar marker overlies the lumpectomy bed in the right breast. Mild postsurgical distortion and density in the lumpectomy bed is stable. Benign morphology mass in the right upper inner breast is also stable and compatible with a cyst as seen on prior MRI from 2014. No suspicious mass, microcalcifications or new areas of architectural distortion in either breast. Benign appearing lymph nodes project over both axillae.

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


Instruction: Generate impression based on findings.

Input: Nine-year-old male with new onset of chest pain, shortness of breath, lower extremity clonus, upward gaze. Non-verbal. There is no evidence of intracranial hemorrhage. No mass or midline shift is present. Gray-white differentiation is normal and cortical sulci are preserved.The ventricles and basal cisterns are normal in size and configuration. Slight prominence of the temporal horn of the left lateral ventricle may represent normal anatomic asymmetry -- however, given the patient's symptoms, further evaluation with MRI should be considered.The calvaria and skull base are radiographically normal. Minimal mucosal thickening is present in the sphenoid sinus and ethmoid air cells. The mastoid air cells and middle ear cavities are normal in appearance.

Output: 1. No CT findings of acute intracranial process.2. Slight asymmetry of temporal horns of lateral ventricles -- given reported symptoms, consider further evaluation with MRI.


Instruction: Generate impression based on findings.

Input: Male 18 years old Reason: 18 yo M with metastatic desmoplastic small round blue cell tumor, new onset fecal incontinence and toe numbness, r/o spine mets and spinal cord compression The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology, aside from a few areas of artifact. There is no compromise of the spinal cord. No large focal vertebral or spinal lesion identified. Known abdominal tumors are not well assessed on this limited spine MRI.

Output: No cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Low libido, found to have low testosterone and subsequently abnormal LH response. The pituitary gland is not enlarged or atrophic. The posterior pituitary bright spot and infundibulum are intact. There is no evidence of mass lesions. The imaged portions of the brain parenchyma, optic apparatus, and cavernous sinuses are unremarkable.

Output: No evidence of pituitary lesions.


Instruction: Generate impression based on findings.

Input: Congenital anomaly of cerebrovascular system [747.81], Reason for Study: ^Reason: s/p embolization of vertebrobasilar aneurysm repair History: post-procedure follow up Brain MRIThere is no evidence of new acute ischemic or hemorrhagic lesion on this scan.There is large multi-stage blood clots within previously known basilar aneurysm sac which displaces remained basilar artery toward right side. The largest dimension of the lesion on coronal plane was about 33.1mm x 42.8mm which does not show any significant interval change since prior scan.There is no evidence of surrounding edema.Ventricle size appears to be stable since prior scan.Multiple small high signal intensity lesions on bilateral superior frontal gyri white matter and right external capsule on FLAIR images do not show any interval change since prior scan.The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate patent basilar artery with susceptibility artifacts on the wall where stents were deployed. Comparing to prior scan, the luminal diameter of the stented portion appears to be stable measured about 2.8mm.There is about 6.5mm sized high signal intensity pocket slightly inferior aspect of the parent artery which might have a small communication with parent artery lumen(series 301, image#43/152). Since the lesion's signal intensity appears to be slightly higher than adjacent basilar artery, this could represent paramagnetic artifacts from both stent and inserted detachable coils. Again, the possibility of small residual or recanalization of the aneurysm cannot be completely excluded.Previously measured 2mm sized high signal intensity pocket which is located at superior aspect of the parent artery appears to be stable in size and configuration since prior scan.Visualized bilateral ICA appears to be normal and known left extracranial ICA aneurysm was not included in this scan.

Output: 1. Post endovascular treatment (stent assisted coiling and sacrifice of the left distal vertebral artery) follow up scan shows no change of the size of thrombosing aneurysm without evidence of surrounding edema or increased mass effects.2. Ventricle size remains stable.3. Stented basilar artery lumen is patent and stable in diameter since prior scan.4. Suspicious recanalization or residual aneurysm pockets described above appear to be stable since prior scan.


Instruction: Generate impression based on findings.

Input: Female, 16 years old, with headaches, pseudotumor cerebri, punctate periventricular white matter lesions, yearly follow-up examination. MRI brain:Ill-defined small foci of T2 hyperintensity within the white matter along the left frontal horn are unchanged. No new parenchymal signal abnormality is detected. No edema or mass effect is seen. Diffusion-weighted images are normal. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is stable and normal in size.MRV brain:The dural venous sinuses and the major deep cerebral veins are patent.MRI cervical spine:Alignment is anatomic. Vertebral body morphology and signal characteristics are normal. Minimal prominence of the central canal of the spinal cord beginning at C4 is unchanged and within normal limits. The spinal cord otherwise shows normal morphology and signal characteristics. No epidural abnormalities are seen. No compromise of the spinal canal or neural foramina is suspected.MRI thoracic spine:Alignment is anatomic. Vertebral body morphology and signal characteristics are normal allowing for focal fat within the T6 vertebral body. Mild prominence of the central canal of the spinal cord is again seen, unchanged and within normal limits. No epidural abnormalities are seen. No compromise of the spinal canal or neural foramina is suspected.

Output: 1.Small foci of white matter signal abnormality along the left frontal horn are unchanged. No new or significant intracranial findings.2.No evidence of dural venous sinus thrombosis.3.Evaluation of the cervical and thoracic spine shows no significant abnormalities.


Instruction: Generate impression based on findings.

Input: Diagnosis: HeadacheClinical question: Evaluate Cavernous malformationSigns and Symptoms: increase intensity in HA There redemonstration of a 7x4mm axial dimension lesion located at the anterior aspect of the right cingulate gyrus. It has a "popcorn" like appearance on T2 imaging and susceptibility effect. It is unchanged since the prior exam.There is redemonstration of a T1 and FLAIR hyperintense focus at the left tentorial leaf. It is unchanged since prior exams.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.Stable right cingulate gyrus cavernoma.2.A left tentorial leaf lesion is likely of little clinical significance. Contents may include calcium. It is stable and has a is a benign appearance.


Instruction: Generate impression based on findings.

Input: Elbow pain after injury LIGAMENTS: No significant abnormality noted.TENDONS: There is blooming artifact along the medial soft tissues relating to prior surgical intervention. There is mild interstitial and partial tearing of the common flexor tendon origin at its insertion upon the medial condyle. The medial collateral ligament is intact. The common extensor origin and lateral structures appear intact.ARTICULAR SURFACES AND BONE: There is mild marrow edema in the underlying medial epicondyles in the region of abnormality described above. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: 1. Interstitial and partial-thickness tearing of the common flexor tendon at its insertion upon the medial condyle.2. Mild marrow edema within the medial epicondyle which may reflect mild epicondylitis.


Instruction: Generate impression based on findings.

Input: 31 years, Male, Reason: Crohn's disease. History of ileal disesease with abscess. Eval for abscess/phlegmon and disease activity History: previous abscess. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:Resolution of small bowel obstruction seen on the prior exam with mild residual dilatation. Resolution of right lower quadrant abscess seen previously. No strictures are evident.There is enhancement, diffusion restriction and wall thickening involving the cecum and terminal ileum which is similar to the prior exam and likely represents active Crohn's disease. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Acute on chronic inflammatory changes related to Crohn's disease involving the cecum and terminal ileum with resolution of abscesses and small bowel obstruction seen on the prior exam.


Instruction: Generate impression based on findings.

Input: Reason: abnormality leading to acute loss of LLE function/sensation History: LLE paralysis, anesthesia. Please note the purposes of numbering, there is transitional anatomy with 6 lumbar vertebral bodies identified as seen on recent CT. Vertebral body heights and disc spaces are intact. Alignment is anatomic. 6 lumbar vertebral bodies are identified with partial sacralization of right L6. There is no significant disc disease with minimal disc bulges at L4-L5 and L5-L6. There is no significant spinal canal or neural foraminal stenosis at any level. There is no abnormal enhancement in the lumbar spine. Paraspinal soft tissues are unremarkable.

Output: No significant spinal canal or neural foraminal stenosis at any level in the lumbar spine. No findings to suggest metastatic disease in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 68-year-old female with finger numbness now with worsening arm pain on the right.Additional EMR Data: PMH of lumbar DDD with recent LESI and still without relief of lumbar radicular pain. Main complaint is R>L sharp neck and shoulder pain for 3 days without an inciting event which radiates into right arm to the fingers and down left arm to the elbow. Occasional numbness of the right fingers. No UE weakness. No apparent alleviating or aggravating factors. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Trace central disc osteophyte complex without significant compromise to the spinal canal or neural foramina.C3-4: Small central disc osteophyte complex with mild-to-moderate bilateral neuroforaminal narrowing and mild to moderate spinal canal stenosis, which have progressed compared to the prior exam C4-5: Small left paracentral disc osteophyte complex with mild bilateral neuroforaminal stenosis and moderate left greater than right spinal canal stenosis, appearing similar to the prior exam. C5-6: Disc osteophyte complex with a small left paracentral disc protrusion, with facet and uncovertebral hypertrophy which contributes to moderate to severe right and severe left neural foraminal narrowing and mild spinal canal stenosis. This appears similar to the prior exam. C6-7: Central disc osteophyte complex, uncovertebral hypertrophy and facet arthropathy which contributes to mild bilateral neuroforaminal stenosis and minimal spinal canal stenosis but this is not significant changed.C7-T1: Trace disc osteophyte complex without significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Incidental right thyroid nodule is nonspecific.

Output: Multilevel spondylosis with some progression at C3-4 compared to the prior exam where there is now mild-to-moderate bilateral neuroforaminal narrowing and mild to moderate spinal canal stenosis. The remainder of the degenerative findings are unchanged compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Redemonstrated are prominent subarachnoid CSF spaces, more prominently noted over the frontal lobes and the anterior falx in the supine position.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is present within both middle ear cavities and mastoid air cells. There is no abnormal enhancement within the brain.Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities, masses, or abnormal enhancement identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: 1.Redemonstrated is benign enlargement of the subarachnoid spaces which usually resolves by two years of age.2.Fluid is present within both middle ear cavities and mastoid air cells.3.There are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of urethral cancer status post exenteration with Indiana pouch, surveillance imaging. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Stable mild extrahepatic biliary ductal dilatation, similar to prior and likely related to cholecystectomy. No focal hepatic lesions are identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Minimal expected bilateral hydroureteronephrosis with ureteral diversion into the right lower quadrant Indiana pouch. The kidneys enhance and secrete symmetrically. The previously described punctate focus of delayed enhancement in the right renal pelvis is no longer visualized. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes of anterior pelvic exenteration.BLADDER: Status post cystectomy.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted.

Output: Postsurgical changes without evidence of recurrence or metastatic disease. Previously described focus of delayed enhancement in the right renal pelvis is not seen on this examination.


Instruction: Generate impression based on findings.

Input: Male 65 years old Reason: staging exam History: prostate cancer PELVIS:PROSTATE:Prostate Size: Prostate measures 3.5 x 2.5 x 4 cm.Peripheral Zone: The dominant lesion is in the left mid peripheral zone extending into the left base and measures 8 x 7 mm on image #184, series #1003. No evidence of extracapsular or seminal vesicle invasion. There is a punctate focus in the right base peripheral zone which may also represent a small cancer focus.Central Gland: Benign prostatic hypertrophySeminal Vesicles: UnremarkableExtracapsular Extension: Not presentBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant prostate cancer in the left base and left mid peripheral zone.


Instruction: Generate impression based on findings.

Input: Reason: Multiple hypodense renal cysts and hematuria with a h/o bladder cancer s/p cystectomy and ileal conduit. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal signal intensity without suspicious focal lesions. Status post cholecystectomy. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Please note that evaluation is somewhat limited by motion causing misregistration on subtraction images which limits evaluation for enhancement. Multiple small simple renal cysts are present bilaterally. There are several additional lesions corresponding to the high attenuation lesions described on recent CT. An exophytic right midpole lesion (series 701, image 48) measures 1.6 x 1.7 cm, demonstrates low T2 signal and high T1 signal, does not appear to enhance, and is compatible with a complicated cyst. An exophytic left upper pole lesion (series 61, image 22) measures 1.9 x 1.5 cm, demonstrates intermediate T2 signal and increased T1 signal, does not appear to enhance, and is also compatible with a complicated cyst. Additional smaller complicated cysts are present bilaterally none of which display suspicious features. No hydronephrosis. The kidneys enhance and excrete symmetrically without visualized collecting system filling defects.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of cystectomy and ileal conduit. Herniation of the colon is noted at the ostomy site without evidence of obstruction. Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is atrophic or surgically absent.BLADDER: Status post cystectomy.LYMPH NODES: Status post bilateral lymph node dissection. No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: See above. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Bilateral complicated renal cysts without definite enhancement, however, evaluation is somewhat limited by motion and follow-up is recommended in 6 months to ensure stability.2.No specific evidence of residual or recurrent malignancy.3.Parastomal hernia at the ileostomy site containing nonobstructed colon.


Instruction: Generate impression based on findings.

Input: Low back pain, radiating down left leg, some numbness Examination is mildly motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5 as seen on prior radiograph. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge, ligamentum flavum thickening and mild facet arthropathy. No significant spinal canal or neural foraminal stenosis. L2-L3: Minimal disc bulge, ligamentum flavum thickening and mild facet arthropathy. No significant spinal canal or neural foraminal stenosis. L3-L4: Disc bulge eccentric to the right, ligamentum flavum thickening, and bilateral facet arthropathy. There is mild effacement of the lateral recesses and mild central spinal canal stenosis. There is mild bilateral neural foraminal stenosis, right worse than left. L4-L5: Advanced bilateral facet arthropathy and grade 1 anterolisthesis. There is also disc uncovering and minimal bulge. No significant central spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.L5-S1: There is a disc bulge with small central disc extrusion and moderate bilateral facet arthropathy. No significant central spinal canal stenosis. There is moderate right and moderate to severe left neural foraminal stenosis. There is enhancement associated with the facet arthropathy at the L3-L4 to L5-S1 levels. No suspicious enhancing lesions. Multiple bilateral renal cysts.

Output: Multilevel degenerative changes in the lumbar spine including degenerative grade 1 anterolisthesis at L4-L5. There is mild central spinal canal stenosis at L3-L4. There is also multilevel neural foraminal stenosis worst at the left L5-S1 level where there may be impingement of the left L5 nerve root.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with back pain. The T12 vertebral body demonstrates diffuse marrow replacement and pathologic enhancement along with a compression deformity resulting in approximately 50% loss of vertebral body height. Retropulsion of disc material and nearly circumferential epidural soft tissue extension results in effacement of the thecal sac, a moderate generalized spinal canal stenosis, and slight deformation of the adjacent conus without convincing cord signal abnormality. The T12-L1 left neural foramen also seems to be mildly narrowed. These findings have progressed from the recent prior body CT.Additional smaller foci of marrow replacement and abnormal enhancement are detected within the T11, L1 and L3 vertebral bodies, and the right sacrum. There is no evidence of vertebral body compression or epidural soft tissue extension at these levels.Spinal alignment is anatomic apart from a mild kyphotic angulation centered at T12. The intervertebral discs are largely preserved with only mild loss of disc height and disc bulging seen at L5-S1. No significant spinal canal stenosis or neuroforaminal narrowing is detected except as discussed above. Large Tarlov cysts are evident within the sacral foramina.Partially imaged is a large left renal mass.

Output: 1.Multiple sites of abnormal marrow replacement and pathologic enhancement are demonstrated within the lower thoracic and lumbar vertebral bodies and sacrum concerning for metastatic disease.2.The most severely affected level is T12 where disease results in a compression deformity with 50% loss of vertebral body height, as well as retropulsion and nearly circumferential epidural disease extension resulting in a moderate generalized spinal canal stenosis and slight deformation of the adjacent conus.


Instruction: Generate impression based on findings.

Input: 18 years old male patient with a L5-S1 left lateral recess soft tissue mass please evaluated for biopsy and perform CT guided biopsy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the mass within the left lateral recess of the spinal canal. Following needle removal images obtained that demonstrate no complications .

Output: L5-S1 level biopsy of mass within the spinal canal at the left lateral recess. Seven samples were obtained and delivered to pathology.


Instruction: Generate impression based on findings.

Input: History of MEN1, screen for pituitary adenoma: headache. Pituitary: The pituitary gland demonstrates homogeneous enhancement and is not enlarged. There is no evidence of sellar or suprasellar lesions. The optic apparatus and cavernous sinuses are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of pituitary lesions.2. No evidence of acute intracranial hemorrhage, mass, or cerebral edema.


Instruction: Generate impression based on findings.

Input: 62-year-old male with cervical myelopathy, vertebrobasilar vascular occlusive disease MRI of the brainNo diffusion weighted abnormalities are appreciated. The CSF spaces are appropriate for the patient's stated age with no midline shift. Redemonstrated is T2 hyperintensity involving the right anterior aspect of the medulla, best identified on T2 imaging. This was also present on the previous exam. As before, there are scattered foci of T2 hyperintensity within the periventricular and subcortical white matter without restricted diffusion or susceptibility abnormality consistent with stable chronic small vessel ischemic disease. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Normal vascular flow voids are present in the distal carotid 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 left vertebral artery flow-void is present. The right vertebral artery is slightly smaller than the left vertebral artery but there is no flow void appreciated, as demonstrated previously. The visualized portions of the paranasal sinuses redemonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The anterior communicating artery is identified and is medium size. There is fetal origin of the right posterior cerebral artery. The right P1 segment is medium-sized. The left posterior communicating artery is very small..No intracranial flow is identified in the right vertebral artery. There are tandem stenoses present along the basilar artery. One is located between the level of the anterior inferior cerebellar arteries and the superior cerebellar arteries and has approximately 80% stenosis which has not changed since the prior exam; it is located closer to the anterior inferior cerebellar arteries than the superior cerebellar arteries. Another stenosis is present between the vertebrobasilar junction and the anterior inferior cerebellar arteries which has 70% stenosis which has not changed significantly since the prior exam.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and left vertebral artery. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. The right vertebral artery is occluded at its origin with only minimal reconstitution of flow from muscular branches, as demonstrated previously.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is ossification of the posterior longitudinal ligament present extending from the C2-3 level to the C4-5 level associated with spinal stenosis. At C2-3 there has been interval progression of both ossification of the posterior longitudinal ligament and ligamentum flavum thickening, now causing slight deformation of the cord (without intrinsic cord signal abnormality) and new mild central stenosis. Mild right neural foraminal narrowing is stable.At C3-4 there has been minimal increase in ossification of the posterior longitudinal ligament, now narrowing the central canal to 4 mm (previously 5 mm), demonstrating a moderate to severe degree of central stenosis. There is resultant cord flattening without definite intrinsic cord signal abnormality. Redemonstrated is effacement of the spinal fluid anteriorly and posterior to the spinal cord, with ligamentum flavum thickening. There is encroachment of the exiting nerve bilaterally within the neural foramina at this level, unchanged.At C4-5 there is ossification of the posterior longitudinal ligament associated with a disc bulge and ligamentum flavum hypertrophy associated with effacement of spinal fluid ventral and posterior to the spinal cord. There is mild flattening of the spinal cord without intrinsic cord signal abnormality. Overall there is moderate spinal stenosis at this level. There is encroachment of the exiting nerve roots within the neural foramina. These findings are stable compared to the prior exam.At C5-6 there is no significant compromise to the spinal canal. There are some uncovertebral osteophytes present on the right-sided this level associated with disc material and mild narrowing of the right neural foramen. These findings are stable compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal. There is narrowing of the neural foramina bilaterally at this level due to uncovertebral osteophytes and osteophyte disc complex asymmetric to the left. These findings are stable compared to the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina, unchanged.

Output: 1.Tandem high-grade stenoses along the basilar artery. These are stable compared to the prior exam2.Occlusion of the right vertebral artery at its origin. No flow is appreciated in the right vertebral artery intracranially. These findings are unchanged.3.Stable chronic small vessel ischemic disease.4.There is no evidence for acute cerebral infarction.5.Old lacunar infarction along the anterolateral aspect of the right medulla.6.At C2-3 there has been interval progression of both ossification of the posterior longitudinal ligament and ligamentum flavum thickening, now causing slight deformation of the cord (without intrinsic cord signal abnormality) and new mild central stenosis. 7.At C3-4 there has been minimal increase in ossification of the posterior longitudinal ligament, now narrowing the central canal to 4 mm (previously 5 mm), demonstrating a moderate to severe degree of central stenosis, demonstrating minimal interval progression. 8.At C4-5 there is ossification of the posterior longitudinal ligament associated with a disc bulge and ligamentum flavum hypertrophy resulting in moderate spinal stenosis at this level, unchanged.9.Cervical degenerative changes at other levels, as well as neural foraminal stenoses are stable.


Instruction: Generate impression based on findings.

Input: Redemonstrated are numerous foci of magnetic susceptibility artifact of the brain consistent with the history of multiple cavernous malformations. The lesions primarily involve the cerebral hemispheres but are also noted within the cerebellum and brainstem.There is at least one definite new lesion within the medial left parietal lobe (best seen series 901 image 20) containing T1 hyperintensity however without perilesional edema. There has also been significant increase in size of a right posterolateral pontine lesion, now measuring up to 8 mm in maximal dimension (best seen series 901 image 8) containing T1 hyperintensity however without perilesional edema.Aside from the cavernomas there are no additional parenchymal lesions. No abnormal postcontrast enhancement. The ventricles and sulci are symmetric and normal in size. No significant mass-effect, midline shift, or basal cistern effacement. The midline structures are unremarkable. There is no evidence for acute infarction. There are no extraaxial fluid collections. Flow voids are present within the major vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Redemonstrated are numerous foci of magnetic susceptibility artifact of the brain consistent with the history of multiple cavernous malformations. There is at least one definite new lesion within the medial left parietal lobe (best seen series 901 image 20) containing T1 hyperintensity however without perilesional edema. There has also been significant increase in size of a right posterolateral pontine lesion, now measuring up to 8 mm in maximal dimension (best seen series 901 image 8) containing T1 hyperintensity however without perilesional edema.


Instruction: Generate impression based on findings.

Input: 82 year old female with of sarcoid and hypertension who experienced episodes of chest pain. She underwent a stress echocardiogram which showed normal rest and stress wall motion. She had frequent premature ventricular contractions during the stress echocardiogram. She is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. Prominent LV trabeculation, not meeting criteria for LV noncompaction. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 184 ml (normal range 109+/-23), the LV end systolic volume index is 43 ml/m2 (normal range 18+/-5), the LVESV is 73 ml (normal range 31+/-10), the LV mass index is 36 g/m2 (normal range 67+/-11), and the LV mass is 60 g (normal range 114+/-24). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation time is normal (1000-1050 ms). There is no myocardial iron overload. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 173 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace 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 FindingsThere is mild atelectasis of the left lower lung. Probable right renal cyst. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function (LVEF 61%) without evidence of late gadolinium enhancement. 2. The right ventricle is mildly dilated with normal systolic function (RVEF 61%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 26 years old, with new right-sided weakness. Agenesis of the corpus callosum is again seen. Also redemonstrated is marked parenchymal deformity and encephalomalacia affecting the left parietal and occipital lobes. Scattered additional smaller foci of signal abnormality are unchanged in the periventricular regions. No definite evidence of any new parenchymal lesion is seen. No restricted diffusion is demonstrated.Artifact is seen related to a left parietal approach ventricular shunt catheter. Generalized ventricular dysmorphism is unchanged. The ventricles are not enlarged and are stable in caliber. Dural thickening is noted along the encephalomalacic left parietal and occipital lobes with prominent posterior falcine calcification. No pathologic intracranial enhancement is seen.The posterior fossa is small with herniation of the cerebellar tonsils through the foramen magnum similar to prior. The CSF space at the level of the foramen magnum is crowded and there is little detectable CSF flow through the foramen magnum.

Output: 1.Stable chronic and/or congenital brain dysmorphism including agenesis of the corpus callosum and encephalomalacia of the left parietal and occipital lobes.2.Stable shunted ventricular system with no evidence of ventriculomegaly.3.Redemonstration of findings related to Chiari I malformation.4.No new or acute intracranial abnormalities are detected to account for the patient's new right-sided weakness.


Instruction: Generate impression based on findings.

Input: Other musculoskeletal symptoms referable to limbs(729.89) [729.89], Reason for Study: ^Reason: r/o demyelinating disease History: L leg weakness C-spine:There are multifocal moderate to severe spinal stenosis or cervical spine.In particular, at the level of C4-5 and C6-7, there are subtle high signal intensities of spinal cord on sagittal STIR images indicating development of possible compressive myelopathy.The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate degenerative spondylosis.There is no evidence of abnormal enhancement. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: Diffuse bulging of disc with bilateral diffuse narrowing of neural foramen. Minimal to mild spinal stenosis. C4-C5: Underlying diffuse bulging of disc with a focal central bulging of disc with significant bilateral uncovertebral joint hypertrophy resulting moderate to severe spinal stenosis and bilateral neural foraminal stenosis. Subtle high signal intensity of spinal cord indicating possible compressive myelopathy.C5-C6: Diffuse bulging of disc with bilateral moderate to severe uncovertebral joint hypertrophy resulting moderate to severe spinal canal stenosis and bilateral neural foraminal stenosis. C6-C7: Diffuse bulging of disc with bilateral severe neural foraminal stenosis and moderate to severe spinal stenosis. Subtle high signal intensity on sagittal STIR image indicating possible compressive myelopathy.C7-T1: Minimal bulging of disc otherwise unremarkable. Thoracic spine:At the level of T56, the left side neural foramen appears to be a bit wider than that of the right. In addition, on STIR image, the left neural foramen shows high signal intensity. On T1 axial images, there is tubular low signal intensity lesion which shows diffuse enhancement on post Gad T1 image. These findings suggest possible diagnosis of neurogenic tumor. However, prominent venous plexus including venous varix cannot be completely excluded.Unless clinically significant, no further imaging investigation is necessary. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the L1-L2 level.

Output: 1. Degenerative spondylosis of C spine, including moderate to severe spinal stenosis at the level of C45 and C67 with possibly compressive myelopathy.2. Prominent enhancement of left T56 neural foramen, diagnostic possibilities include incidental neurogenic tumor, venous plexus or venous varix.