Instruction: Generate impression based on findings.

Input: Sustained an injury six weeks ago. Persistent pain in left shoulder. Rule out labral tear of the left shoulder. ROTATOR CUFF: There is perhaps minimal undersurface tearing of the supraspinatus tendon, but otherwise the tendon and muscle appear normal. The infraspinatus tendon and muscle appear normal. The teres minor muscle and tendon appear normal. The subscapularis tendon is intact. There is a small amount of contrast infiltrating the subscapularis muscle, likely iatrogenic.SUPRASPINATUS OUTLET: Tiny acromioclavicular joint osteophytes suggest minimal osteoarthritis. I see no frank impression upon the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. Articular cartilage of the glenohumeral joint appears normal. There is detachment of the superior labrum and anterosuperior labrum from the underlying glenoid from approximately the 11:00 position to the 3:00 position. While it is possible that this could represent an unusually prominent sublabral sulcus combined with a normal variant sublabral foramen, I suspect that it represents a true labral tear. The inferior labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Detachment of the superior and anterosuperior labrum from the underlying glenoid as described above. While it is possible that this could represent an unusually prominent sublabral sulcus coupled with a normal variant sublabral foramen, I suspect that it represents a true labral tear.


Instruction: Generate impression based on findings.

Input: Right side meningioma: surveillance. There is an unchanged enhancing dural-based lesion overlying the right peri-rolandic region, measuring approximately 6 mm in thickness, without significant mass effect upon the brain. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged minimal scattered foci of T2 hyperintensity in the cerebral white matter. 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 right aphakia. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. No significant interval change in a the small extra-axial dural based enhancing lesion overlying the right peri-rolandic region, which may represent a meningioma. 2. Minimal probable chronic small vessel ischemic disease, without evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Mild degenerative changes are seen including disc bulges and uncovertebral hypertrophy at the C5-C6 and C6-C7 levels. There is mild effacement of the thecal sac at the C5-C6 and C6-C7 levels without significant spinal canal stenosis overall. There is mild to moderate bilateral C5-C6 neural foraminal stenosis and mild bilateral C6-C7 neural foraminal narrowing. Remainder of the cervical spinal canal and neural foramina are patent.THORACIC SPINE

Output: 1. There is no mass or abnormal enhancement within the cervical, thoracic, or lumbar spine to suggest leukemia involvement.2. Mild degenerative changes are seen in the spine as described above without significant spinal canal stenosis at any level. There is mild to moderate bilateral neural foraminal stenosis at the C5-C6 level. No significant neural foraminal stenosis in the thoracic or lumbar spine. Please see additional details above.3. Small bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: 72 year old woman with history of coronary artery disease who presents with chest pain and shortness of breath. Patient presents for cardiac MRI to evaluate for myocardial ischemia.MEDICATIONS: carvedilol, furosemide, lisinopril, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 43 %, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 210 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 118 ml (normal range 31+/-10), the LV mass index is 63 g/m2, and the LV mass is 139 g. There is global mild hypokinesis.No intracardiac thrombus.Left AtriumThe left atrium is moderately to severely dilated in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 114 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is mildly dilated with reduced systolic function (LVEF 43%).4. The right ventricle is normal in size with mildly reduced systolic function. (RVEF 42%).5. Left atrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 64-year-old female with left lumbar radicular pain, left leg pain, and low back pain; history L4/5 disc herniation The signal intensity in the alignment the vertebral column remains unremarkable. Moderate degenerative disk disease at L4/5 and L5/S1 levels are again noted. The conus terminates at an appropriate level and is normal in signal as well as morphology. The visualized paraspinal contents are unremarkable.T12/L1 through L3/4: Redemonstrated are minimal to mild degenerative changes and no central spinal stenosis or neural foramina compromise. L4/L5: There is a new left paracentral disc protrusion which effaces the left lateral recess and causes a moderate degree of central stenosis. Previously demonstrated mild degenerative disk disease and hypertrophic changes of posterior elements are again noted without significant neural foramina compromise.L5/S1: Redemonstrated is degenerative disk disease with disk bulge and loss of disk height and signal intensity.There is no central spinal stenosis or neural foramina compromise. A previously suspected small herniated disk in the left paramedian location not evident on the current exam.

Output: L4/L5: There is a new left paracentral disc protrusion which effaces the left lateral recess and causes a moderate degree of central stenosis.


Instruction: Generate impression based on findings.

Input: Prostate malignancy PELVIS:PROSTATE:Suboptimal assessment due to patient motion artifact and extensive T1 hyperintense signal throughout peripheral zones, consistent with hemorrhage.Prostate Size: 4.6 cm in transverse dimension x 4 cm in craniocaudal dimension x 4.8 cm in AP dimension.Peripheral Zone: Globular right-sided mid peripheral zone posterolaterally located T2 hypointense lesion measuring 8 x 6 mm on image 38 series 701, focus abuts prostatic capsule without definite extracapsular extension. Possible mild corresponding decreased ADC signal suggested. Mild adjacent as well as contralateral peripheral zone linear scarring seen as evidenced by focal sites of curvilinear T2 hypointense signal. Additional apical right-sided paramedian 9 x 6 mm focus demonstrating similar signal characteristics seen on image 12 series 501.Central Gland: Moderate degree BPH visualized. Seminal Vesicles: Unremarkable, symmetric in appearance.Extracapsular Extension: Right-sided mid peripheral zone lesion alluded to above abuts prostatic capsule without definite extracapsular extension.BLADDER: Extrinsic impression by prostate gland.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small left-sided fat-containing inguinal hernia.OTHER: Extensive T1 hyperintense signal seen throughout peripheral zones, consistent with hemorrhage. Colon diverticulosis.

Output: 1. Suboptimal assessment due to patient motion artifact and extensive T1 hyperintense signal throughout peripheral zones, consistent with hemorrhage.2. Indeterminate 8 mm right-sided mid peripheral zone focus with low T2 signal seen, corresponding decreased ADC signal not as well visualized (may be technical). Additional apical right-sided paramedian 9 x 6 mm focus demonstrating similar signal characteristics also seen.


Instruction: Generate impression based on findings.

Input: Ms. Lindsey is a 24 year old female with personal history of right breast lumpectomy and sentinel lymph node biopsy in 2014 for IDC treated with neoadjuvant chemotherapy and radiation. She has no current breast related complaints. There is extreme amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Expected postsurgical changes are identified in the right central breast and right axillary region, compatible with provided history of right breast lumpectomy with sentinel lymph node biopsy. No abnormal enhancement is seen in either breast. There is an area of increased T2 signal in the right anterior lung, which corresponds to the known area of maturing radiation reaction better characterized on recent CT from September 2015. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 16-year-old female with chest heaviness, new reduced EF Clinical TTE. Evaluate for signs of myocarditis. Left VentricleFrequent ectopy limits quantification of ejection fraction. Wall motion is suggestive of frequent premature ventricular contractions during the entire examination. The left ventricle is visually normal in size. The LV systolic function is globally, mildly reduced. The overall LV ejection fraction is approximately 42%.On the short-axis view, there is minimal high signal intensity of the mid myocardium at the mid chamber of the inferior wall compatible with enhancement. This is a focal, limited to the inferior wall. No other enhancement is identified, specifically no enhancement is identified at the interventricular septum.No intracardiac thrombus is present.Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is mildly dilated. The RV systolic function is moderately reduced. The overall RV ejection fraction is 35%.Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumNo significant pericardial effusion, pericardial enhancement or thickening.

Output: There is a linear mid myocardial high signal at the inferior wall at the mid chamber of the left ventricle. This is compatible with limited gadolinium enhancement. There is global, mildly reduced systolic function with an approximate left ventricular ejection fraction of 42%. Preventricular contractions are noted throughout the entire examination. The wall motion abnormality is disproportionate to the extent of enhancement.The right ventricle and atrium appear mildly dilated; no associated enhancement of the right ventricle is noted. The constellation of imaging findings, along with negative serology at the time of imaging, raises a question of a remote or subacute myocarditis with possible remodeling of the right ventricle. The ventricular ectopy may be related to prior inflammation.Dedicated imaging does not suggest pericardial inflammation at this time. The results were discussed with Dr. Arredondo.


Instruction: Generate impression based on findings.

Input: Examination is again limited by lack of intravenous contrast. Redemonstrated is diffuse destruction and replacement of the L1-2 disc space, destruction of the adjacent endplates, and significant collapse of the L1 greater than L2 vertebral bodies. There is no significant change in residual abnormal T2/STIR hyperintensity involving the bone marrow and intervertebral disc. The degree of moderate retropulsion appears similar at the L1 level with unchanged moderate spinal canal stenosis and bilateral L1-L2 foraminal stenosis. No other worrisome marrow signal is appreciated. Again seen are areas of T1 and T2 hypointensity involving the right greater than left psoas musculature which are again seen and not significantly changed compared to 4/1/2015; these correspond to sites of previously seen abscesses and may represent areas of cavitation/necrosis. No discrete fluid collections to suggest abscess. More extensive diffuse STIR hyperintensity in the iliopsoas and paraspinous musculature similar to prior and compatible with combination of atrophy and edema. The lumbar spine is otherwise in stable alignment. The vertebral body and disc heights are otherwise unchanged. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The previously described degenerative changes appear similar. Again noted is prominence of the epidural fat including focal epidural fat along the right lateral aspect of the thecal sac at the L3-4 level. Partially imaged are bilateral renal atrophy with innumerable microcysts. There is clumped appearance of the cauda equina nerve roots suggestive of arachnoiditis and present previously.

Output: 1. Lack of contrast again limits evaluation. Compared to 6/3/2015 and 5/6/2015, there is no significant change in residual signal abnormalities related to L1-L2 discitis-osteomyelitis. Please note imaging findings often lag behind clinical response and do not necessarily imply residual discitis-osteomyelitis. No worsening marrow or disc signal abnormalities to suggest progression of infection. 2. No significant change in compression fractures of the L1 greater than L2 vertebral bodies. No significant change in osseous retropulsion at L1 with associated moderate spinal canal stenosis as well as moderate to severe bilateral L1-L2 neural foraminal stenosis. 3. Extensive signal abnormality involving the iliopsoas and paraspinous musculature as described above compatible with combination of atrophy and edema. No convincing evidence of residual abscess. No new fluid collections.


Instruction: Generate impression based on findings.

Input: Male, 60 years old. Evaluate for ligament injury or quadraceps/sartorious tendon or distal muscle belly tear. History of knee pain and swelling. MENISCI: There is mild fraying of the free margin of the posterior horn of the medial meniscus, otherwise the medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is surface fraying of the medial facet of the patella. There is thinning of the articular cartilage of the lateral femoral condyle and full-thickness fraying of the articular cartilage of the medial femoral condyle. No bone marrow edema or evidence of fracture. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is near full-thickness tear of the quadriceps tendon which is detached at the patella with only the deep layer remaining intact. There is retraction of the tendon measuring approximately 2 to 3 cm. There is moderate to severe tendinosis of the quadriceps tendon. The patellar tendon is intact.ADDITIONAL

Output: 1. Near full-thickness tear of the quadriceps tendon with retraction.2. No evidence of fracture.3. No significant ligamentous or meniscal injury.


Instruction: Generate impression based on findings.

Input: 47-year-old female. Status post OATS procedure to the MFC. Continued pain medially. MENISCI: Globular signal abnormality in the posterior horn of the medial meniscus consistent with intrasubstance degeneration, similar to prior study. No discrete tear is evident. The lateral meniscus is normal in signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: Again seen are two adjacent osteochondral transplant grafts, each approximately 2 cm in diameter, in the medial femoral condyle. The marrow edema type signal in the more posterior graft has nearly completely resolved while the marrow edema type signal in the anterior graft is not significantly changed. The overlying articular cartilage is normal in signal and is flush with the native articular cartilage surface. The alignment of these grafts is unchanged with approximately 3.5 mm cortical concave stepoff between the two grafts.Marked thinning of the patellofemoral cartilage, most pronounced at the medial patellar facet, without underlying marrow edema, not significantly changed. New small area of deep fissuring of the lateral femoral trochlear articular cartilage. Mild diffuse thinning of the lateral femoral condyle articular cartilage, similar to prior study. Small tricompartmental osteophytes. LIGAMENTS: ACL, PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Medial femoral condyle osteochondral transplant grafts with near complete resolution of edema in the more posterior graft and similar amount of edema in the anterior graft. Unchanged alignment of these grafts with intact overlying cartilage.


Instruction: Generate impression based on findings.

Input: Reason: 3T; chronic right middle cerebral artery occlusion with no evidence of ischemic symptoms, carotid aneurysm, annual surveillance for stability History: near syncope and muscle tightening in past, migraines. Brain MRI:Again noted are minimal and scattered T2/FLAIR hyperintense foci in the left frontal white matter that are nonspecific, unchanged as compared to prior exam. There is no mass effect or midline shift. There is no intracranial hemorrhage. There is no abnormal brain diffusion restriction. The dural venous sinuses are patent. The visualized paranasal sinuses are clear.Cranial MR Angiography:Again noted is fusiform dilatation and tortuosity of the supraclinoid/intradural segment of the right internal carotid artery, with a maximum diameter of 8 mm, extending into and mildly involving the right A1 segment and proximal portion of the right A2. There is infundibulum along the origin of lenticulostriate artery trunks at the distal right internal carotid artery and the proximal right anterior cerebral artery A1 segment which collateralize to reconstitute the right middle cerebral artery. There is enlargement of the right recurrent artery of Heubner which supplies right sided lenticulostriate arteries to the right basal ganglia and also collateralizes to the right middle cerebral artery through these lenticulostriate arteries. The tortuous fusiform dilatation results in mild mass effect on the right uncus is unchanged. An anterior communicating artery is present. There are dilated pial vessels along the watershed zone between the right anterior middle cerebral arteries suggesting leptomeningeal collateral reconstitution of the right middle cerebral artery.There is a developmental venous anomaly present along the right thalamus.The left internal carotid artery is preserved in caliber and flow-related signal. The left anterior and middle cerebral arteries are preserved as well. The basilar artery is codominantly supplied by the vertebral arteries. The right posterior communicating artery is medium-sized. The left posterior communicating artery is very small. Anterior communicating artery is medium-sized. There is triplication of the anterior cerebral artery. The vertebral arteries are similar in size.

Output: 1.Fusiform aneurysmal dilatation of the distal ophthalmic and communicating segment of the right internal carotid artery with extension into the right A1 and proximal right A2 segment are stable compared with the prior exam.2.There is a redemonstration of occlusion of the right middle cerebral artery at its origin with collateral reconstitution through lenticulostriate arteries as well as well as leptomeningeal collaterals. This gives a unilateral moyamoya like picture.3.Several punctate left frontal T2/FLAIR periventricular and subcortical white matter lesions are nonspecific and unchanged.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with altered mental status. Assess for stroke. A 4 mm focus of mildly restricted diffusion is seen within the white matter adjacent to the left ventricular atrium. A similar lesion was seen on the prior examination at 6/18/2015 but is now reduced in signal intensity. No other definite diffusion restricting lesions are seen.Motion artifact substantially degrades image quality on most of the other sequences. Mild patchy foci of T2 hyperintensity are evident within the cerebral white matter and the pons. Scattered foci of susceptibility are also evident, the largest of which are within the inferior aspect of the right postcentral gyrus, stable, and along the right basal ganglia, possibly new.Postcontrast images are degraded, but no definite pathologic intracranial enhancement is seen.Thin bilateral subdural collections are evident along the cerebral hemispheres demonstrating T2 hyperintense and T1 isointense signal. These collections are symmetric bilaterally and measure no more than 3 mm in thickness. They exert no significant mass effect upon the brain.The ventricles and sulci are stable in caliber relative to the prior exam.

Output: 1.Small evolving late subacute small vessel stroke within the left periatrial white matter.2.Evidence of chronic small vessel ischemic disease and scattered microhemorrhage.3.Interval development of small symmetric bilateral subdural collections which could represent very small subdural hemorrhages or nonhemorrhagic effusions. These exert no significant mass effect upon the brain. Imaging follow-up is suggested to document resolution.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of testicular cancer. Evaluate for metastatic disease. Due to a technical malfunction, the precontrast T1 and majority of postcontrast images of the abdomen were reviewed on a separate imaging viewing system.ABDOMEN:LIVER, BILIARY TRACT: No hepatic lesions. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate T2 hyperintensities are too small to characterize. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:Due to a technical malfunction, only the three-minute postcontrast series of the pelvis was available on PACS.PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence for abdominopelvic metastatic disease.


Instruction: Generate impression based on findings.

Input: Known CCM lesions, yearly follow up,. There is an unchanged punctate focus of susceptibility effect in the right pons. There is no evidence of acute intracranial hemorrhage or acute cerebral infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged punctate right pontine lesion that is compatible with a cavernous malformation.


Instruction: Generate impression based on findings.

Input: 28 year old male with a history of non-ischemic cardiomyopathy s/p heart transplant in 4/2016, hypertension, history of pericarditis now with chest pain. Referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 59 ml/m2 (normal range: 74+/-15), the LVEDV is 140 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 28 g/m2 (normal range 85+/-15), and the LV mass is 66 g (normal range 164+/-36). There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation times are normal (1000-1050 ms). The ECV fraction is also within normal limits. The global relative enhancement ratio is mildly elevated (4.8).Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is evidence of pericardial late gadolinium enhancement suggesting pericardial inflammation or fibrosis. There is no CMR evidence of constriction based on myocardial tagging and absence of interventricular septal variation with respiration. Extracardiac FindingsThere are sternotomy wires present consistent with previous surgery. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 55%) without any late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and normal in systolic function (RVEF 50%).3. There is evidence of pericardial late gadolinium enhancement suggesting pericardial inflammation or fibrosis. No evidence of pericardial constriction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 57 years, Female, with history of multiple sclerosis. Off treatment for over one year. Several T2/FLAIR hyperintense lesions are seen in the periventricular and deep white matter, many are ovoid and perpendicular to the corpus callosum, similar in distribution and size compared to prior study, and compatible with known demyelinating disease. No new lesion is appreciated, with mild motion degradation and slight differences in technique slightly limiting comparison of small lesions. There is mild to moderate burden of T1 hypointense foci, unchanged. Mild parenchymal volume loss similar to prior. No abnormal enhancement.

Output: Compared to 10/12/2009, there is no evidence of progression of demyelinating disease.


Instruction: Generate impression based on findings.

Input: Known mycosis fungoides and CNS involvement. Brain: There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is no evidence of acute infarct. There is persistent diffuse enhancement of the cisternal segments of the bilateral trigeminal nerves and oculomotor nerves, left more than right. There also appears mild diffuse enhancement involving the bilateral facial nerves. There are persistent mild nonspecific patchy areas of high T2 signal in the cerebral white matter bilaterally. The rest of the brain parenchyma appears to be unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is persistent mild high T2 signal and hyperenhancement of the left inferior, medial, and superior oblique muscles. The high T2 signal in the right inferior recuts muscle appears to have resolved. The bilateral globes, lacrimal glands, and optic nerves are otherwise unremarkable.

Output: 1. Persistent enhancement of multiple cranial nerves related to lymphoma.2. Residual mild denervation edema in the extraocular muscles supplied by the left oculomotor nerve.


Instruction: Generate impression based on findings.

Input: Elevated alkaline phosphatase. Evaluate bile ducts,? PTLD. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. Mild extrahepatic biliary ductal dilatation. The common duct measures up to 10 mm. However it tapers smoothly and is well seen to the level of the ampulla. No evidence of choledocholithiasis or pancreatic head mass.SPLEEN: Spleen measures upper limits of normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys are atrophic and demonstrate bilateral simple cysts. Few complex left renal cysts. No hydronephrosis or hydroureter. Right iliac fossa renal transplant is partially imaged and incompletely evaluated.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right lower quadrant renal transplant

Output: 1.No specific evidence of post transplant lymphoproliferative disorder.2.Mild dilation of common bile duct. No evidence of pancreatic head mass or choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with atypical facial pain, pre-DBS evaluation. No evidence of parenchymal edema or mass effect is seen. A 5 mm thick plaque-like area of dural enhancement along the left aspect of the interhemispheric falx at the paracentral lobule may represent a meningioma. No pathologic parenchymal enhancement is seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricular size and morphology are within normal limits.

Output: No significant parenchymal abnormalities are detected. A small area of dural thickening along the interhemispheric falx may represent an incidental meningioma.


Instruction: Generate impression based on findings.

Input: Female, 28 years old. Reason: eval for stress fracture femoral neck History: hip pain for 6 weeks while training for a marathon. Localized to groin and joint. There is abnormal signal on T2 sequences along the medial aspect of the left distal femoral neck/proximal diaphysis adjacent to the lesser trochanter. There is minimally decreased signal locally on T1 sequences. No discrete fracture line is seen. Findings are consistent with a stress reaction.The remainder of the bone marrow appears normal. The musculature is unremarkable.

Output: Findings compatible with a stress reaction along the left distal femoral neck/proximal diaphysis. No discrete fracture line is seen.


Instruction: Generate impression based on findings.

Input: Foot swelling MRI of the forefoot and midfoot was performed although the most proximal aspect of the cuboid and navicular are not included in the coverage.Within the limits of the provided field of view, there are no findings to suggest the presence of abscess. There are also no marrow abnormalities to confirm osteomyelitis. Muscles and tendons are unremarkable. There is mild osteoarthritis of the midfoot and moderate to severe osteoarthritis of the first MTP joint. A small focus of signal void is noted medial to the head of the first metatarsal which may represent susceptibility artifact from prior intervention.

Output: Osteoarthritis without evidence of abscess or osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: hx of prostate cancer, scheduled for prostatectomy, evaluate further to guide nerve sparing and for extraprostatic disease History: see aboveBiopsy 3/22/2016: Right base Gleason 6, right mid Gleason 6, right apex Gleason 7, left apex Gleason 7 PELVIS:PROSTATE:Prostate Size: 4.4 x 2.8 x 3.4 cmPeripheral Zone: There is ill-defined low T2 signal in the left mid and apex peripheral zone (801/10) without early enhancement, suspicious for prostate adenocarcinoma. In the left apex, this lesion measures approximately 2.0 x 1.2 cm and has an ill-defined capsule with enhancing spiculations (801/11), suggestive of extracapsular extension.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left apical lesion lies immediately adjacent to the capsule which is ill-defined with enhancing spiculations, suggestive of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Ill-defined region of low T2 signal in the left mid and apex peripheral zone is suspicious for prostatic adenocarcinoma with findings suggestive of extracapsular extension.2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Reason: L1 bone and sacrum biopsy History: pt with bil. lower extremity pain Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. There is anterior fusion of T12 on L1.

Output: L1 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis. One sample for flow cytometry and six for surgical pathology.


Instruction: Generate impression based on findings.

Input: 25-year-old female with history of AML status post embolization. Limited exam; only wide field of view survey images obtained.Multiple bilateral renal lesions are incompletely evaluated. Gravid uterus.

Output: Limited exam as above. Bilateral renal lesions are incompletely evaluated. Recommend patient returns to complete exam when clinically appropriate.


Instruction: Generate impression based on findings.

Input: 18 year-old male with rupture of previous left knee ACL reconstruction. Evaluate tunnel position.IMAGE ACQUISITIONS: CT of the left knee; IV administration of 80 cc of iodinated contrast at 2 cc/sec. Transverse, coronal, sagittal re-formations provided. Patient is status post ACL reconstruction, although the graft appears disrupted as seen on recent MRI study. The tibial tunnel begins at the intercondylar eminence between the medial and lateral tibial spines and courses anteriorly and medially through the proximal tibia, breaching the anteromedial cortex. The slope of the tunnel is greater than that of Blumenstadt's line.The femoral tunnel originates near the junction of the physeal scar and posterior femoral cortex and courses superomedially, where it intersects with two tunnels created by crossed pins.Please note that the ACL itself is not well seen on this CT study nor are the menisci. The PCL is seen on the sagittal reformatted images. A small joint effusion is noted. The remaining visualized bone and soft tissue structures are within normal limits.

Output: Postoperative changes as described above.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of HCV cirrhosis and liver lesions who presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology with the liver measuring 18-cm in length. There is no suspicious arterially enhancing and washing out lesion to suggest hepatocellular carcinoma. Subcentimeter foci of arterial enhancement scattered at the periphery of the liver, likely perfusional abnormality.SPLEEN: Spleen measures 11 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhosis without evidence of suspicious arterially enhancing and washing out lesion.


Instruction: Generate impression based on findings.

Input: Low back pain radiating to the left leg. There is a disc desiccation and bulge at L4-L5 with superimposed disc extrusion that extends into the left lateral recess with impingement upon the descending left L5 nerve roots. There is no significant neural foramen stenosis. There are trace effusions in the L5-L5 facet joints bilaterally with an associated subcentimeter posterior right synovial cyst. There is mild loss of the usual lumbar lordosis. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Disc desiccation and bulge at L4-L5 with superimposed disc extrusion that extends into the left lateral recess with impingement upon the descending left L5 nerve roots.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of a right frontal craniotomy with resection of a right middle frontal gyrus lesion. At the superior margin of the resection cavity, there is again a non-specific enhancing nodule which measures approximately 5 mm in greatest dimension. This has not significantly changed since the prior examinations dating back to 7/5/2016. There are foci of susceptibility artifact again seen within the surgical bed, likely related to hemosiderin deposition. A heterogeneous ring-enhancing lesion is again seen extending into the trigone of the right lateral ventricle, which measures 21 x 15 mm (series 1100, image 90) compared to 21 x 16 mm previously. Portions of the wall of the lesion again demonstrate restricted diffusion and enhancement, similar to the previous examination. Stable FLAIR signal abnormality surrounding the lesion is consistent with vasogenic edema. No new enhancing lesions are identified.Scattered foci of signal hyperintensity on FLAIR and T2-weighted images in the periventricular and subcortical white matter likely reflect chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1.A right periventricular white matter lesion appears stable compared to the prior exam on 11/24/2016. No new enhancing lesions are identified.2.Stable appearance of the right middle frontal gyrus resection cavity.


Instruction: Generate impression based on findings.

Input: History of elective carotid stenting on 11/2/15 for an incidental 2.3 cm right-sided carotid aneurysm. The stent was deployed in the appropriate location, but the superior portion of the stent retracted into the aneurysmal sac and was unable to be re-wired. The patient complained of a headache and nausea the following morning which prompted a CT head which demonstrated a new region of hypodensity in the lateral right precentral gyrus. There are multiple foci of restricted diffusion and corresponding T2 hyperintensity involving the grey-white matter junctions in the right cerebral hemisphere. The largest area is in the right frontal opercular region and measures up to approximately 20 mm. There is a partially-imaged stented pseudoaneurysm that measures up to 25 mm in width. In particular, the superior end of the stent lies within the pseudoaneurysm sac, rather than within the parent vessel, which appears to be compressed by the pseudoaneurysm. There is no evidence of intracranial hemorrhage or mass. 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 grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is high T2 signal and enhancement surrounding the root of a left mesiodens.

Output: 1. Multiple acute to early subacute right cerebral hemisphere infarcts essentially scattered throughout the middle cerebral artery territory, which may represent an embolic stroke related to the recent endovascular stenting of the right cervical internal carotid artery pseudoaneurysm. 2. The cervical right internal carotid pseudoaneurysm has not decreased in size and the superior end of the stent lies within the pseudoaneurysm sac, rather than within the parent vessel. Dedicated vascular imaging may be useful for further evaluation.2. Possible inflammatory changes associated with a left mesiodens.


Instruction: Generate impression based on findings.

Input: There is a subcentimeter T2 hyperintense enhancing focus within the dorsal columns of the cervical cord at the level of the C3 vertebral body, without appreciable expansion of the spinal cord. At C3-4, there is a posterior disc-osteophyte complex that slightly effaces the anterior thecal sac CSF. At C4-5, there is a disc-osteophyte complex with an eccentric left disc protrusion that indents the anterior aspect of the spinal cord. At C5-6, there is a disc-osteophyte complex that mildly indents the spinal cord. There is no significant neural foraminal stenosis in the cervical spine. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. The cerebellar tonsils extend up to 2 mm inferior to the foramen magnum.THORACIC SPINE

Output: 1. A subcentimeter enhancing lesion within the cervical spinal cord at the level of C3 may represent active demyelinating disease, an infectious myelitis, or autoimmune process, or vasculitis, for example. A brain MRI with contrast may be useful for further evaluation of disease extent if clinically warranted.2. Multilevel posterior disc-osteophyte complexes within the cervical spine, with impingement upon the spinal cord at C4-5. 3. The thoracic spine is unremarkable.


Instruction: Generate impression based on findings.

Input: Patient is a 53-year-old man with end-stage hepatitis B liver cirrhosis and portal hypertension who presented with altered mental status, acute respiratory and renal failure and hypotension now with multiorgan failure status post intubation with unclear neurological prognosis. Please evaluate for ischemia, cerebral edema, and encephalopathic changes. There is no evidence of intracranial hemorrhage, mass or edema. There are no CT findings of stroke, however if stroke is of clinical concern recommend MRI.The ventricles and basal cisterns are normal in size and configuration. There are no CT findings of cerebral edema.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Pain status post fall. Evaluate for fracture. Right hip: The bones appear demineralized, suggesting osteopenia/osteoporosis. Mild osteoarthritis affects the right hip. I see no fracture.Left hip: The bones appear demineralized, suggesting osteopenia/osteoporosis. Mild osteoarthritis affects the hip. I see no fracture line. A faint triangular-shaped density is noted within the soft tissues projecting lateral to the ischium. I see no donor site, and this may be chronic in etiology. However, if the patient complains of pain along her left ischial tuberosity, then CT or MRI may be considered to assess for a hamstring avulsion fracture.

Output: No fracture line is evident. A faint triangular-shaped density within the soft tissues projecting lateral to the ischium may be chronic in etiology; however, if the patient complains of pain along her ischial tuberosity, then CT or MRI may be considered to assess for hamstring avulsion fracture.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is deformity of the posterior horn of the medial meniscus likely relating to an overlying osteochondral lesion however there is no discrete tear identified. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: An osteochondral lesion is seen involving the medial femoral condyle measuring 1.6 cm in both the AP and transverse dimensions. There is loss of the overlying articular cartilage with increased marrow signal within the femur suggesting some component of instability. The lateral compartment is normal. There is mild irregularity of the articular cartilage of the medial patellar facet without full-thickness defect. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Osteochondral defect within the medial femoral condyle measuring approximately 1.6 cm. There is slightly increased marrow signal surrounding the lesion which may suggest a component of instability however there is no fluid signal undercutting the lesion and no evidence of detachment.


Instruction: Generate impression based on findings.

Input: Left shoulder pain The examination is limited by motion and by the patient's body habitus.ROTATOR CUFF: There is increased signal of the supraspinatus tendon particularly near its insertion on the greater tuberosity. This likely reflects tendinopathy with interstitial or partial thickness tearing although no discrete full-thickness tear of the rotator cuff is identified. There is a similar appearance of the infraspinatus tendon although again no discrete full-thickness tear is appreciated. There is tendinopathy of the supraspinatus tendon without evidence of full-thickness tear. There is no significant muscle atrophy.SUPRASPINATUS OUTLET: Mild hypertrophic changes of the acromioclavicular joint noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased signal of the anterior inferior labrum suggesting tearing but no full-thickness detachment is appreciated. There is loss of the articular cartilage of the glenohumeral joint and subchondral cystic changes noted at the insertion of the rotator cuff on the greater tuberosity.BICEPS TENDON: Mild amount of fluid is seen surrounding the biceps tendon which is otherwise intact. ADDITIONAL

Output: Limited examination secondary to motion artifact and the patient's body habitus. There is suspected high-grade partial-thickness articular surface tearing of the supraspinatus superimposed upon severe tendinopathy. Similar tendinopathic changes of the infraspinatus are also noted without evidence of discrete full-thickness tear. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate intracranial hemorrhage. Signs and symptoms: Headache with seizure. CT of brain without infusion:No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Vertical sulci, ventricular system and all CSF cisterns remain within normal. There are subtle foci of low-attenuation in the subcortical white matter of both cerebral hemispheres. These findings are suspect that for small vessel disease of indeterminate age. These findings were noted on prior MRI examination from 3 -- 16 -- 2009. In comparison with prior CT examination from 11 -- 5 -- 2009 no definitive appreciable interval change is detected.Calvarium, limited view of paranasal sinuses and mastoid air cells are also unremarkable.

Output: 1.No evidence of hemorrhage as clinically is suspected.2.Findings consistent with small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: History of numbness and pain in the lower extremity, history of metastatic prostate cancer with known spinal metastasis. Rule out cord compression. Motion degraded exam. No definite abnormal signal intensity within the cord to suggest acute cord compression. No definite compromise of the spinal cord. There are extensive metastatic bony lesions involving all vertebral body levels as seen on prior nuclear medicine bone scan. Posterior disc osteophyte complex at C6-C7 without compromise of the cord. Prominent dorsal epidural lipomatosis in the thoracic spine and lumbar spine levels.

Output: Limited exam due to motion artifact. Within this limitation, no cord compression is identified. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Extensive osseous metastatic lesions throughout the spine.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Bilateral shoulder pain. Right hip pain. Right shoulder:Moderate to severe osteoarthritis with bulky osteophytes, sclerosis, and subchondral cysts.Left shoulder:Osteoarthritic changes appear mildly progressed with new chondrocalcinosis.Right hip:Moderate to pronounced osteoarthritic changes. The femoral head shape is preserved.

Output: 1. Moderate to severe bilateral shoulder osteoarthritis.2. Moderate to pronounced osteoarthritic changes of the right hip.


Instruction: Generate impression based on findings.

Input: Patient with history of parotitis and sialolithiasis status post endoscopic removal of stones. Now with right parotid cutaneous fistula and infection, recurrent abscess in the past 3 months. There has been interval removal of the right parotid duct calculi. However, there is now a tract that extends from the overlying skin to the and decreased inflammation involving the junction between the parotid gland and parotid duct. There is diffuse enhancement of the right parotid gland and overlying subcutaneous tissues, but this is less extensive than on the prior exam and there is no evidence of abscess or discrete tumor. There are mildly prominent right parotid lymph nodes, which are likely reactive. The left parotid gland and submandibular glands appear to be unremarkable. There is interval resolution of the fluid and mucosal thickening within the right maxillary sinus. There is a ovoid cystic lesion in the left auricle, which may represent an inclusion cyst. There is a partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.

Output: 1. Interval removal of the right parotid duct calculi with development of a parotid-cutaneous fistula. Diffuse enhancement of the right parotid gland and overlying subcutaneous tissues related to parotitis, albeit less extensive than on the prior exam and no evidence of abscess or discrete tumor.2. Partially-characterized left supraclinoid internal carotid artery aneurysm that measures up to approximately 15 mm.


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:4/12/1954)Reason: Brain tumor History: SeizuresPROVIDER/ATTENDING NAME: CHRISTOPHER M GOMEZ CHRISTOPHER M GOMEZ The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a 23 x 14 mm axial dimension right parafalcine mass located adjacent to the right cingulate gyrus. There is a cortical venous structure and an ACA branch interposed between the mass and the falx suggesting this mass is intra-axial. There is associated dural and leptomeningeal enhancement. There is adjacent vasogenic edema. There is redemonstration of leptomeningeal enhancement along the right cingulate sulcus adjacent to this above described mass. It is significantly larger compared to the December 2012 exam when it measured approximately 8 mm.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 a mass present involving the right cingulate gyrus associated with some leptomeningeal enhancement. This mass demonstrated significant growth since December suggesting it is an aggressive/higher grade lesion. Differential considerations include primary brain tumor, metastatic disease, lymphoma, granuloma and infection. Given the leptomeningeal reaction this brings to mind lesions with a tendency towards leptomeningeal reaction such as pleomorphic xanthoastrocytoma, granuloma and lymphoma.


Instruction: Generate impression based on findings.

Input: Left lateral thigh numbness, history of breast cancer. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is heterogeneous without discrete lesions appreciated. No abnormal enhancement. The conus medullaris is normal in position.Minimal 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: Minimal disc bulge eccentric to the right. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge eccentric to the right. Minimal right neural foraminal narrowing. No spinal canal or left neural foraminal stenosis. There is mild facet arthropathy, worse on the left.L5-S1: Disc desiccation with mild loss of height. No spinal canal or neural foraminal stenosis. Mild left-sided facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Minimal degenerative changes in the lumbar spine as described above without significant spinal canal or neural foraminal stenosis at any level.2. No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 45-year-old female with right knee pain, evaluate for medial meniscal tear MENISCI: There is an oblique undersurface tear of the posterior horn of the medial meniscus that extends into the body. There is no associated flip fragment or meniscal extrusion. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a small focus of full-thickness cartilage loss at the medial trochlea that is approximately 6 mm. The articular cartilage is otherwise unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Oblique undersurface tear of the posterior horn of the medial meniscus with extension into the body.2. Small focus of full-thickness cartilage loss at the medial trochlea.


Instruction: Generate impression based on findings.

Input: 42-year-old female with a painful growing mass. 2 vitamin E capsules overlying the medial soft tissues of the right foot, presumably corresponding to the patient's palpable area of concern. Interposed between these 2 markers is a lobulated focus of fluid signal intensity along the medial aspect of the navicular bone, measuring 1.5 x 1.0 x 1.1 cm with minimal peripheral enhancement on postcontrast sequences consistent with a ganglion. No additional enhancing mass lesions are identified. There is mild fatty infiltration of the flexor hallucis longus. The peroneal tendons appear intact. The extensor tendons appear intact. The flexor tendons appear intact. The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The imaged components of the deltoid ligament appear intact. There is a small amount of fluid within the tibiotalar joint without evidence of a large effusion. There is a small amount of fluid within the subtalar joint.

Output: 1.5 cm mass within the soft tissues along the medial aspect of the navicular bone most consistent with a ganglion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: concern for cerebral venous thrombosis History: see MRI brain order - blurry vision, headache, D-dimer elevated and OCP use MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening along the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Low marrow signal in the visualized osseous structures is non-specific but probably at least in part related to the patient's younger age.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left transverse sinus, sigmoid sinus and jugular vein are larger than their right sided counterparts; this is a a normal variation.

Output: 1.No abnormal lesions are appreciated intracranially.2.MR venogram of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Right leg weakness for months. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse patchy cerebral white matter T2 hyperintensity and a more focal areas of T2 hyperintensity in the right basal ganglia and pons. There are multiple scattered foci of supratentorial and infratentorial susceptibility effect. 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. There is partially imaged multilevel degenerative spondylosis of the cervical spine.

Output: Findings suggestive of chronic small vessel ischemic disease, scattered chronic microhemorrhages, and chronic right lacunar infarcts in the right basal ganglia and pons, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 64 years, Female, evaluate for frontal meningioma, status post resection and radiation and continues to have headaches that are worse than usual. Also a seizure history. Examination is severely limited. Postsurgical changes of bifrontal craniotomy and encephalomalacia involving the inferior frontal lobes, left greater than right, again seen and better appreciated previously. No evidence of acute infarct. There is no gross intracranial mass effect, midline shift, or herniation. No hydrocephalus. Note this examination is not adequate to assess for small tumor recurrence.There appears to be diffuse opacification of the right frontal sinus and right posterior ethmoid air cells, which has been present on multiple prior studies.

Output: 1. Severely limited exam due to patient's claustrophobia; please see comment in technique section. There is no large mass, intracranial mass effect, midline shift, or herniation. Note this examination is not adequate to assess for small tumor recurrence.2. There appears to be diffuse opacification of the right frontal sinus and right posterior ethmoid air cells, which has been present on multiple prior studies.


Instruction: Generate impression based on findings.

Input: 19-year-old male patient with increased right knee pain and swelling. Known OCD lesion at the medial femoral condyle. Assess for loose body. MENISCI: The medial meniscus and lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: Again seen is a large ovoid focus of subchondral marrow signal abnormality within the medial femoral condyle consistent with a known osteochondral defect. The lesion is low signal intensity on T1-weighted images and heterogeneous on T2 weighted images. Extensive subchondral cyst formation is noted within this region along with bone marrow edema surrounding the defect within the posterior medial femoral condyle. The defect is similar in size to the prior examination measuring approximately 3 cm in the transverse dimension and 2.4 cm in craniocaudal dimension. The underlying cartilage appears degenerated though no intervening T2 signal is identified to suggest instability. There is a new crescentic region of signal abnormality within the anteromedial aspect of the medial femoral condyle consistent with an osteochondral defect. This defect measures approximately 1.3 cm in the AP dimension, 1.2 cm in the transverse dimension, and has a depth of approximately 0.9 cm. The defect itself demonstrates increased T2 signal though there is no intervening T2 signal to suggest instability. The underlying cartilage is degenerated without full-thickness defect.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. New osteochondral defect with the anterior aspect of the medial femoral condyle. Similar appearance of an existing osteochondral defect with the posterior medial femoral condyle.2. Large Baker's cyst. No definite loose body.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: There is left central disc protrusion which indents the anterior cord surface without intrinsic cord signal abnormality and no resulting stenosis.C4/5: Mild disc bulge containing a posterior central annular tear without cord abutment and no resulting stenosis.C5/6: Left paracentral disc protrusion which causes slight anterior left hemicord flattening without intrinsic cord signal abnormality and no resulting stenosis.C6/7: Tiny left paramedian disc protrusion without cord abutment and no resulting stenosis.C7/T1: Unremarkable

Output: 1.C3/4: Left central disc protrusion which indents the anterior cord surface without intrinsic cord signal abnormality and no resulting stenosis.2.C4/5: Mild disc bulge containing a posterior central annular tear without cord abutment and no resulting stenosis.3.C5/6: Left paracentral disc protrusion which causes slight anterior left hemicord flattening without intrinsic cord signal abnormality and no resulting stenosis.4.C6/7: Tiny left paramedian disc protrusion without cord abutment and no resulting stenosis.


Instruction: Generate impression based on findings.

Input: Status post endoscopic third ventriculocisternostomy for hydrocephalus due to aqueduct stenosis. Scoliosis and lipomyelomeningocele status post L4 and L5 osteoplastic laminoplasty, repair, and subtotal resection of intradural lipoma causing spinal cord tethering. Brain: There are postoperative findings related to endoscopic third ventriculostomy. There is no discernible CSF flow across the third ventriculostomy. There is no significant interval change in the marked dilatation of the lateral and third ventricles with mild mass effect upon the brainstem and cerebellum. There is no evidence of acute infarction, hemorrhage, or tumors. There is no midline shift. The major cerebral flow voids are grossly intact. The skull and scalp soft tissues are unchanged. There is persistent fluid within the bilateral middle ears and mastoid air cells.Spine: There is unchanged cervicothoracic scoliosis and postoperative findings related to lipomeningocele surgery in the lumbar spine. There is persistent fluid signal within the central spinal cord diffusely, which measures up to 2 mm in width. The conus medullaris terminates at the L3-4 level. There is an unchanged fatty signal intensity of the filum terminalis and fat within the spinal canal extending from L5 to S3. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a distended urinary bladder.

Output: 1. No significant interval change in the hydrocephalus associated with the aqueductal stenosis.2. No discernible CSF flow across the third ventriculostomy.3. Unchanged cervicothoracic scoliosis.4. The conus medullaris terminates at the L4 level and there is an unchanged fibrofatty filum terminalis and fat within the spinal canal that extends from L5 to S3. 5. Unchanged long-segment syrinx.


Instruction: Generate impression based on findings.

Input: 54-year-old woman with history of meningioma. Postsurgical changes of a subtotal resection of sellar and suprasellar meningioma are again seen. Again seen is an avidly enhancing lesion in the pituitary fossa which extends along the planum sphenoidale and posteriorly along the clivus into the interpeduncular and prepontine cisterns. This lesion also surrounds the supraclinoid internal carotid arteries, right greater than left. The optic chiasm is indistinguishable from and surrounded by this lesion. This lesion has not changed in size compared with most recent as well as MRI examination on 11/17/2014. There is no new mass effect on the adjacent brain. There are postsurgical changes of prior bifrontal craniotomy with encephalomalacia and increased subcortical T2/FLAIR signal in the bilateral anterior and inferior frontal lobes.Additional, scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter is nonspecific but compatible with small vessel ischemic disease. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. The ventricles are within normal limits in size and configuration. The major flow-voids are preserved. There is mucosal thickening with atelectasis of the left maxillary sinus, stable from prior examinations and compatible with chronic sinusitis.

Output: Stable appearance of the residual meningioma and posttreatment changes.


Instruction: Generate impression based on findings.

Input: 37-year-old female patient with chronic diarrhea, perianal abscess fistula. Confirm diagnosis of Crohn's. ABDOMEN:LIVER, BILIARY TRACT: A subcentimeter T2 hyperintense focus within the right hepatic dome too small to characterize, but likely a cyst. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are no areas of bowel wall thickening, restricted diffusion, or abnormal enhancement. The terminal ileum is normal in appearance. No small bowel obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No intraabdominal abscess is identified.PELVIS:UTERUS, ADNEXA: A cystic lesion within the right ovary is likely physiologic in a premenopausal female. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially imaged and assessed are bilateral perianal fistulous tracts, right greater than left, with the right fistulous tract extending to the right gluteal cleft. The origin of the fistulae is difficult to ascertain, though they appear to originate at approximately the 6 to 7 o'clock position. No associated abscess is identified.OTHER: No intrapelvic abscess is identified.

Output: 1. Partially assessed bilateral perianal fistulae as described above. No associated abscess.2. Relatively normal appearing small and large bowel otherwise.


Instruction: Generate impression based on findings.

Input: Male 73 years old Reason: Adrenal and kidney lesion - please evaluate History: Adrenal and kidney lesion - please evaluate ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule is mildly T2 hyperintense shows enhancement does not have significant intra-Voxel fat. There are small foci of signal dropout on out of phase imaging but the majority of the lesion does not lose signal.KIDNEYS, URETERS: Small bilateral renal cysts. Some of the cysts in the kidney have internal complexity and several septations. No hydronephrosis.The previously measured left upper pole renal lesion currently measures 3.3 cm likely due to differences in technique. The lesion is hyperintense on T2-weighted imaging and shows some hairline internal enhancement and is compatible with a minimally complex cyst.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left adrenal gland nodule may represent a lipid poor lipoma given its signal characteristics. It remains indeterminate but probably benign given its size stability for a year.2.Bilateral small renal cysts some of which have increased complexity with internal septations.3.The 3.3 cm left upper pole renal cyst has minimal internal complexity.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of meninges, unspecifiedClinical question: change in meningiomaSigns and Symptoms: multiple unrelated There is redemonstration of a calcified focus present along the falx cerebri on the right side it is low signal on all pulse sequences and has susceptibility effect associated with it.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities in the maxillary sinuses which were also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A right parafalcine lesion is calcified. It could represent a branch out meningioma for example. It is unchanged since previous exams2.Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.3.Periventricular and subcortical white matter signal changes of a mild degree are present. Given the small number, it is suspected that these are of little clinical significance.


Instruction: Generate impression based on findings.

Input: Anterior knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The lateral and medial compartments are unremarkable. A bipartite patella is noted. The articular cartilage which overlies the interface of the bipartite patella demonstrates a small focus of low signal intensity which may represent an area of degeneration. Immediately deep to this area is an 8 mm rounded focus of near fluid signal intensity which is situated within the joint between the bipartite patella and anterior aspect of the lateral femoral condyle. The etiology of this finding is uncertain but may represent a small ganglion. The remaining femoral cartilage of the femoral trochlea and remaining patella is otherwise normal.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Subcentimeter nodular focus of near fluid signal intensity within the joint immediately anterior to the lateral femoral condyle and subjacent to the patella is of uncertain clinical significance but may represent a ganglion arising from focally degenerated cartilage overlying a bipartite patella. Remaining MRI evaluation of the knee is otherwise normal.


Instruction: Generate impression based on findings.

Input: 65-year-old male with type 2 diabetes mellitus with unspecified complication. Right diabetic foot ulcer. Rule out osteomyelitis. TENDONS: The flexor and extensor tendons appear grossly intact. The peroneal tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the fifth metatarsal remnant on fluid sensitive sequences with decreased signal abnormality on T1-weighted sequences consistent with osteomyelitis. There is cortical distinctness along the lateral aspect of the base of the fifth metatarsal consistent with osteolysis. No focal fluid collection is identified, although evaluation for abscess formation is limited on this noncontrast examination. Note is made of postsurgical changes of prior transmetatarsal amputation.ADDITIONAL

Output: Findings consistent with osteomyelitis of the base of the fifth metatarsal remnant as described above. No focal fluid collection to suggest abscess formation, within the limitations of a noncontrast examination. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for tFCC tear History: wrist pain for a month with tennis; history of tfcc tear on left LIGAMENTS: No contrast is present in the mid carpal row, suggesting the scapholunate and lunate-triquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC is in contact, no contrast is seen in the distal radioulnar joint.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Normal examination of the right wrist.


Instruction: Generate impression based on findings.

Input: Male, 41 years old, with anaplastic astrocytoma, follow-up exam. Again seen are sequelae of right frontal craniotomy and right frontal lobe surgery for tumor resection. Heterogeneous extradural and probable subdural collections along the craniotomy flap have not significantly changed from the prior examination. A thick rim of enhancement along the periphery of these collections, best seen on delayed postcontrast images, likely represents granulation and is not significantly changed.The right frontal lobe is severely encephalomalacic. The right frontal horn shows ex vacuo dilatation, more pronounced than on the prior exam. T2 hyperintensity and gyral thickening within the inferior right frontal gyri are not significantly changed when compared to the prior two examinations. T2 hyperintensity within the right middle and superior frontal gyri is slightly progressed from the exam of 11/10/2014, but similar to that seen on 7/12/2014. A small focus of white matter T2 hyperintensity along the posterior right lateral ventricle body is new.T2 hyperintensity and thickening of the genu of the corpus callosum, with some associated diffusion restriction appears similar to the prior exam of 11/10/2014, and improved when compared to 7/12/2014. T2 hyperintensity extending into the left periventricular white matter has progressed when compared to both prior exams.Single and multi voxel spectroscopy was performed on the areas of signal abnormality surrounding both the left and right frontal horns. No unequivocally suspicious choline elevation is seen, and most voxels show either benign or nonspecific metabolite patterns. rCBV mapping was also performed which shows low blood volume correlating to most of the periventricular T2 hyperintense regions. Some elevated blood volume is suspected within the far anterior left frontal lobe but this is of uncertain significance as the parenchyma in this region does not appear thickened or infiltrated.No evidence of pathologic parenchymal enhancement is seen. No new mass effect is detected. Apart from progressive ex vacuo dilatation of the right frontal horn, the ventricular system is not significantly changed.

Output: 1.Demonstration of extensive postoperative findings related to prior right frontal tumor resection.2.T2 hyperintensity within the white matter surrounding the right frontal horn, as well as more posteriorly along the body of the right lateral ventricle, and along the left frontal horn, has progressed compared to the immediate prior examination. There is no associated enhancement in these areas. Spectroscopy and rCBV mapping of this tissue show no definite concerning features. As such, this may simply represent treatment effect with progressive tumor considered less likely.3.Abnormal signal and thickening of the genu of the corpus callosum is similar to that seen on the prior exam, and is improved relative to older studies.


Instruction: Generate impression based on findings.

Input: 46-year-old female with shoulder pain. ROTATOR CUFF: There is a full-thickness insertional tear of the supraspinatus tendon extending slightly posterior to involve the anterior fibers of the infraspinatus as well, measuring approximately 13 mm in the AP dimension, with approximately 1 cm of retraction of the bursal surface fibers. There is increased signal abnormality of the supraspinatus suggesting mild tendinosis. There is minimal fatty atrophy of the supraspinatus muscle at the level of the myotendinous junction. The supraspinatus muscle appears intact. There is mild interstitial tearing and fatty infiltration of the infraspinatus along the myotendinous junction. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Minimal osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Given the limitations of a non arthrogram study, we see no evidence of a labral tear. There is no joint effusion.BICEPS TENDON: The tendon of the long head of the biceps is normal in appearance.

Output: Full-thickness insertional tear of the supraspinatus/infraspinatus with mild retraction. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Follow-up progression. There are numerous periventricular and subcortical FLAIR hyperintense lesions, as well as additional lesions within the brainstem and cerebellum. There is no significant interval change. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. A cavum septum pellucidum et vergae is incidentally noted, a normal variant.

Output: No significant interval change in numerous FLAIR hyperintense lesions, consistent with history of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 43 year-old status post left lumpectomy in July 2015 and re-excision in September 2015 for DCIS. Final pathology reported negative surgical margins. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are post-surgical changes, including a seroma, mild architectural distortions and a few surgical clips at 12:00 position in the left breast. No abnormal enhancement is seen near the surgical site in the left breast. An enhancing focus is unchanged in the left breast at upper outer quadrant. No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable enhancing focus in the left upper outer quadrant.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: NF-2 and bilateral vestibular schwannomas. Prior subtotal resection of right vestibular tumor in 2015. Headaches. There are postoperative findings related to right suboccipital craniotomy, with mild encephalomalacia in the right cerebellar hemisphere. There is an enhancing mass in the right cerebellopontine angle cistern with slight extension into the right internal auditory canal that measures up to 30 mm, previously 25 mm. There is associated mass effect upon the adjacent brainstem and right cerebellar hemisphere. There is also an enhancing lesion in the left cerebellopontine angle cistern internal auditory canal that measures up to 12 mm, previously 10 mm, without significant mass effect upon the cerebellum or brainstem. There is an enhancing lesion along the posterior falx cerebri, measuring up to 5 mm in thickness. There is no evidence of acute infarction. The ventricles are unchanged in size. There is no midline shift or herniation. There is a left maxillary sinus retention cyst.

Output: 1. Interval increase in size of the bilateral vestibular schwannomas, right larger than left.2. A small lesion along the posterior falx cerebri likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: Female 87 years old with a 22mm x 14mm mass in pancreatic head biopsy with EUS 5/25/16. Needle aspiration indicated high-grade neuroendocrine tumor. Evaluate for pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no suspicious, enhancing hepatic lesion. The hepatic vasculature is patent. Please note that the right hepatic artery arises from the SMA.The gallbladder is collapsed. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The tail of the pancreas is atrophic. There is a 20 x 19 mm round, T2 hyperintense, avidly arterially enhancing lesion at the junction of the pancreatic head and uncinate process (series 12, image 134). The pancreatic duct is not dilated. The pancreatic duct crosses the common bile duct suggesting pancreas divisum.ADRENAL GLANDS: Mild nodular thickening of the left adrenal gland is nonspecific.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is a prominent right retrocrural lymph node within normal appearing fatty hilum. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.29 x 19 mm enhancing lesion in the uncinate process of the pancreas is consistent with history of a pancreatic neuroendocrine tumor. 2.No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 43 year old male with paroxsymal atrial fibrillation, refractory to medical therapy and plan for atrial fibrillation ablation. Pre procedure MRI. Left VentricleThe left ventricle is normal in size with globally decreased function. The overall LV ejection fraction is 37%. The LVEDV is 220 ml (normal range 142+/-34), the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVESV is 82 ml (normal range 47+/-19) and the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9). The LV mass is 203 g (normal range 164+/-36) and the LV mass index is 30 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is dilated. The left atrial appendage appears free of clot. Right VentricleThe right ventricle is normal in size with reduced function. The overall RV ejection fraction is 34%. The RVEDV is 264 ml (normal range 142+/-31), RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVESV is 175 ml (normal range 54+/-17), and the RV end systolic volume index is 78 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.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 mild 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 FindingsSmall scattered pulmonary micronodules. Probable left renal cyst. Enhancing left thyroid lobe nodule measuring at least 2.9 cm. 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: 2.9 cm enhancing left thyroid lobe nodule. Correlation with thyroid ultrasound and possible tissue sampling depending on the ultrasound appearance of this lesion is suggested.Left ventricle is normal in size with globally decreased function. The overall LV ejection fraction is 37%. Right ventricle is normal in size with reduced function, RVEF is 34%There are 4 pulmonary veins draining into the left atrium. Left atrial appendage free of clot. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1, consistent with the last exam. There are findings consistent with bilateral L5 pars inter-articularis defects with no significant spondylolisthesis. There is persistent 15-mm wide defect in the anterior/superior endplate of L4 vertebral body with mild loss of signal and height at the L3-4 disk space. There is persistent stable apparent defect in the left posterior elements of S1 consistent with spina bifida occulta. There is no osseous marrow edema. The conus terminates at L1-2.There is no significant spinal canal or neural foraminal stenosis, or disk herniation at any level of the lumbar spine.

Output: Unchanged bilateral L5 spondylolyses without spondylolisthesis, S1 spina bifida occulta and L4 superior endplate Schmorl's node.


Instruction: Generate impression based on findings.

Input: Chronic headaches, occipital and then generalized. Now with new complaint of seeing double. Evaluate anatomy. No evidence of hemorrhage, edema, mass effect among midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns are essentially within normal limits for patient's stated age of 6. Calvarium, paranasal sinuses and in the tibial blastic air cells and middle ear cavities are also within normal. Considering provided clinical date of follow up examination with an MRI is recommended.

Output: Negative nonenhanced CT of brain.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:12/12/1977)Reason: patient with metastatic breast cancer with recent photosensitivity, please evaluate for brain mets History: patient with metastatic breast cancer with recent photosensitivityPROVIDER/ATTENDING NAME: RITA NANDA RITA NANDA 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 evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: 41-year-old male with right pelvic schwannoma Again visualized is a heterogeneously T2 bright, inhomogeneously enhancing mass in the right hemipelvis extending through the sciatic notch. The cranial portion of the bilobed mass measures 6.5 x 4.7 cm and previously measured 6.5 x 4 .3 cm (image 25 series 1001, minimally increased in size. There is mass effect on the posterior aspect of the bladder. The osseous structures appear unremarkable.

Output: Pelvic mass consistent with recurrent schwannoma, minimally increased in size.


Instruction: Generate impression based on findings.

Input: 53-year-old with past medical history of bilateral mastectomies with breast cancer with thickening of the left flap. Postoperative changes of bilateral mastectomies. There is diffuse skin thickening on the left without abnormal enhancement. A focal region of postsurgical scarring and fat necrosis in the left axillary region measures 25 x 15 x 21 mm. On postcontrast images, no suspicious enhancement or mass is seen.No abnormal axillary lymph nodes are identified in either axillary region.Note is made of a T2 bright lesion in the right hepatic lobe which appears similar to prior CT given differences in technique.

Output: Skin thickening of the left breast without abnormal enhancement and postsurgical changes/fat necrosis as described above. No MRI evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with history of lymphoma, left lower extremity weakness and pain, right upper extremity weakness. Evaluate for cord compression, vertebral body involvement or metastases. No acute cord compression is seen. No significant compromise of the spinal canal is noted. The spinal cord as assessed on sagittal imaging is within normal limits.Spinal alignment is anatomic. However, there is patchy marrow replacement compatible with osseous metastatic involvement involving the spine and sacrum. Vertebral body heights are preserved and there does not appear to be any significant epidural disease extension. Multiple intra-abdominal masses are partially visualized as well.

Output: No evidence of acute cord compression. However, there are findings to suggest scattered osseous metastatic involvement.


Instruction: Generate impression based on findings.

Input: 76-year-old male with history of kidney cancer ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver cyst in the hepatic dome, unchanged. No significant abnormality noted.SPLEEN: Subcentimeter T2 hyperintense focus in the spleen is unchanged, possibly a complicated cyst or lymphangioma. No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrent disease.Multiple T2 hyperintense simple appearing renal cysts in the left kidney, unchanged since prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact.Pituitary gland is overall normal in height without discrete mass appreciated. Centrally there is appearance of a partially empty sella. There is however thickened appearance of the pituitary tissue involving the peripheral aspect of the sella, anteriorly where it measures 4 mm in the AP dimension and 11 mm in height as well as posteriorly where it measures 4 mm in the AP dimension and 8 mm in height. Similarly there is prominence of the pituitary tissue involving the lateral aspects of the sella particularly on the left. There is a small defect involving the inferior aspect of the sella on the left with mild associated soft tissue extending inferiorly into the sphenoid sinus measuring approximately 4 mm. Combined the mildy hypoenhancing soft tissue in the left lateral aspect of the sella measures 14 x 11 mm in the craniocaudal and transverse dimensions.(coronal post gad image 6/18). No evidence of cavernous sinus invasion, suprasellar extension, or mass effect on the optic chiasm. The infundibulum is midline. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple unchanged punctate foci of T2 hyperintensity within the supratentorial and infratentorial white matter including the brainstem. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants. There is an apparent partially imaged unchanged expansile mass within the left hemi-maxilla.

Output: 1.Pituitary gland appears normal in height centrally with partially empty sella appearance. There is however prominence of the soft tissue in the peripheral aspects of the sella particularly anteriorly and the left lateral aspect of the sella where there is focal downward bowing/dehiscence of the left sellar floor and extension of 4 mm soft tissue into the left sphenoid sinus. Findings are favored to represent residual pituitary adenoma. Overall appearance is unchanged since 8/30/2013. No suprasellar extension or mass effect on the optic chiasm. Comparison with remote priors may be helpful if available.2.Unchanged mild to moderate chronic small vessel ischemic disease within the supratentorial and infratentorial white matter including the brainstem.3.Unchanged left hemi-maxilla expansile mass is compatible with the presumed fibro-osseous lesion as seen on CT neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 44-year-old female with history of Devics disease. Patient presents with 3 day history of left-sided numbness and right-sided weakness. There is no evidence of intracranial hemorrhage, mass or edema. Patchy diffuse white matter changes compatible with patient's previous MRI. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses, although limited appear patent and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.