Instruction: Generate impression based on findings.

Input: History of pineal abnormality, comparison. The pineal contains cystic component that measures up to 13 mm is unchanged. This lesion again causes slight flattening of the tectal plate; however, the cerebral aqueduct remains patent. The brain parenchyma is otherwise unremarkable. The ventricles are normal in size and configuration. The skull and imaged extracranial structures are unchanged.

Output: The cystic pineal gland appears unchanged dating back to 3/2/2012.


Instruction: Generate impression based on findings.

Input: 36 years Female (DOB:5/3/1980)Reason: follow up on periventricular lesions, any cause of severe headaches History: severe headachesPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no intracranial mass lesion to account for the patient's headaches. An MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Reason: syncope History: syncope MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate signal hypointensity on susceptibility imaging located in the left thalamus. This most likely represents a microhemorrhage.No abnormal 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.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is fetal origin of the left posterior cerebral artery associated with a hypoplastic left P1 segment. The left A1 segment is very small.

Output: 1.No evidence for intracranial cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.There is an isolated microhemorrhage in the left thalamus.


Instruction: Generate impression based on findings.

Input: Pain and abnormal sclerotic lesion on L2 per x-ray. There is a non-enhancing low T1 and T2 focus that measures up to 14 mm in right aspect of the L2 vertebral body. There is an intravertebral disc herniation in the inferior endplate of the L3 vertebral body with associated enhancement. There is a disc bulge at L2-3 with mild bilateral neural foraminal narrowing. There is an eccentric right disc bulge at L3-4 and ligamentum flavum thickening with mild to moderate right and slight left neural foraminal narrowing, as well as spinal canal narrowing, with impingement upon the descending nerve roots in the right lateral recess. There is a disc bulge, facet hypertrophy, and ligamentum flavum thickening at L4-5, with moderate right and moderate to severe left neural foraminal narrowing and narrowing of the spinal canal with apparent impingement upon the descending nerve roots in the bilateral lateral recesses. There is no significant neural foraminal or spinal canal stenosis at T12-L1, L1-2, or L5-S1. The vertebral column alignment is within normal limits. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. A non-enhancing low T1 and T2 focus that measures up to 14 mm in the L2 vertebral body may represent an enostosis, versus less likely a metastasis. 2. Multilevel degenerative spondylosis of the lumbar spine with variable degrees of neural foraminal and spinal canal narrowing, which is most pronounced at the L3-4 level.


Instruction: Generate impression based on findings.

Input: Severe shoulder pain and weakness with fall. Please evaluate for acute rotator cuff tendinopathy. ROTATOR CUFF: There are complete tears of the supraspinatus and infraspinatus tendons with retraction to the level of the glenohumeral joint. There is thickening and increased signal intensity of the retracted tendons, but I cannot determine with certainty if this is due to chronic tendinosis, acute rupture, or a combination of the above. There is mild to moderate fatty atrophy of the infraspinatus muscle. There is also increased signal intensity within the supraspinatus and infraspinatus muscles on the fluid sensitive sequences which is nonspecific and could reflect subacute denervation or edema from an acute injury. The teres minor tendon and muscle appear intact. Although superficial fibers of the subscapularis tendon can be followed to their insertion on the greater tuberosity, there is delamination of the undersurface fibers of the subscapularis tendon with retraction medial to the glenoid. There is moderate to severe fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is fluid within the subacromial/subdeltoid bursa. The coracoacromial ligament is intact. The coracohumeral ligament is not well visualized and I suspect is torn.GLENOHUMERAL JOINT AND GLENOID LABRUM: Fluid within the glenohumeral joint communicates with that in the subdeltoid bursa via the aforementioned complete rotator cuff tear. Intermediate signal intensity within the superior labrum likely reflects degeneration/degenerative tearing. There also appears to be mild fraying of the anterior labrum. The humeral head is high riding with narrowing of the acromiohumeral interval to 4 mm, but glenohumeral joint alignment is otherwise within normal limits.BICEPS TENDON: There is dislocation of the tendon of the long head of the biceps medially from the bicipital groove with thickening and increased signal intensity of the tendon as it courses along the anterior aspect of the humeral head indicating severe tendinosis. It is difficult to confirm on this study whether or not the tendon attaches to the supraglenoid tubercle. ADDITIONAL

Output: 1.Complete and retracted tears of the supraspinatus and infraspinatus tendons as described above.2.Delamination and retraction of the undersurface fibers of the subscapularis tendon associated with dislocation of a degenerated biceps tendon as described above. I cannot determine with certainty if the biceps tendon attaches to the supraglenoid tubercle.3.Additional degenerative changes and other findings as described above.


Instruction: Generate impression based on findings.

Input: 37y female with a pmh of heart failure with reduced EF secondary to postpartum cardiomyopathy. Referred for cardiac MRI for reassessment. Left VentricleThe left ventricle is mildly dilated with systolic function at the lower limit of normal (unchanged from prior LVEF of 51%). The overall LV ejection fraction is 50%. The LVEDV is 184 ml (normal range 109+/-23), LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), LVESV is 92 ml (normal range 31+/-10), and LV end systolic volume index is 41 ml/m2 (normal range 18+/-5). The LV mass is 97 g (normal range 114+/-24) and the LV mass index is 43 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 52%, the RVEDV is 193 ml (normal range 110+/-24), the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVESV is 92 ml (normal range 35+/-13), and the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is mildly dilated. Small patent foramen ovale with left to right shunt.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 significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Mildly dilated LV with systolic function at the lower limit of normal, LVEF 50% (unchanged from prior LVEF of 51%). 2.Mildly dilated RV with normal systolic function, RVEF 52%.3.Small patent foramen ovale with left to right shunt.4.There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.


Instruction: Generate impression based on findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: 74 y/o man w/ a hx of stroke who p/w AMS Motion artifact degraded exam quality.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are, however, multiple chronic ischemic infarctions with encephalomalacia including right frontal lobe superior frontal gyrus, right inferior parietal lobule, right temporal and occipital lobes, left inferior parietal lobule and left occipital lobe. There are subtle susceptibility lesions involving right inferior parietal lobule and left occipital lesion indicating prior hemorrhagic conversion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal chronic ischemic infarct with encephalomalacia involving bilateral hemispheres.


Instruction: Generate impression based on findings.

Input: Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: GBM sp/Clinical Investigation History: GBM Motion artifact significantly degraded image quality.Right temporal lobe resection cavity appears to be slightly increased in size (28.6 mm x 42 mm, was 21 mm x 38 mm) compared to prior scan.Contrast enhancement surrounding the resection cavity involving temporal lobe is more conspicuous on today's scan but the extent of the enhancement appears to be unchanged.Air signal intensities within the resection cavity is not seen anymore indicating usual postoperative progression.There is no evidence of new abnormal enhancement.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Subtle effacement of the right lateral ventricle is not seen anymore indicating decreased mass effect. Ventricle size remains stable and within normal limits.There is no evidence of midline shift.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Fluid collections are seen on the right mastoid air cells unchanged since prior scan.

Output: 1. Post resection status of the right temporal lobe intra-axial lesion.2. Resection cavity of the right temporal lobe appears to be slightly increased in size since prior scan.3. Enhancing lesions surrounding resection cavity are again demonstrated which do not show any significant interval changes.4. Lessened mass effects toward right lateral ventricle since prior scan.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for rotator cuff tear versus labral tear (arthrogram ordered with this order) History: persistent left shoulder pain and snapping ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating mild to moderate tendinosis. The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid is identified within the subacromial subdeltoid bursa. No intra-articular gadolinium is identified within the subacromial subdeltoid bursa. The acromioclavicular joint is unremarkable.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. No full-thickness articular cartilage defects are identified. There is linear signal abnormality within the anterior superior labrum which fills with intra-articular gadolinium likely representing a normal variant sublabral recess. There is heterogeneity of the posterior superior glenoid labrum likely representing a combination of degeneration and degenerative tearing.BICEPS TENDON: The tendon along the biceps appears intact. ADDITIONAL

Output: 1. Degeneration/degenerative tearing of the posterior superior labrum. 2. Mild to moderate rotator cuff tendinosis without evidence of a full-thickness rotator cuff tear or retraction.


Instruction: Generate impression based on findings.

Input: Pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a 2.2 cm TV x 1.7 cm AP x 1.9 cm CC lesion at the posteromedial aspect of the distal femoral metaphysis demonstrating heterogeneously high signal on T1 and T2 sequences. There mild elevation of the adjacent cortex. No associated soft tissue mass or surrounding inflammation is evident.No significant cartilaginous abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Cortically based lesion in the posterior medial distal femur. The appearance of this lesion is non-specific though suggestive of a benign cortical desmoid. Given the patient's age and pain, repeat imaging of this lesion to assess for potential change would increase specificity for an aggressive etiology such as neoplasm or infection.Additionally, if prior imaging is available and can be submitted, comparison can be made and an addendum to this report issued.


Instruction: Generate impression based on findings.

Input: 35 year-old female with headache, recent delivery via c/s. Evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. The orbital contents are within normal limits.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: MCP deformity LIGAMENTS: No significant abnormality noted.TENDONS: There is buckling, increased signal, and thickening of the ulnar collateral ligament of the thumb however there is no significant increased signal within the surrounding bone or soft tissue. The radial collateral ligament is intact.The flexor pollicis longus appears normal at its insertion however more proximally it is enlarged and demonstrates increased signal throughout the remaining visualized portion into the flexor compartment. It is not well seen within the flexor compartment. Additionally, there is fluid signal surrounding the flexor pollicis longus as it courses between the flexor compartment and its insertion.BONES: There is severe osteoarthritic changes of the first metacarpal phalangeal joint.

Output: 1. Probable partial tearing of the ulnar collateral ligament which is likely chronic in nature given the lack of edema and inflammation in the surrounding area.2. Increased signal and thickening of the flexor pollicis longus as it enters the flexor compartment suggesting intrasubstance tearing. The tendon is not well seen within the flexor compartment which is suspicious of a proximal tear and retraction of the tendon.3. Tenosynovitis of the flexor pollicis longus.


Instruction: Generate impression based on findings.

Input: Myasthenia with persistent right lateral rectus paresis. Orbits: The right lateral rectus and other extraocular muscles are unremarkable. The bilateral orbital fat, globes, optic nerves, and lacrimal glands are intact bilaterally. There is no evidence of intraorbital tumors. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense foci bilaterally. The brainstem and cerebellum are unremarkable. The cavernous sinuses are intact. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the anterior ethmoid sinuses.

Output: 1. The right lateral rectus and other extraocular muscles are unremarkable. 2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Mild scattered cerebral white matter T2 hyperintense foci bilaterally are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of hepatitis C virus and HCC. Status post resection. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and signal intensity. Status post cholecystectomy. Mild central biliary ductal dilatation which tapers smoothly to the level of ampulla without an obstructing mass. Postsurgical changes from a wedge resection at segment 6. Several simple appearing cysts. No evidence of residual or recurrent tumor.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical changes from a wedge resection of the segment 6 lesion without residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: 67-year-old woman with left retrocrural node or mass with FNA showing cancer cells presents for ultrasound guided core biopsy of the FNA proven malignant mass, abnormal left axillary lymph node and an additional mass seen in the 2:00 position on MRI 7/14/2015. Left ultrasound re-identified the target lesions for biopsy. The first lesion to be targeted is a hypoechoic mass measuring 16 x13 x 12 mm at the 10 o’clock position with increased vascularity, 2 cm from the nipple. The lesion was readily visible.The second lesion to be targeted is an oval hypoechoic mass measuring 6 x 4 x 5 mm at the 2:00 position without internal vascularity, 3 cm from the nipple. The lesion was identified on MRI 7/14/2015, and MR directed ultrasound detected a sonographic correlate. The lesion was somewhat subtle. The third lesion to be targeted is an abnormal lymph node measuring 2.1 x 1.7 cm in the left axilla, readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the first target area (10 o'clock position). Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Subsequently, local anesthesia was obtained for the second lesion (2 o'clock position) using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, two 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged very good. All specimens partially sank in the prefilled container of 10% formalin. Specimen quality was judged good. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. Finally, local anesthesia was obtained for left axilla using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, two 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged excellent. Both specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Specimens were sent to Pathology with an accompanying history sheet. Pressure was held over the biopsy sites until all bleeding subsided. The skin incisions were closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed Hydromark clip to be in the expected location in the central anterior aspect of the first lesion at 10:00, Bard wing clip to be in the expected location at 2:00 position and Hydromark clip to be in the left axillary lymph node. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe. Dr. Udoji, fellow assisted.

Output: Successful ultrasound-guided core biopsy of two left breast lesions and left axillary lymph node with clip placement. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: History of a left insular lesion. Preop planning for resection. History of prostate cancer. Limited sequences were obtained for stereotactic localization purposes. Within the left insular region adjacent to the left temporal pole is a heterogeneously intra-axial enhancing mass measuring 2.1 x 1.7 cm (series 501, image 92), provided previous precontrast imaging on the outside exam. There is also evidence of infiltrative gyral thickening and expansion of the insula with mass effect on the left basal ganglia and likely involvement of the left hippocampus. There is also nonspecific gyriform thickening in the left temporal lobe anteriorly and medially including the hippocampus, as well as abnormal T2 hyperintense signal extending along the left anterior commissure. Associated localized sulcal effacement is noted. The left temporal horn is partially effaced due to the mass effect and there is subtle flattening of the left cerebral peduncle. Branches of the left MCA course through and around the lesion without narrowing.Incidental note is made of a small cystic area within the clivus which likely represents a benign developmental finding such as a craniopharyngeal canal. Fiducials are noted along the skin surface.

Output: Heterogeneously enhancing left insular mass with extension of abnormal signal involving the left insula, anterior and mesial left temporal lobe with gyriform thickening, and anterior left commissure. Localized mass effect noted with left MCA branches coursing around and through this area of abnormality. This is suspicious for a primary brain neoplasm.


Instruction: Generate impression based on findings.

Input: Female; 44 years old. Reason: bright red blood per rectum. History: abdominal pain, LLL quadrant ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Few subcentimeter omental, mesenteric, and cardiophrenic lymph nodes are likely benign, however could also represent early metastatic disease in the setting of ovarian carcinoma.BOWEL, MESENTERY: Narrow-mouthed low midline ventral hernia containing mesenteric fat, a small bowel loop, and small amount of free fluid (series 3 image 111). No wall thickening in the herniated loop or evidence of obstruction. There is a mild amount of surrounding stranding in the pannus, suggestive of mild inflammation. The hernia sac measures approximately 13 x 8.5 cm with a 3-cm orifice.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is absent. Enlarged left adnexa/ovary (series 3 image 120) measures 4.8 x 4.3 cm; ovarian mass cannot be excluded and correlation with gynecologic ultrasound and/or MRI is advised. Cystic lesion in the right ovary (series 3.1) measures 4.1 x 3.5 cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Ventral hernia containing small bowel loop and small free fluid with mild inflammatory changes of the surrounding  pannus. No evidence of bowel obstruction or bowel inflammation. 2. Enlarged, solid appearing left ovary and a 4 cm cyst in the right ovary. Correlation with pelvic ultrasound or MR is recommended to exclude a mass.Critical findings discussed and acknowledged by Dr. Patel via telephone at the time of dictation.


Instruction: Generate impression based on findings.

Input: There is no significant change in the size or appearance of a non-enhancing focus of susceptibility effect in the right postcentral gyrus measuring 1 to 2mm in diameter. There are no new intracranial lesions. There is unchanged confluent cerebral white matter T2 hyperintensity, which is likely related to radiation therapy. There is no abnormal intracranial enhancement or diffusion abnormality. There is no evidence of intracranial hemorrhage or acute infarction. The ventricles, sulci, and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no midline shift. There is scattered mild paranasal sinus mucosal thickening, as well as persistent fluid signal within the bilateral mastoid air cells.

Output: Unchanged appearance of a punctate focus of susceptibility effect in the right postcentral gyrus, and no evidence of new metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 30-year-old female with cavernous malformation. Redemonstrated are numerous supratentorial and infratentorial foci of susceptibility hypointensity, which are not significantly changed, none of which demonstrate perilesional edema. There is an unchanged 4 mm transverse dimension enhancing lesion along the right falx cerebri which is unchanged in appearance. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is a right maxillary sinus retention cyst, unchanged.

Output: 1.Numerous supratentorial and infratentorial cavernous malformations have not significantly changed, none demonstrating perilesional edema. No evidence of acute intracranial hemorrhage or acute infarct.2.An unchanged 4 mm wide enhancing lesion along the right falx cerebri likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: 65-year-old female with myelofibrosis and prior x-rays demonstrating possibility of osteonecrosis. RIGHT HUMERUS:ARTICULAR SURFACES AND BONE: Diffuse signal abnormality within the humerus, ribs, and scapula is likely secondary to known history of myelofibrosis. No specific evidence to suggest intraosseous edema or other specific indications of osteonecrosis. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Findings compatible with myelofibrosis without specific evidence of osteonecrosis bilaterally.


Instruction: Generate impression based on findings.

Input: Right upper extremity radiculopathy. There is reversal of the usual cervical spondylosis, but not spondylolisthesis. There is a prominent disc-osteophyte complex a at C4-5, which substantially indents the right parasagittal spinal cord at this level. However, there is no associated neural foraminal stenosis. There is also a posterior disc-osteophyte complex C5-6, which mildly indents the spinal cord. However, there is no associated neural foraminal stenosis. There is no significant spinal canal or neural foraminal stenosis at the cervical spine levels other than C4-5 and C5-6. The spinal cord displays normal signal. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Prominent disc-osteophyte complexes at C4-5 and C5-6, which indent the spinal cord, eccentrically to the right, particularly at C4-5, but no evidence of spinal cord edema or myelomalacia.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of uncertain behavior of brain, unspecified. Unspecified convulsionsClinical question: Eval for growth of low grade glioma. No prior RT.Signs and Symptoms: low grade glioma.Comments: Low grade glioma. S/p surgery in 2008. | There is redemonstration of a 17 x 36 mm axial dimension extra-axial cyst adjacent to the left inferior and middle frontal gyri as well as the left temporal pole. There is associated calvarial scalloping present.There is redemonstration of cystic encephalomalacia of the right temporal lobe anteriorly associated with 26 x 35 mm cyst. This has not changed since the prior exam. There is signal change present along the right temporal lobe adjacent to the cyst. This likely represents gliosis. The patient is status post right-sided craniotomy for removal of a right temporal lobe mass.There is redemonstration of a small T2 and FLAIR hyperintense lesion the left thalamus. This is stable compared to prior examsNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cyst in the right maxillary sinus as well as mucosal thickening in the ethmoid air cells, frontal sinuses sphenoid sinuses and left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for tumor recurrence in the right temporal lobe.2.Left-sided arachnoid cyst this is stable3.Stable lesion in the left thalamus


Instruction: Generate impression based on findings.

Input: Proven DCIS in the right retroareolar region. History of left mastectomy and reconstruction. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Status post left mastectomy and reconstruction.A metallic artifact from a marker clip is identified at lower inner retroareolar region in the right breast, at 5 o'clock position.There is a focal non-mass enhancement measuring 10 x 15 x 11 mm (AP x LR x CC), located immediately lateral to the marker clip.No abnormal enhancement is seen in left reconstructed breast. No abnormal lymph nodes are identified in either axillary region.

Output: Focal non-mass enhancement at the biopsy site for DCIS in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 38 year old woman with non-ischemic cardiomyopathy referred for interval assessment. Left VentricleThe left ventricle is severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 122 ml/m2 (normal range: 65+/-11), the LVEDV is 230 ml (normal range 109+/-23), the LV end systolic volume index is 73 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 120 g (normal range 114+/-24). Abnormal septal wall motion and dyssynchrony consistent with left bundle branch block. LV dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of acute inflammation or edema on T1 or T2 imaging. The native myocardial T1 time was mildly elevated in the interventricular septum (1,116msec) and borderline in the inferolateral wall (1,077msec).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 64%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 52 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 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.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC 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 severely dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%. Abnormal septal wall motion and dyssynchrony consistent with left bundle branch block. LV dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of acute inflammation or edema on T1 or T2 imaging. The native myocardial T1 time was mildly elevated in the interventricular septum.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%.3. Compared to prior cardiac MRI on 3/10/2011, the LVEF is slightly lower. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Deep brain stimulation planning for Parkinson disease. There is a developmental venous anomaly in the left frontal lobe. There is diffuse cerebral volume loss. 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: Pre-treatment planning MRI demonstrates diffuse cerebral volume loss and a developmental venous anomaly in the left frontal lobe.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:9/26/1951)Reason: NSCLC with newly diagnosed brain mets; RT planning History: RT planningPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of 2 ring-enhancing lesions along the left superior frontal gyrus one measures 10 x 8 mm axial dimensions and the other one measures 10 x 11 mm axial dimensions. These are similar dimensions the prior exam. Enhancement is more prominent on the prior compared to the current exam which may be related to technique. There is associated T2 signal hyperintensity along the left superior frontal gyrus white matter in a vasogenic pattern. As was also present on the prior exam.There is a 7 mm T2 hyperintense lesion present along the left parotid gland posteriorly. It appears that also been present on the prior exam.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 demonstrate opacification of right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.A couple ring-enhancing lesions present in the left frontal lobe which are relatively stable compared to the prior exam. Differential considerations include metastatic disease as well as septic emboli. Please correlate with patient's clinical symptoms2.Examinations performed the purpose of stereotactic guidance for treatment planning.


Instruction: Generate impression based on findings.

Input: 68-year-old female with history of IPMN. ABDOMEN:LIVER, BILIARY TRACT: Few scattered T2 hyperintense nonenhancing foci compatible with cysts. No intrahepatic biliary ductal dilatation. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: There is a mildly complex, lobulated, T2 hyperintense nonenhancing lesion in the distal pancreatic body which measures 2.5 x 1.9 cm (series 7, image 30) and communicates with the pancreatic duct. This lesion previously measured 2.2 x 1.9 cm on MRI 2/13/2014. There are 2 additional subcentimeter cystic lesions within the pancreatic tail, likely side branch type IPMNs. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mildly complex cystic lesion in the pancreatic body communicating with the pancreatic duct, likely a sidebranch type IPMN, has slightly increased in size.


Instruction: Generate impression based on findings.

Input: Pain, unspecified [R52] / Slow transit constipation [K59.01] / Urgency of urination [R39.15] / Multiple sclerosis [G35], Reason for Study: ^Reason: thoracic cord mass? History: has MS New R T10 pain and UTI and ascending slowly progressing sensory loss of right leg. There is no evidence of abnormal signal intensity on thoracic spinal cord.The extruded T10-T11 disc central to left and inferior direction compresses thecal sac and spinal cord. However, there is no evidence of spinal cord signal changes.Comparing to prior scan, the extent of disc extrusion and the degree of thecal sac compression do not show any significant interval change. At the level of T9-T10, there is focal disc protrusion which abuts thecal sac, unchanged since prior scan.At the level of L23, there is diffuse bulging of disc which abuts thecal sac. No evidence of spinal stenosis is seen, unchanged since prior scan.There is normal thoracic kyphosis. 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 conus medullaris terminates at the T12-L1 level.

Output: 1. No evidence of abnormal signal intensity on spinal cord.2. Left paracentral disc extrusion at the level of T10-11 which compresses thecal sac and spinal cord, unchanged since prior scan.3. Degenerative changes of T9-10 and L23, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Pituitary mass. Ptosis and ophthalmoplegia. The sella turcica is expanded by a heterogeneous lesion with thin peripheral enhancement. Overall, the lesion measures 3.2 cm x 2.1 cm in the coronal plane and 1.7 cm in the anteroposterior dimension and there is associated suprasellar extension with mild mass effect upon the optic apparatus, particularly on the left side. In addition, the lesion also extends laterally into the bilateral cavernous sinuses and the left cavernous sinus appears to be mildly prominent and heterogeneous. The pituitary infundibulum is slightly thickened and displaced to the right. There is mucosal thickening in the sphenoid and posterior ethmoid sinuses which is associated with T1-hyperintense fluid on the left side. There appears to be mild enhancement of the sphenoid body. There is diffuse dural thickening and enhancement.

Output: 1.The sellar lesion that measures up to 3.2 cm produces mass effect upon the optic apparatus may represent a pituitary adenoma with apoplexy versus an abscess that could be associated with adjacent sinusitis and possible early central skull base osteomyelitis. 2.The slightly heterogeneous appearance and thickening of the cavernous sinuses, particularly on the left may represent cavernous sinus thrombosis versus compressive effects by the adjacent lesion. Follow up via dedicated CT venography may be useful.3.Diffuse pachymeningeal thickening may be related to a recent lumbar puncture.


Instruction: Generate impression based on findings.

Input: Pineocytoma WHO I status post surgery: surveillance. There are postoperative findings related to right transfrontal endoscopic third ventriculostomy and biopsy of a pineal tumor. There is slight interval decrease in size of the pineal tumor, which measures 15 RL x 18 SI x 28 AP mm, previously 17 RL x 23 SI x 29 AP mm. There is a right transfrontal ventricular catheter that terminates in the basal cisterns. There is no longer dilatation of the third and lateral ventricles. There is no evidence of acute infarct or hemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Interval slight decrease in size of the size of the residual pineocytoma.2. Interval decrease in size of the shunted ventricular system.


Instruction: Generate impression based on findings.

Input: Metastatic renal cel carcinoma. There is no significant interval change in the partly enhancing lesion in the right parietal lobe with susceptibility effect and surrounding T2 hyperintensity. There is also no significant interval change in the partly enhancing lesion in the left superior cerebellum with susceptibility effect and surrounding T2 hyperintensity. There is an unchanged background of diffuse cerebral white matter T2 hyperintensity. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No significant interval change in the right parietal lobe and left superior cerebellar lesions.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of parietal lobeClinical question: History of GBM, has received radiation, now off chemo.Signs and Symptoms: none The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right-sided craniotomy. There is a surgical defect present along the right parietal lobe which appears stable when compared to the prior exam. There is associated surrounding T2 and FLAIR signal change of a mild degree which is also stable compared to the prior exam. There are susceptibility changes present along the margins of the surgical site. There is no associated enhancing lesion at the surgical site.The visualized portions of the paranasal sinuses demonstrate a minor mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post right parietal lobe surgery for removal of a mass. There is no evidence for recurrence.


Instruction: Generate impression based on findings.

Input: Left wrist mass. A marker was placed along the volar aspect of the wrist. There is a subcutaneous mass situated volar to the radial vessels between the flexor carpi radialis and abductor pollicis longus. The mass is lobulated in morphology. The bulk of the mass is approximately 12 mm x 7 mm in transverse dimension and 17 mm in longitudinal dimension, although several smaller components are seen more distally and medially. The mass is of fluid signal intensity on T2-weighted images and shows thin peripheral and septal enhancement following gadolinium administration. It is hyperintense to skeletal muscle on T1-weighted images likely reflecting proteinaceous content. Overall these findings are compatible with a ganglion. We see no additional soft tissue masses.There is a small cyst in the lunate. Increased signal intensity within the membranous portion of the scapholunate ligament suggests degeneration. There is irregularity of the medial fibers of the articular disc of the triangular fibrocartilage suggesting tearing. The ulnar groove is shallow and there is slight volar subluxation of the extensor carpi ulnaris tendon, which may reflect stripping of the subsheath. There appears to be a bifid median nerve. These findings are not necessarily of any current clinical significance.The remaining bones and soft tissues are unremarkable.

Output: Wrist ganglion and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: signal abnormality seen on pervious MRI over left temporal and frontal area History: signal abnormality seen on pervious MRI over left temporal and frontal area The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left transverse sinus is smaller than the right transverse sinusThe 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.Incidental note is made of partial empty sella.

Output: MRI of the brain is within normal limits. There is no frontal lobe of temporal lobe abnormality appreciated.


Instruction: Generate impression based on findings.

Input: Numbness and tingling, subcutaneous amyloidosis The marrow signal intensity of the distal radius and ulna is normal. The marrow signal intensity of the carpal bones is also normal. The scapholunate and lunotriquetral ligaments are intact as is the triangular fibrocartilage complex.There is no abnormal enhancement or evidence of a mass lesion following administration of contrast. The soft tissues of the wrist including the subcutaneous fat and musculature demonstrate no signal abnormalities. The visualized portion of the ulnar and median nerves are normal.

Output: Normal MRI examination of the wrist.


Instruction: Generate impression based on findings.

Input: CERVICAL: There is some motion degradation of the axial images limiting evaluation. There is straightening of the cervical spine. The vertebral body heights are preserved. There is disk desiccation at all levels in the cervical spine with mild loss of disk height at C4-5, C5-6 and C6-7. The cord caliber and signal are within normal limits. No abnormal enhancement is seen within the limitations of mild motion degradation.C2-3: Minimal disk and endplate degenerative changes with no spinal stenosis.C3-4: Minimal disk and endplate degenerative changes with no spinal stenosis.C4-5: Minimal disk and endplate degenerative changes with no spinal stenosis.C5-6: Minimal disk and endplate degenerative changes and mild left facet arthropathy with mild left neural foraminal stenosis.C6-7: Small disk osteophyte complex with left paracentral component causing moderate left neural foraminal stenosis.C7-T1: Unremarkable.T1-2: Unremarkable.LUMBAR: The last well formed disk space is referred to as L5-S1. There is straightening of lumbar lordosis. Vertebral body heights are preserved. The conus terminates in superior L2 level and shows normal signal intensity. There is no abnormal enhancement in the lumbar spine.T12-L1: No disk herniation or spinal stenosis.L1-2: Prominence of posterior epidural fat, ligamenta flava thickening and mild facet arthrosis with no spinal stenosis.L2-3: Prominence of posterior epidural fat, ligamenta flava thickening and mild facet arthropathy. No disk herniation or spinal stenosis.L3-4: Prominence of posterior epidural fat, ligament flava thickening, mild facet arthrosis. No disk herniation or spinal stenosis.L4-5: Disk desiccation with mild loss of disk height, diffuse disk bulge asymmetric to the right with annular fissure, ligamenta flava thickening, moderate facet arthrosis combining to cause moderate right neural foraminal stenosis. Disk material encroaches upon the right subarticular zone with mild posterior displacement of the traversing right L5 nerve root as compared to the left.L5-S1: Disk bulge with right foraminal protrusion and osteophytic ridging causing moderate right neural foraminal stenosis. No spinal canal or neural foraminal foraminal stenosis.This is an incompletely imaged prominent cystic structure in the right hemipelvis.

Output: 1.Degenerative changes in the cervical spine causing left neural foraminal stenosis at C5-6 and C6-7.2.Multilevel lumbar spondylosis worst at L4-5. There is moderate right neural foraminal stenosis at this level with disk material encroaching upon the right subarticular zone with mild posterior displacement of the traversing right L5 nerve root as compared to the left.3.No significant spinal canal compromise at any other level in the cervical or lumbar spine.4.Incompletely imaged cystic structure in the right hemipelvis of uncertain etiology, though such lesions are commonly adnexal in origin. Dedicated pelvic imaging should be considered.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: please evaluate MS lesion burden and r/o old lesions History: 57yof with MS for 29y presenting with acute worsening of old MS symptoms of rt spasticity and severe intention tremor Brain MRIThere are multiple various sized FLAIR/T2 high signal intensity lesions especially around bilateral periventricular white matter and centrum semiovale which are consistent with demyelinating disease.Those lesions, however, do not show any evidence of contrast enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C spine MRIThe spinal cord signal intensity is normal.There is no evidence of abnormal enhancement.Cervical spine appears to be straightened, however, the spine alignment is anatomic.Vertebral height is preserved.There are minimal bulging of discs at the level of C45 and C56, without evidence of thecal sac compression or spinal canal stenosis.There is no evidence of cervical spinal neuroforaminal narrowing.

Output: 1. Multifocal bihemispheric various sized periventricular and centrum semiovale demyelinating lesions consistent with known multiple sclerosis.2. There is no evidence of abnormal enhancement.3. No evidence of spinal cord lesion.4. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Epilepsy and autism with increased frequency of staring episodes and worsening behavior and sleep issues. There is persistent subcortical T2 hyperintensity in the right parahippocampal and fusiform gyri without appreciable mass-effect or volume loss. The hippocampi appear to be unaffected. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: A persistent subcortical lesion involving the right parahippocampal and fusiform gyri without appreciable mass-effect may represent gliosis rather than a low-grade neoplasm, for example. Follow up via MRI with contrast may potentially offer additional insights.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for adenomyosis History: heavy, frequent menstrual bleeding. Pelvic pain. Dyspareunia. PELVIS:UTERUS, ADNEXA: Retroverted uterus, previously anteverted. The junctional zone measuring up to 15 mm and cystic foci in the myometrium, compatible with adenomyosis. A few intramural fibroids largest measuring 1.2 x 1.1 cm (series 8 image 14). Bilateral ovaries appear normal for premenopausal female.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid, likely physiologic in premenopausal female.

Output: 1.Findings compatible with adenomyosis with a few small intramural fibroids.


Instruction: Generate impression based on findings.

Input: 52 years, Male, chronic headaches. Brain MRI: No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Patchy areas and scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. There is mild global parenchymal volume loss. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Sella and orbits are grossly within normal limits. There is moderate degree of mucosal thickening involving the right maxillary sinus and to a slightly lesser degree the left maxillary sinus. There is also moderate right frontal sinus opacification. Mild mucosal thickening is also evident in the left frontal sinus, anterior and posterior ethmoid air cells, and the sphenoid sinuses. There is a nonspecific 1 cm lesion involving the left aspect of the clivus. No associated osseous destruction. Bone marrow signal and calvarium are otherwise unremarkable.Brain MRA: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Right vertebral artery is dominant. Anterior communicating artery and left posterior communicating artery are not definitively seen which can be normal variant.

Output: 1. No intracranial mass or mass effect. There are mild to moderate chronic small vessel ischemic changes and mild parenchymal volume loss. Brain parenchyma appears otherwise unremarkable.2. Pansinus disease, which may be contributing to patient's headaches.3. MRA head is unremarkable with no aneurysms or significant stenosis.4. There is a 1 cm enhancing osseous lesion involving the left aspect of the clivus which is nonspecific. No osseous destruction or soft tissue component. Would suggest comparison with prior CT or MRI if available. Alternatively, follow-up should be considered to confirm stability.


Instruction: Generate impression based on findings.

Input: Clinical question: r/o intracranial pathologySigns and Symptoms: headache MRI of the brainNo diffusion weighted abnormalities are appreciated.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified in each hemisphere on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the right sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eye lens is thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior cerebral artery has a fetal origin. The left posterior communicating artery is small and intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.No evidence for acute ischemic cerebral infarction.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease.4.No evidence for dural sinus thrombosis.5.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They are likely of little clinical significance given their size and number at this age.


Instruction: Generate impression based on findings.

Input: 57 years, Female, rule out structural cause of amnesia. There is no restricted diffusion involving the hippocampi or elsewhere in the brain. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are patchy foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, particularly in the parieto-occipital region, which are nonspecific. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct, hemorrhage, mass or mass effect.2. Mild patchy T2/FLAIR hyperintensity involving the bilateral parieto-occipital subcortical and periventricular white matter which is very nonspecific but may reflect gliosis related to prior inflammation, toxic metabolic injury or small vessel ischemia. Brain MRI is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: High risk screening based on family history in her mother (47) and grandmother (42). Prior benign lumpectomy. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of right nephrectomy and cystectomy with ileal conduit for bladder and upper tract cancer, surveillance imaging ABDOMEN:LIVER, BILIARY TRACT: Punctate left hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: Stable 5 mm cystic focus at junction of pancreatic head/uncinate process compatible with a sidebranch IPMN; additional stable punctate pancreatic cystic foci may reflect additional lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right-sided nephrectomy. No suspicious left renal lesion. Stable punctate left upper pole simple appearing renal cyst. Stable additional mid and lower pole hemorrhagic/proteinaceous cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left-sided ostomy.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive sigmoid colon diverticulosis.BONES, SOFT TISSUES: Vertebral body hemangioma formation. Diastases of rectus abdominis muscles.OTHER: No significant abnormality noted.

Output: 1. Stable study with postoperative changes seen without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Ms. Martinez is a 48-year-old female with multiple palpable right retroareolar masses, the largest of which was biopsied with pathology of hyalinizing intraductal papilloma. She presents today for further imaging evaluation with MRI. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.In the right superior breast, there are multiple lobulated enhancing masses identified, measuring approximately 4.6 x 3.0 x 3.9 cm (AP x ML x SI). The maximal dimension in the AP oblique direction (measured in the sagittal plane) is approximately 4.8, corresponding to the mammographically-detected measurement of 5.0 cm. The largest of these masses measures up to 2.5 cm and contains susceptibility artifact from a biopsy marker clip. In addition, just lateral to the right nipple base, is an enhancing focus, which may represent an additional focus related to the above-mentioned process versus background parenchymal enhancement. No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Multiple lobulated enhancing masses measuring up to 4.8 cm in the maximal dimension, one of which is biopsy proven to be a papilloma. MRI extent of disease approximates mammographic extent of disease. If excisional biopsy is desired for additional tissue sampling, then two mammographically localized wires can be placed bracketing the lobulated masses. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Pain after lumbar steroid injection yesterday. Signs and symptoms: Pain in back and legs bilaterally. Pre and post enhanced lumbar MRI:The signal intensity of vertebral column is unremarkable and without abnormal enhancement.The alignment of vertebral column is anatomical and without interval change since prior exam.There is no detectable abnormal signal or collection in the epidural space and no detectable abnormal enhancement.Degenerative changes at L3-L4 and a small central disc protrusion demonstrate no significant change since prior study. Findings at this level results in mild central spinal stenosis without change.Degenerative changes at L4/L5 and including a broad-based disc protrusion demonstrate slight interval improvement since prior exam and with mild central spinal stenosis.Degenerative changes at L5-S1 and a small shallow central located disc protrusion demonstrates subtle interval improvement and without evidence of spinal stenosis.Paraspinal soft tissues remain within normal angles without detectable abnormal enhancement.

Output: 1.No detectable complication from recent intervention.2.Multilevel central disc protrusion at L3-4, L4-L5 and L5-S1 levels demonstrate mild interval improvement since prior exam.3.No detectable abnormal enhancement of the vertebral column, cord, cauda equina or epidural spaces.


Instruction: Generate impression based on findings.

Input: Ms. Igielski is a 54-year-old woman with a personal history of left breast lumpectomy 2003 for IDC followed by radiation therapy. She has a family history of breast cancer in her paternal grandfather, paternal aunt, and paternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Expected post surgical volume loss and distortion is present in the left breast and left axilla. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with cervical radiculopathy. Reversal of the normal cervical lordosis is seen. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen.Visualized spinal cord demonstrates normal signal characteristics throughout. No epidural abnormalities are suspected.The discs demonstrate mild loss of T2 signal, and in addition, there is loss of disc height at C5-6 and C6-7. Additional level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C4-5: Left facet hypertrophy. No significant spinal canal or foraminal stenosis. C5-6: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation with uncovertebral hypertrophy, asymmetric to the right foraminal zone. The central portion of the disc osteophyte complex contacts the ventral cord, but there is no significant generalized canal stenosis. Moderate right and mild left foraminal narrowing. C6-7: Left facet hypertrophy. Posterior disc-osteophyte complex formation, asymmetric to the right foraminal zone. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing.C7-T1: Small central disc extrusion. No significant spinal canal or foraminal stenosis.

Output: Posterior disc-osteophyte complex formation is seen at multiple levels, but most notably at C5-6 and C6-7, where there is asymmetric disc osteophyte formation towards the right foraminal zones. This results in moderate right foraminal narrowing at these levels. In addition, the disc osteophyte complex at C5-6 mildly contacts the ventral spinal cord, though there is no cord compression, cord edema or significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 59-year-old man with nonischemic cardiomyopathy. Cardiac MRI was obtained to assess for presence of LGE. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 182 ml/m2 (normal range: 74+/-15), the LVEDV is 387 ml (normal range 142+/-34), the LV end systolic volume index is 134 ml/m2 (normal range 25+/-9), the LVESV is 285 ml (normal range 47+/-19), the LV mass index is 75 g/m2 (normal range 85+/-15), and the LV mass is 159 g (normal range 164+/-36). The basal to mid inferior and inferolateral walls are thinned and akinetic. There is basal to mid lateral and inferolateral transmural late gadolinium enhancement. These segments are not viable. Also noted are 3 small areas of patchy epicardial late gadolinium enhancement in the mid and apical anterior and anteroseptal walls, not described in the report of the previous cardiac MRI. This pattern could be consistent with healing myocarditis. However, other infiltrative, inflammatory, or fibrosing processes should also be considered. Unable to perform direct visual comparison with previous cardiac MRI as it was no longer available in the PACS system.Left AtriumThe left atrium is severely dilated .Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 163 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 98 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet opens widely. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is at least moderate mitral regurgitation visually. Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left-sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsA previously noted anterior liver mass is seen, approximately 1.1 x 1.1cm. 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: When compared to the previous report:1. Severely dilated left ventricle with severely reduced systolic function (EF 26%), slightly improved from previous. 2. The basal to mid inferior and inferolateral walls are thinned and akinetic. There is basal to mid lateral and inferolateral transmural late gadolinium enhancement. These segments are not viable. Also noted are 3 small areas of patchy epicardial late gadolinium enhancement in the mid and apical anterior and anteroseptal walls, not described in the report of the previous cardiac MRI. This pattern could be consistent with healing myocarditis. Unable to perform direct visual comparison with previous cardiac MRI as it was no longer available in the PACS system.3. Normal right ventricular size with mildly reduced systolic function (RVEF 40%), which is improved from the previous study.4. At least moderate mitral regurgitation.5. Small (1cm), round mass in the superior portion of liver. Consider ultrasound for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Newly diagnosed MGUS vs myeloma; please evaluate for myeloma lesions. There is mild diffuse intermediate signal intensity in the lower lumbar spine, bones of the pelvis, and proximal femora, suggestive of residual red marrow. We see no convincing focal lesion to confirm myeloma. Low signal intensity focus adjacent to the lateral aspect of the right greater trochanter is noted, likely representing calcium hydroxyapatite deposition with adjacent soft tissue inflammation. There is also mild peritrochanteric inflammation on the left. These findings are of questionable current clinical significance.Mild osteoarthritis affects both hips.

Output: Residual red marrow without focal lesion to confirm myeloma. Other findings as above.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with paresthesias. There is no significant change in the numerous (greater than 10) T2 hyperintense white matter lesions, many of which demonstrate T2 hypointensity. There is no convincing evidence of associated enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No significant interval change of the demyelinating lesions in the brain.


Instruction: Generate impression based on findings.

Input: Transient unresponsiveness. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere. There is minimal nonspecific scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant.

Output: No evidence of acute infarct. A punctate focus of susceptibility effect in the left cerebellar hemisphere is nonspecific, but may represent a chronic microhemorrhage.


Instruction: Generate impression based on findings.

Input: Reason: Femur diaphyseal Lesion (CA) vs. Stress Fx History: Pain No bone marrow signal abnormalities identified to suggest stress reaction or stress fracture. No discrete fracture line is identified. There is a small amount of fluid within the right hip which is not necessarily of any clinical significance. The imaged musculature of the right thigh is normal in appearance. There is a small amount of fluid within the right knee without evidence of a large effusion. Although this examination was not protocoled for detailed evaluation of the knee, there is apparent partial-thickness articular cartilage degeneration and along the medial facet of the patella. No enhancing mass lesions are identified on postcontrast sequences. There is mild intermediate signal intensity within the common tendon of origin of the long head of the biceps femoris and semitendinosus of the hamstring tendons indicating a mild tendinosis (image 18; series 12). No fluid filled tear is evident. There is intermediate signal abnormality within the anterior superior acetabular labrum suggesting degeneration within the limitations of this nondedicated non arthrogram study. There is mild peritrochanteric inflammation bilaterally which is of doubtful current clinical significance. On the large field-of-view images, there is a small amount of fluid within the left hip without evidence of an effusion.

Output: No evidence of stress reaction/fracture or metastases. Mild tendinosis of the hamstring tendons at their origin as described above.


Instruction: Generate impression based on findings.

Input: Female, 15 years old. Knee pain, sports and swelling after dance injury MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is normal. No focal cartilage defects.LIGAMENTS: The cruciate and collateral ligaments are normal. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: 55-year-old male with left leg weakness. There is metallic susceptibility artifact related to the patient's history of orthopedic fixation of the lumbosacral spine with associated postoperative changes in the adjacent soft tissues. There is grade 2 anterolisthesis of L5 on S1 with severe degenerative disc disease at this level. Please see the dedicated lumbar spine MRI report for additional details. There are small lobulated foci of signal abnormality within the intertrochanteric region of the left femur with minimal enhancement likely representing enchondromas. The bone marrow signal intensity of the pelvis is otherwise normal. Mild osteoarthritis affects both hip joints, which otherwise appear normal for the patient's age. There is bony bridging along the anterior aspect of the sacroiliac joints which is likely degenerative in etiology. Mild degenerative arthritic changes affect the pubic symphysis. We see no focal mass lesions within the pelvis. The musculature of the hips is symmetric without evidence of edema. Other than the soft tissues posterior to the aforementioned lumbosacral spine we see no abnormal enhancement. Although this examination was not protocoled for detailed evaluation of the prostate, there is decreased signal abnormality within the body and apex of the right peripheral zone of the prostate gland, which is incompletely characterized. There may be post surgical changes of prior TURP.

Output: 1. Postoperative and degenerative changes of the lumbosacral spine. Please refer to the lumbar spine MRI report for additional details.2. Mild osteoarthritis of the hips, sacroiliac joints, and pubic symphysis but no findings within the pelvis to account for the patient's left leg weakness.3. Signal abnormality within the prostate gland which is incompletely characterized on this non dedicated MRI examination. Correlation with PSA levels is recommended as we cannot exclude the possibility of prostate carcinoma on this examination.


Instruction: Generate impression based on findings.

Input: Autonomic dysfunction and prior head trauma. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellar parenchyma and pituitary gland appear unremarkable. There is a cavum septum pellucidum and vergae. 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.Cervical and Thoracic Spine: The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial demyelinating lesions or stigmata or traumatic brain injury.2. No evidence of spinal cord lesions.


Instruction: Generate impression based on findings.

Input: 51-year-old male with history of ADPKD and stage II-III CKD. Please provide kidney measurements including length, width, and depth. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar subcentimeter T2 hyperintense foci are most compatible with cysts. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Multiple subcentimeter T2 hyperintense foci predominantly of the pancreatic body and tail are too small to fully characterize and favored to be cystic. No pancreatic ductal dilatation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral enlarged kidneys containing numerous cysts of varying size and signal intensity. The majority of these cysts are simple T2 hyperintense cysts. A few T1 hyperintense cysts are noted and could represent hemorrhage versus proteinaceous material. No solid components identified. No hydronephrosis.The right kidney measures at least 15 cm in length, 10 cm in AP and 9.8 cm in transverse diameter.The left kidney measures at least 12 cm in length, 9.5 cm in AP, and 9.5 cm in transverse diameter.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral enlarged kidneys containing numerous cysts of varying size and signal intensity. Measurements of the kidneys are listed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out spinal cord pathology. Signs and symptoms: 80-year-old female with weakness and hyperreflexia. Nonenhanced cervical MRI:Extensive degenerative changes of cervical spine mostly at C3-C4-C6/C7 levels are noted.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease as well as mild grade 1 anterolisthesis. There is also a left paramedian superiorly migrated extruded disc with resultant significant mass effect, flattening deformity and posterior displacement of the cord which in combination with degenerative changes results in significant central spinal stenosis. There is also significant right and moderate to significant left neural foraminal compromise. Additionally note is made of increased T2/FLAIR signal intensity within the cord at this level which extends inferiorly to at least mid C5 level and consistent with myelitis.C4-C5 demonstrate advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and facet degenerative changes. Shallow broad-based bulging disc and hypertrophic spur is also noted. Constellation of findings results in moderate central spinal stenosis and moderate to severe bilateral (left greater than right) neural foraminal compromise. Increased T2 signal intensity of the cord as mentioned above.C5-C6 demonstrate advanced disc disease and significant loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Findings results in moderate central spinal stenosis, significant left and moderate right neural foraminal compromise.C6-C7 demonstrate moderate disc disease and loss of disc height and moderate bilateral ligamentum flavum hypertrophy. Mild central spinal stenosis and moderate bilateral neural foraminal compromise is noted.C7-T1 demonstrates mild degenerative changes with resultant mild bilateral neural foraminal compromise and no spinal stenosis.Upper most visualized thoracic spine and thoracic cord is unremarkable.

Output: 1.Extensive degenerative changes of cervical spine with resultant multilevel significant to moderate central spinal stenosis at C3-C4, C4-C5 and C5-C6 levels as detailed above. An extruded and superiorly migrated disc on the left at C3-C4 as mentioned.2.Multilevel bilateral mostly significant neural foraminal compromise as detailed per level.3.Increased T2 signal intensity of the cord extending from C3 inferiorly to mid C5 with decreased cord caliber consistent with myelitis.


Instruction: Generate impression based on findings.

Input: 8-day-old female with fever and bradycardia/desaturations and sepsis with low glucose levels. Brain: There is a small amount of high T1 signal intensity in the subdural spaces overlying the posterior left cerebellar and cerebral convexities without appreciable mass effect. There is no evidence of acute infarct. The brain parenchyma appears unremarkable, with a normal degree of myelination. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.Pituitary: The pituitary gland is not enlarged. The posterior pituitary bright spot is in the expected location. The infundibulum is intact.

Output: 1. A small amount of subacute subdural hemorrhage along the left posterior cerebellar and cerebral convexities without appreciable mass effect.2. No stigmata of hypoglycemic encephalopathy.3. Unremarkable pituitary gland.


Instruction: Generate impression based on findings.

Input: Female, 18 years old, with left palm and sole numbness. Assess for thalamic or sensory cortical abnormality. Assess for cervical spine intramedullary or extramedullary lesions. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of parenchymal enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. A chronic deformity of the right orbital floor is seen with some herniation of orbital fat towards the maxillary sinus.C-spine:Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic intraspinal enhancement is seen. The intervertebral disk spaces are preserved. No spinal canal or neuroforaminal stenosis is seen.

Output: 1.Unremarkable evaluation of the brain with no specific findings to account for the patient's symptoms.2.Unremarkable evaluation of the cervical spine with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 17-year-old male with right knee pain after injury, concern for ACL tear MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a subchondral defect in the anterior aspect of the lateral femoral condyle with associated surrounding bone marrow edema, compatible with an impaction fracture. A defect in the articular cartilage is also noted in this area. There is also bone marrow edema in the medial patellar facet. The bone marrow signal elsewhere is normal.LIGAMENTS: The anterior and posterior cruciate ligament are intact. The medial collateral ligament and lateral collateral ligament complex is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.There is evidence of lateral patellar dislocation with impaction fracture in the bilateral femoral condyle as well as disruption of the medial retinaculum.2.There is associated bone marrow and soft tissue edema, a large joint effusion, and likely strain of the medial gastrocnemius and vastus medialis tendons.


Instruction: Generate impression based on findings.

Input: Status post MVA with loss of consciousness on 8 -- 24 -- 2009. Now with headaches. Evaluate for bleed or new findings. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and also some cisterns remain within normal. There, paranasal sinuses and mastoid air cells are also unremarkable.If clinical symptoms persist an MRI is recommended.

Output: Unremarkable CT of brain without infusion and stable since prior study.


Instruction: Generate impression based on findings.

Input: Multiple myeloma on clinical trial, right sciatic nerve pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is some straightening of the lumbar spine curvature which is otherwise normal in alignment. Bone marrow signal is benign without suspicious osseous lesions. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a right foraminal and extra foraminal disc protrusion which contacts the right exiting L3 nerve root and mildly narrows the right neural foramen. No spinal canal or left neural foraminal stenosis.L4-L5: There is a small left sided annular fissure with small left foraminal disc protrusion with mild to moderate narrowing of the left neural foramen. No spinal canal or right 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. Mild degenerative changes in the lumbar spine with small foraminal disc protrusions at the right L3-L4 and left L4-L5 levels. There is contact with the right L3 nerve root.2. No significant spinal canal stenosis or high-grade foraminal stenosis at any level.3. No suspicious osseous lesions in the lumbar spine. Please note small osseous lesions can be better assessed by CT.


Instruction: Generate impression based on findings.

Input: 69-year-old woman with history of breast cancer on Eribulin who presents with nausea, vomiting, and fatigue. There are multiple, new enhancing lesions in the calvarium. The largest of these in the left parietal calvarium (11/23) involves both the inner and outer table and measures approximately 19 x 16 x 8 mm. There is no abnormal parenchymal or meningeal enhancement.No restricted diffusion to suggest acute ischemia. Previously seen areas of diffusion restriction infarct in the right precentral and inferior frontal gyri no longer restrict diffusion and there is corresponding volume loss with increased T2 signal compatible with gliosis. Additionally, there is thin, linear susceptibility artifact along the sulci, likely from hemosiderin deposition. There is no intracranial hemorrhage. There is no parenchymal mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The brain parenchyma is otherwise unremarkable for age. The major flow-voids are preserved.The sella and orbits are grossly within normal limits. There is mucosal thickening and intermediate signal inspissated mucous within the left ethmoid air cells. The mastoid air cells are clear.

Output: 1.New calvarial metastases without evidence of parenchymal or meningeal metastases.2.Evolution of previously seen right frontal lobe infarcts, now chronic with encephalomalacia and gliosis. No evidence of acute infarct or hemorrhage.


Instruction: Generate impression based on findings.

Input: Patient is status post left craniotomy for tumor resection with small extra-axial collection beneath the craniotomy flap appearing unchanged. There is increased T2/FLAIR signal surrounding the resection cavity with linear enhancement along the medial border appearing unchanged from the previous study. No new FLAIR signal abnormality, new mass effect, or suspicious enhancement. Susceptibility effect related to chronic blood products again seen. No hydrocephalus, mass effect, midline shift or herniation. Paranasal sinuses and the osseous structures are within the normal limits.

Output: Unchanged post-treatment changes in the left frontoparietal lobes without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: 69 year old man with history of smoldering myeloma and recent diagnosis of renal amyloidosis (AL type), currently under evaluation for autologous stem cell transplant candidacy. He was referred for cardiac MRI to evaluate for possible cardiac amyloidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 68 g/m2 (normal range 85+/-15), and the LV mass is 141 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is mild-moderate asymmetric left ventricular hypertrophy (septal thickness 12-13mm; posterior wall thickness7mm). Within the hypertrophied segment, the native myocardial T1 relaxation time is mildly elevated (1105ms). In the remainder of the myocardium, the native myocardial T1 relaxation time is within normal limits. There is late gadolinium enhancement in a "mid-wall stripe pattern" involving the basal inferior wall which is atypical for infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The extracellular volume fraction is elevated at 46% (normal 20-30%), which speaks to a diffuse infiltrative or fibrotic process. However, the gadolinium kinetics are not suggestive of overt cardiac amyloidosis. Left AtriumThe left atrium is moderate-severely dilated. The interatrial septum is aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 204 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet and opens widely with no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is posterior mitral annular calcification.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. There is mild atherosclerosis in the descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 62%) with evidence of asymmetric hypertrophy. 2. There is late gadolinium enhancement in a "mid-wall stripe pattern" involving the hypertrophied basal inferior wall. This pattern is not consistent with prior myocardial infarction. The finding suggests the presence of an underlying infiltrative or inflammatory process. There is additionally a focal area of increased myocardial T1 relaxation time within the hypertrophied segment. This regional variation in hypertrophy and T1 relaxation time is not classically seen in cardiac amyloidosis and may rather represent an another infiltrative process such as myocarditis, sarcoidosis, etc. However, there is significant global increase in extracellular volume fraction, which raises the possibility that these findings may potentially represent early cardiac amyloidosis. 3. The right ventricle is normal in size with normal systolic function (RVEF 54%).4. Moderate posterior mitral annular calcification. 5. Biatrial dilation. 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: Rule out structural abnormality. Signs and symptoms: Chronic headaches. Nonenhanced brain MRI:No diffusion weighted abnormalities. There is normal anatomical morphology of brain and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are unremarkable.Unremarkable calvarium, scalp, orbits, paranasal sinuses and mastoid air cells

Output: Unremarkable nonenhanced brain MRI.