Instruction: Generate impression based on findings.

Input: Clinical question: Secondary GBM on Avastin. Signs and symptoms: GBM. Pre and post enhanced brain MRI:Examination demonstrated a large focus of FLAIR/T2 hyperintensity in the left anterior and mid temporal lobe with extension into left remaining inferior frontal lobe and extensive extension medially into the left basal ganglia and left periventricular white matter. Findings demonstrate regional mass effect and with very irregular configuration. Finding is consistent with patient's known GBM. There is no convincing evidence of any interval change in the signal intensity or extent/size of this lesion. On post enhanced images there is a focus of enhancement in the left inferior frontal component of above described finding which minimally extends into the left anterior temporal parenchyma similar to prior exam. All measurements of this focus of enhancement appear fairly similar to prior exam and without convincing evidence of change in size.There is an additional isolated small focus of enhancement in the left periventricular white matter component of this lesion measuring approximately 7 mm in transaxial dimensions which is less conspicuous compared to prior study however without definitive change in size.Above findings results in regional mass effect and effacement of adjacent cortical sulci, subtle mass effect in the left anterior aspect of the lateral ventricle similar to prior exam and without deviation of midline.Stable postoperative changes of left inferior frontal partial lobectomy for removal of tumor. Mild dilatation of the lateral ventricles similar to prior exam.Stable patchy and confluent FLAIR hyperintensity in the left hemisphere which is believed to represent post treatment changes. Possibility of overlapping chronic small vessel ischemic strokes cannot be excluded. No detectable new foci of signal abnormality or new foci of abnormal enhancement since prior exam.

Output: 1.No evidence of an acute or definitive evidence of new finding since prior exam.2.A large left hemispheric anterior temporal, left inferior frontal, left basal ganglia and left periventricular white matter mass with 2 internal noncontiguous foci of enhancement and its associated mass effect remains fairly similar to prior study. The larger focus of enhancement in the left inferior frontal lobe measures at 19.5 x 17 mm and a 7mm focus of isolated enhancement in the left periventricular white matter component of tumor similar to prior exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: fluctuating weakness r handSigns and Symptoms: stuttering hand weakness 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 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right A1 segment is smaller than the left A1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally with small P1 segments.. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: History of multiple myeloma and breast and endometrial adenocarcinomas status post recent cervical spine tumor resection. There are postoperative findings related to recent C4 through C6 laminectomy with posterior rods and screws. There is a fluid collection with mildly convex margins and layering intermediate T1 and T2 components in the posterior extradural portion of the surgical bed in addition to what corresponds to floseal. The fluid collection measures approximately 20 AP x 25 RL x 50 SI mm. In conjunction with reversal of the usual lordosis, posterior disc-osteophyte complexes, and ossification of the posterior longitudinal ligament, there appears to be slight mass effect upon the spinal cord. There is diffuse high T2 signal in the spinal cord from C2 to C7. There is a small amount of residual intradural extramedullary tumor within the left aspect of the spinal canal at the C3-4 and C4-5 levels that measures up to 2 mm in thickness, as well as unchanged thickening and enhancement along the exiting left C4 and C5 nerve roots that extends beyond the neural foramina. There are multiple T2 hyperintense enhancing lesion in the imaged portions of the axial skeleton, including the T1 and T4 vertebrae and manubrium. The vertebral body heights appears to be preserved nevertheless. There is right axillary, supraclavicular, and parotid lymphadenopathy. There are bilateral maxillary sinus retention cysts.

Output: 1. Postoperative findings related to resection of a spinal cord tumor with a fluid collection containing a probable hematocrit level in the epidural compartment of the surgical bed contributes to slight mass effect upon the spinal cord at C4 through C7 in conjunction with reversal of the usual lordosis, posterior disc-osteophyte complexes, and ossification of the posterior longitudinal ligament. Nevertheless, the overall mass effect is markedly reduced compared to before surgery.2. A small amount of residual tumor is evident within the left aspect of the spinal canal at the C3-4 and C4-5 levels with extension along the exiting left C4 and C5 nerve roots beyond the neural foramina. 3. Diffuse signal abnormality in the cervical spinal cord may represent residual edema or sequela prior ischemic changes.4. Multiple lesions in the imaged axial skeleton are compatible with neoplasm.5. Right axillary, supraclavicular, and parotid lymphadenopathy likely represent neoplasm as well. Please refer to the prior neck CT report for additional details.Discussed with Dr. Lesniak on 4/24/2015 at 9:30 AM.


Instruction: Generate impression based on findings.

Input: History of non-Hodgkin's lymphoma status post rituximab and radiation. Follow-up imaging. History of thyroid cancer status post lobectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly enlarged measuring 19.5 cm in the coronal plane. There is no intra or extrahepatic biliary ductal dilatation. The portal and hepatic veins are patent. Unchanged enhancing T2 hyperintense lesions within segment 6 and 5, probable hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: L1 vertebral body hemangioma, unchanged. PELVIS:PROSTATE/SEMINAL VESICLES: Right scrotal hydrocele partially imaged.BLADDER: No significant abnormality noted.LYMPH NODES: Unchanged representing a left inguinal lymph node measures 3.7 x 3.5 cm (series 19, image 46). Unchanged left external iliac lymph node measures 1.8 x 1.2 cm (series 19, image 24). Subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Edema within the left ilium. No suspicious abnormality.OTHER: No significant abnormality noted.

Output: Unchanged left inguinal and left external iliac adenopathy.


Instruction: Generate impression based on findings.

Input: Dysarthria [784.51], Reason for Study: ^Reason: eval for vessel stenosis History: dysarthria, facial weakness? TIA work up There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Several scattered bihemispheric periventricular white matter high signal intensity lesions on FLAIR imaging indicating nonspecific minimal small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral posterior communicating arteries and anterior corticate and artery are patent.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. There is no intracranial arterial aneurysm.There is no evidence of significant arterial luminal stenosis on both extracranial and intracranial arterial system.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Minimal nonspecific small vessel ischemic disease.3. Normal brain and neck MR angiogram.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement.Brain MRA:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis.

Output: 1.Negative MRI of the brain including gadolinium enhancement.2.Negative MRA of the brain. Specifically, there are no hemodynamically significant intracranial stenoses.


Instruction: Generate impression based on findings.

Input: Follow up of a pituitary lesion. There is a mildly hypoenhancing lesion in the left pituitary gland that measures up to 10 mm. There is no mass effect upon the optic apparatus or cavernous sinus. There is slight deviation of the pituitary infundibulum to the right. The cavernous carotid artery flow voids are intact.

Output: An unchanged lesion in the left pituitary gland that measures up to 10 mm likely represents an adenoma.


Instruction: Generate impression based on findings.

Input: Head and neck cancer. Head CT:There is a vague area of enhancement in the left temporal lobe (image #11, series 10). This should be evaluated with MRI brain to exclude the possibility of a metastatic disease. No obvious mass is identified.Neck CT:Post-treatment changes with associated soft tissue thickening in the neck are unchanged. There is no evidence of mass, or adenopathy based on size criteria.The limited view of the upper lungs appear unremarkable.Degenerative disease of the cervical spine is again present, with mild neuroforaminal narrowing at C3 -- C4 and C4 -- C5 levels.

Output: 1. Vague enhancement in the left temporal lobe may be vascular in etiology. However, further evaluation with MRI brain without and with contrast is recommended to exclude the small possibility of a metastatic focus. 2. No evidence of recurrence or adenopathy in the neck.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:9/10/1975)Reason: transphenoidal hypo to be done today in the OR. Please do MRI Stealth for intraoperative image guidance during surgery. History: pituitary massPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 14 x 13 mm axial dimension cystic lesion suprasellar cistern.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 minor opacities The visualized portions of the mastoid air cells demonstrate some scattered opacities in the left The visualized portions of the orbits are intact.

Output: There is a cystic type lesion in the suprasellar cistern. The possibility that this represents a craniopharyngioma cannot be excluded. Please compare to the prior MRI exam for further comments.


Instruction: Generate impression based on findings.

Input: 38-year-old female with a right ulnar wrist mass for 4 months. Evaluate for cyst versus solid mass. Incomplete examination secondary to the patient's inability to tolerate the examination as well as technical/mechanical issues. A dedicated wrist coil could not be utilized for this examination resulting in slightly suboptimal image quality.A marker was placed along the volar and ulnar aspect of the wrist denoting the site of the patient's mass. There is a lobulated mass of fluid signal intensity situated volar to the ulna and medial to the flexor tendons. The mass measures approximately 12 x 11 mm in the transverse dimension and just over 2 cm in the longitudinal dimension. Based on these nonenhanced images, this most likely represents a ganglion. Although the cyst does not directly communicate with the triangular fibrocartilage on this examination, there is a similar appearing but smaller cystic lesion, which appears to arise from the ulnar aspect of the disc and hence this ganglia and may represent an extension of mucoid material from the triangular fibrocartilage. There may be a tear within the more central/radial fibers of the triangular fibrocartilage, although this is difficult to ascertain due to patient motion artifact. We see no additional soft tissue masses. There is a small amount of fluid within the distal radioulnar joint. Although this study was not protocoled for detailed evaluation of the ligaments, there is mild heterogeneity of the scapholunate ligament which may represent partial thickness tearing. Mild osteoarthritis affects the basilar joint and trapezioscaphoid articulation with a small cyst within the trapezium that is likely degenerative in etiology. The tendons of the wrist appear normal. We see no findings to suggest nerve compression.

Output: Incomplete study as described above showing a soft tissue mass volar to the ulna that likely represents a ganglion that we suspect arises from the articular disc of the triangular fibrocartilage. A malignant neoplasm is considered exceedingly unlikely given the morphology and homogeneity of this mass, however, the patient can return for a complete study following gadolinium administration if desired.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: r/o stroke, evaluate for demyelination History: acute left sided weakness, questionable dx of MS Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There scattered tissue losses involving bilateral caudate nuclei, thalami, pons and centrum semiovale indicate chronic lacunar infarctions. Underlying brain shows multifocal patchy T2/FLAIR high signal intensity lesion on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 40% of luminal stenosis at the level of proximal right MCA M1 segment. Due to vascular tortuosity, the MIP image of the MRA shows exaggerated the degree of stenosis. Otherwise unremarkable bilateral ACAs and left MCA. There is less than 10% of luminal narrowing at mid basilar artery. And the right distal vertebral artery is small which may indicate congenital hypoplastic artery. Right Pcom artery and Acom artery are patent. The left Pcom artery is not seen.There is no evidence of intracranial arterial luminal stenosis. No intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, and internal/external carotid arteries. The right vertebral artery is hypoplastic and the left vertebral artery is dominant.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal lacunar infarctions with underlying non specific small vessel ischemic disease.3. About 40% of luminal stenosis of the proximal right MCA M1 segment and less than 10% luminal stenosis at the mid basilar artery. No other intracranial and extracranial arterial luminal stenosis. No intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: 28-year-old male with right shoulder pain and infraspinatus atrophy. ROTATOR CUFF: The rotator cuff appears intact. There is mild tendinopathy of the distal supraspinatus and infraspinatus tendons. The muscle bellies themselves appear without significant pathology, including fatty atrophy.SUPRASPINATUS OUTLET: The supraspinatus outlet appears well-maintained.GLENOHUMERAL JOINT AND GLENOID LABRUM: Articular cartilage remains intact along the glenohumeral joint and glenoid labrum. There is a complete tear of the posterior labrum.BICEPS TENDON: The biceps tendon appears well seated within the bicipital groove and no significant pathology is visualized at the coracoid origin. ADDITIONAL

Output: 1. Mild tendinopathy of the distal supraspinatus/infraspinatus tendons, however no tear. No significant infraspinatus atrophy as clinically queried.2. There is a complete tear of the posterior labrum, as outlined above.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 34 seconds

Output: Successful fluoroscopic left hip arthrogram injection.


Instruction: Generate impression based on findings.

Input: History of sarcoidosis. Evaluate for biliary obstruction or other abnormality. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size with a nodular contour compatible with chronic liver disease. Recanalized periumbilical vein.Note is made of bilateral percutaneous biliary drains with mild adjacent signal changes of the parenchyma. There is persistent irregular narrowing and moderate dilatation of the common bile duct and intrahepatic biliary tree. There is mild enhancement of the biliary tree centrally, unchanged and likely related to chronic mild inflammation. No new dominant stricture or discrete mass lesion. No suspicious arterial enhancing lesion.The main portal vein and intrahepatic portal branches are chronically occluded with extensive perigastric peripancreatic, intrapancreatic and splenic collaterals.SPLEEN: The spleen is normal in size morphology and signal intensity.PANCREAS: The main pancreatic duct appears to drain into the minor papilla compatible with pancreas divisum. No main pancreatic ductal dilatation or focal lesion. There are extensive intra and peri-pancreatic collateral vessels. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cortical scarring is noted. Splenorenal shunt is again noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild morphologic changes of cirrhosis, chronic portal vein occlusion and stable dilatation/stricturing of the common bile duct and intrahepatic biliary tree. No suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The right cerebellar tonsil is slightly low-lying, extending 5 mm below the level the foramen magnum. However, there is no crowding of structures at this level and the cerebellar tonsils remain rounded. Otherwise, the midline structures are within normal limits. There are scattered mucosal thickening in the ethmoid sinuses.

Output: No MR evidence of demyelinating disease. No evidence of traumatic brain injury. Very minimal incidental right cerebellar tonsillar ectopia


Instruction: Generate impression based on findings.

Input: BRAIN: Motion artifact slightly limits the study. A curvilinear area of enhancement in the anterior right cingulate gyrus is likely represents a developmental venous anomaly. The susceptibility weighted images are degraded due to motion artifact, however there is no definite evidence of mixed vascular malformation. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There is no additional abnormal enhancement within the brain. There is mild diffuse mucosal thickening of the bilateral maxillary sinuses and ethmoid air cells. LUMBAR SPINE: Vertebral body and intervertebral disc heights are preserved. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is normal. The conus is normal in signal and morphology and terminates at an appropriate level. There is no evidence of neural foraminal stenosis. There are no areas of abnormal enhancement. The visualized intra-abdominal and paraspinal contents are unremarkable.

Output: 1.No finding to explain the patient's symptoms in the brain or lumbar spine. 2.Diffuse mucosal inflammation of the paranasal sinuses.


Instruction: Generate impression based on findings.

Input: 76 year old man with coronary artery disease s/p TECAB CABG in May 2015. He presents with persistent dyspnea on exertion and referred to evaluate for ischemia and viability.MEDICATIONS: aspirin, clopidogrel, atorvastatin, HCTZ, lisinopril, metoprolol, insulin First Pass PerfusionDuring hyperemia, a large, severe perfusion defect was seen involving the basal and inferolateral and anterolateral walls and also the apical lateral wall. The overall ischemia score is 9 out of 32 and 28% of the ventricle is ischemic.Viability/ Myocardial ScarThe possibility of a small transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal inferolateral wall can not be excluded. It is unclear if this segment is viable. However, the remainder of the heart is without late gadolinium enhancement and is very likely to be viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 48 ml/m2 (normal range: 74+/-15), the LVEDV is 97 ml (normal range 142+/-34), the LV end systolic volume index is 17 ml/m2 (normal range 25+/-9), the LVESV is 35 ml (normal range 47+/-19), the LV mass index is 46 g/m2, and the LV mass is 92 g. There is tardokinesis of the basal inferior wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 43 ml/m2 (normal range 82+/-16), the RVEDV is 86 ml (normal range 142+/-31), the RV end systolic volume index is 14 ml/m2 (normal range 31+/-9), and the RVESV is 28 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral 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. Mild atherosclerosis is noted in the descending thoracic aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. There is a large burden of pericardial fat.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large severe perfusion defect during hyperemia, as described above.2. The possibility of a small transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal inferolateral wall can not be excluded. It is unclear if this segment is viable. However, the remainder of the heart is without late gadolinium enhancement and is very likely to be viable. 3. Normal LV size and systolic function (LVEF 64%). There is tardokinesis of the basal inferior wall.4. Normal RV size and systolic function (RVEF 67%).


Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer, status post resection on April 20, 2014. There are postsurgical findings related to a right pterional craniotomy with unchanged enhancement in addition to mild intrinsic T1 hyperintensity and susceptibility effect along the margins of the right inferior frontal gyrus resection cavity, as well as unchanged surrounding confluent T2 hyperintensity. There is a new 2 mm diameter lesion at the grey-white matter interface with T1 hyperintensity and possibly contrast enhancement and susceptibility effect posterior medial to the treatment bed in the inferior right frontal gyrus. The 2 mm diameter enhancing lesion in the left superior cerebellar hemisphere is now much less conspicuous and there is no associated vasogenic edema. The punctate focus of susceptibility effect without associated enhancement in the right basal ganglia is unchanged. The ventricles and sulci are unchanged. There is no midline shift or mass effect. There is no evidence of acute infarction. There is an unchanged subcentimeter posterior nasopharynx retention or Thornwaldt cyst. There is minimal mucosal thickening in the inferior aspect of the right maxillary sinus.

Output: 1.Post-treatment findings related to resection of a right frontal lobe metastasis. 2.A new 2 mm diameter lesion medial to the treatment may represent a metastasis. However, the previously demonstrated 2 mm diameter lesion in the left superior cerebellar hemisphere is much less conspicuous.


Instruction: Generate impression based on findings.

Input: Female 56 years old with tenderness palpation of the right foot. Assess soft tissue mass in right foot. There is a multilobulated lesion within the septations in the soft tissues overlying the talus and medial cuneiform bones and medial to the extensor digitorum tendon. The lesion measures 2.3 x 1.6 x 3.9 cm (series 1201, image 13 and series 1101, image 12). It is low in signal intensity on T1 and high on T2-weighted image. There is mild peripheral contrast enhancement but no enhancement of the septations. A 5 mm ossicle posterior to the talocalcaneal articulation compatible with an os trigonum. Bone marrow signal intensity is within normal limits. There is no fracture, dislocation tibiotalar joint effusion. The Achilles tendon is normal in appearance. The flexor and extensor tendons are intact. The ligamentous structures appear intact.

Output: 2.3 x 1.6 x 3.9 cm lesion in the anterior soft tissues of the ankle is most compatible with a ganglion cyst.


Instruction: Generate impression based on findings.

Input: Thyroid cancer with recurrences in the past, and now with increasing thyroglobulin level. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening.Neck: There are postoperative findings related to thyroidectomy, without measurable tumor or significant lymphadenopathy in the neck. There are scattered subcentimeter cervical lymph nodes that are not significantly enlarged. The salivary glands are unremarkable. The major cervical flow voids are intact. The osseous structures are unremarkable.

Output: 1. No evidence of intracranial metastases. 2. Postoperative findings related to thyroidectomy, without measurable tumor or significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, history of thyroid cancer with metastases, compare to prior. Numbering is performed as per prior reports.Thoracic MRI: An enhancing lesion in the left anterior aspect of the T5 vertebral body measures is unchanged from the prior exam. The lesion is associated with mild superior endplate concavity, also unchanged.Lesions within the left transverse process and pars interarticularis of T5 and T6 also show no significant interval change.Instrumented fusion of T10 through T12 is again seen, and the T11 vertebral body remains compressed demonstrating diffusely abnormal signal characteristics compatible with metastatic involvement. Findings are stable.No new lesions are seen. No epidural disease extension is identified. As before, the spinal canal is not significantly narrowed. Mild kyphotic angulation centered at T11 is stable.T1 shortening in the thoracic and lumbar likely related to prior radiation. Increased signal within the T9 and L1 vertebral bodies on fat-suppressed T1 post contrast images is at least in part artifactual and due to metal related failure of fat suppression.Lumbar MRI:A lesion within the right L2 vertebral body is unchanged.A lesion within the left L3 vertebral body is unchanged.A small nonspecific lesion along the left inferior endplate of L4 is unchanged.A lesion in the left L5 vertebral body measures is unchanged.No new lesions are significant epidural disease extension is identified. No spinal canal encroachment or significant foraminal narrowing is detected.Mild degenerative changes are again seen without significant spinal canal or foraminal stenosis, stable in appearance.

Output: 1.No significant change in multiple osseous lesions in the thoracic and lumbar spine without significant interval change in size or morphology. 2.No new lesions are detected. 3.No significant epidural disease or spinal canal/foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Deteriorating memory. Symptoms compatible with depression vs subacute cognitive decline. Screening tools as the NE and MMSE are normal. There is a punctate focus of susceptibility artifact in the pons to the right of midline which correlates with focal contrast enhancement and may reflect an incidental capillary telangiectasia. There is no other abnormal intracranial enhancement. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. For age, there is minimal global parenchymal volume loss but no hydrocephalus. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Mild global parenchymal volume loss but no focal lesion.2.No evidence of intracranial hemorrhage, mass, or acute infarct. 3.Small incidental pontine capillary telangiectasia is suspected.


Instruction: Generate impression based on findings.

Input: Other headache syndrome [G44.89], Reason for Study: ^Reason: r/o mass History: headache No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement. There are multiple scattered FLAIR/T2 high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Minimal nonspecific small vessel ischemic disease.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 67 year old man with history of HTN, HL, known RBBB on ECG and family history of sudden cardiac death who presented after a syncopal episode. He was referred for cardiac MRI to evaluate for structural heart disease and scar. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 167 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 55 ml (normal range 47+/-19), the LV mass index is 60 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). Wall thickness is normal (9-10mm in the basal septum). There are no regional wall motion abnormalities present. There were technical limitations for the late gadolinium imaging portion of this exam, but grossly there is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 980ms, which is normal. There is no myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 92 ml (normal range 54+/-17). There are no regional wall motion abnormalities. 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 ascending aorta measures 37x 35mm. There is mild atherosclerosis.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly-moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size LV with normal systolic function (EF 67%). Wall thickness is normal. Technically difficult late gadolinium imaging, but there is no gross evidence of late gadolinium enhancement to suggest the presence of underlying myocardial infiltration, inflammation or fibrosis. 2. Normal size RV with normal systolic function (EF 50%). There are no regional wall motion abnormalities. 3. Biatrial enlargement. 4. Main pulmonary artery dilatation.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, 21 weeks gestational age, with ventriculomegaly on prenatal ultrasound. The lateral ventricles are slightly enlarged measuring up to 11 mm at the level of the atria. The third and fourth ventricles are normal in size. The cerebral aqueduct is not adequately visualized to allow a confident assessment of patency. The cavum septum pellucidum is visualized and the corpus callosum is present. Cortical morphology and the degree of gyration are within expected limits for gestational age. The thalami and brainstem appear to be normally formed. The cerebellar vermis and hemispheres are likewise normally formed. The posterior fossa as a whole is normal in size.

Output: Mild ventriculomegaly without clear evidence for an underlying etiology or any additional associated abnormalities.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:3/12/1965)Reason: r/o cord compression History: right lower extremity weaknessPROVIDER/ATTENDING NAME: DAVID A HARTER DAVID A HARTER Cord compression protocol:The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.The patient is status post laminectomies at L3, L4 and L5 and there is soft tissue swelling and fluid collections at the surgical site.MRI lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.The patient is status post laminectomies at L3, L4 and L5 and discectomy at L4-5 and L5-S1.. There is a fluid collection present measuring 92 mm superior-inferior length extending at the laminectomy sites which bulges into the spinal canal. It measures 12 mm in thickness. It is associated with effacement of the spinal fluid surrounding the nerve roots within the thecal sac extending from L3 down to the L4-5 disc space. Below that level there is fluid surrounding the thecal sac extending down to the L5-S1 level. There is soft tissue swelling present along the left and right hemicanal at the L5-S1 level extending into the disc space and also bilaterally at L4-5 extending into the disc space. There are blood products present along the right hemicanal at L5-S1. This is associated with some encroachment of the nerve roots at the right lateral recess at L5-S1 and some partial effacement of the thecal sac at this level.There is an additional fluid collection present in the subcutaneous tissues adjacent to the perivertebral space which measures 43 x 19 mm axial dimensions and approximately 104 mm superior-inferior length.There is heterogeneous signal within the medial and posterior paravertebral musculature at the surgical sites.There is narrowing of the neural foramina due to disc bulge at L3-4 and L4-5 and to a lesser degree L5-S1 bilaterally. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.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. No cord compression is identified. However, the cauda equina does appear to be potentially compressed. Please note that the postsurgical findings may mimic compression of the cauda equina, however, clinical correlation is needed to confirm this.2.The patient is status post laminectomies at L3, L4 and L5 with discectomy at L4-5 and L5-S1. 3.There is fluid collection at the laminectomy sites at L3 and L4 associated with findings suspicious for compression of the cauda equina. Please correlate clinical symptoms.4.There is soft tissue swelling surrounding the thecal sac at the L4-5 and L5-S1 levels extending from the L4-5 disc space down to the sacral spinal canal associated with some blood products in the right hemicanal at L5-S1. This results in some circumferential narrowing of the thecal sac and affects the nerve roots at the lateral recesses sees at these levels.5.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.6.Findings were discussed with Dr Constantine.


Instruction: Generate impression based on findings.

Input: Reason: Right knee pain after "ligament injury" years ago; recent re-injury 1 month. History: right knee pain MENISCI: There is a radial tear through the posterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the central weightbearing component of the articular cartilage of the medial femoral condyle without focal defect. There is irregularity of the articular cartilage of the lateral femoral condyle with multiple small focal partial-thickness defects. There are several small partial thickness tears of the patellar cartilage at the junction between the medial and lateral facets.LIGAMENTS: The ACL is not visualized, consistent with complete tearing. There are no secondary signs of ligamentous injury and the bone marrow signal appears normal, indicating subacute or chronic injury. The PCL, LCL, and MCL are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact.ADDITIONAL

Output: 1. Nonvisualization of the ACL, consistent with subacute or chronic tearing.2. Radial tear through the posterior horn of the medial meniscus.3. Articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Male 17 years old Reason: eval for meniscal pathology History: L knee pain/clicking MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema in the tibial plateau anteriorly with what appears to be slight depression of the overlying bone which may represent a mild depressed fracture if there is a history of trauma. Remainder of the marrow is unremarkable. The articular cartilage is normalLIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex are intact. However, there is mild edema superficial to the iliotibial band at, and just proximal to its insertion on Gerdy's tubercle.EXTENSOR MECHANISM: Extensor mechanism is intact.

Output: 1.Minimally depressed fracture of the anterior tibial plateau.2.Mild edema superficial to the iliotibial band and just proximal to its insertion on the greater tubercle.


Instruction: Generate impression based on findings.

Input: Clinical question:Rule out cord compression. Signs and symptoms: Bilateral lower extremity weakness, urinary/stool incontinence, paresthesias of large toes. Non-enhanced total spine MRI:Examination is performed utilizing cord compression protocol and without axial images.Examination of thoracic and lumbar spine demonstrate normal anatomic alignment the vertebral column. No evidence of spinal canal compromise or stenosis at any level. No detectable mass effect on the cord or thecal sac at any level. There is normal signal intensity and caliber of cord. There is no detectable perispinal soft tissue abnormalities.Nonenhanced cervical MRI:Examination demonstrate normal anatomical alignment the vertebral column.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 is unremarkable.C4 -- C5 demonstrate mild degenerative changes and unremarkable otherwise.C5 -- C6 demonstrate moderate disk disease, loss of disk height and mild facet and ligamentum flavum degenerative changes. There is resultant significant bilateral neural foraminal compromise and moderate central spinal stenosis. Mild flattening and posterior displacement of the cord secondary to degenerative changes is noted.C6 -- C7 demonstrate moderate disk disease and loss of disk height and mild bilateral facet and ligamentum flavum degenerative changes. There is no spinal stenosis however moderate right and mild to moderate the left neural foraminal compromise is noted.C7 -- T1 demonstrate mild right neural foraminal compromise and unremarkable otherwise.

Output: 1.Nonenhanced MRI of cervical spine demonstrates degenerative changes at C5 -- C6 with resultant significant neural foraminal compromise and moderate central spinal stenosis. At C6 -- C7 moderate right and mild to moderate left neural foraminal compromise is noted. Unremarkable exam otherwise.2.Nonenhanced total spine MRI demonstrate no evidence of cord compression. Unremarkable sagittal only images of thoracic and lumbosacral spine.


Instruction: Generate impression based on findings.

Input: Achilles pain TENDONS: There is perhaps minimal thickening and increased signal intensity of the Achilles which may reflect minimal tendinosis but this is equivocal. There is distention of the retrocalcaneal bursa with fluid indicating bursitis and there is associated reactive edema in the underlying calcaneus. The flexor, extensor, and peroneal tendons are intact.LIGAMENTS: The anterior talofibular ligament appears slightly thinned but is otherwise intact. The calcaneofibular, posterior talofibular, and ligaments of the distal tibiofibular syndesmotic complex as well as the visualized portion of the deltoid ligaments are intact. There is a tiny focus of fluid signal intensity adjacent to the posterior talofibular ligament which may reflect a small ganglion.ARTICULAR SURFACES AND BONE: Aside from the reactive edema within the posterior calcaneus, the remaining marrow signal of the ankle is normal. There is no osteochondral lesion.

Output: Retrocalcaneal bursitis with other findings described above.


Instruction: Generate impression based on findings.

Input: Patient with two days history of headaches with frontal neurologic signs, vertigo, sensory deficit, bilateral hand tingling, right cranial nerves 6 palsy, vertical nystagmus. CT of brain without and with infusion:No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Subtle foci of low-attenuation in the periventricular white matter of bilateral hemispheres are not specific and non-enhancing. The findings considering patient's age are concerning for demyelinating disease. Possibility of stroke cannot be entirely ruled out. Follow up with a dedicated MRI of brain is recommended. There is no evidence of parenchyma volume loss. Cortical sulci and ventricular system remain within normal. No evidence of any abnormality of cortex is detected.On post infusion images no abnormal enhancement of brain parenchyma or leptomeninges is detected.Calvarium is intact. Mastoid air cells and limited view of paranasal sinuses are unremarkable.100 cc of Omnipaque 350 was utilized for the above study.

Output: 1.Periventricular foci of low attenuation without enhancement is concerning for demyelinating disease considering patient's age. Ischemic stroke or other etiologies cannot be entirely ruled out and further follow-up with an MRI is recommended.2.There is no abnormal enhancement on post infusion images.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: MRI Brain:The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. Moderate periventricular and subcortical T2/FLAIR hyperintense foci, nonspecific and probably reflecting chronic small vessel ischemic disease. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Patchy right mastoid air cell opacification noted.MRA neck:Phase contrast technique is limited in evaluation of tortuous segments of the vasculature. There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is mild atherosclerosis of the carotid bifurcations, left greater than right. The carotid arteries are normal in course without evidence of significant steno-occlusive lesion. Both vertebral artery origins are patent. The vertebral arteries are co-dominant. There is no evidence of stenosis or occlusion.

Output: 1.Chronic small vessel ischemic disease. No evidence of acute ischemia.2.Within the limitations of a noncontrast MRA, there is no gross vascular compromise in the major neck arteries.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with history of atypical meningioma status post resection, with recent progressive left leg dysfunction causing gait disorder. Assess for cause of left leg dysfunction. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Specifically, cortical activation related to foot movement is seen bilaterally at the high paramedian vertex of the precentral gyri. The degree of cortical activation is, if anything, somewhat greater on the right than on the left.All tested language paradigms produced reliable language related cortical activation. On the sentence completion paradigm, language is left dominant with Broca's area identified predominantly along the pars orbitalis, and Wernicke's area is identified along the posterior aspect of the left superior temporal sulcus. On the verb generation and word generation paradigms, Broca's area remains best visualized along the left pars orbitalis. Wernicke's area, however, is much more prominently seen along the posterior aspect of the right superior temporal sulcus with only mild Wernicke's area activity detected on the left.

Output: Functional assessment of sensorimotor cortical activation identifies the motor strip in its customary location. Cortical activation related to lower extremity/foot motion is seen bilaterally along the high paramedian precentral gyri. Cortical activation is, if anything, more robust on the right than on the left. This discrepancy can be technical in origin, though it can also reflect increased effort related to left leg dysfunction. Given this finding, and the fact that no impinging or compressing lesions are seen at the foot motor area, the etiology of the patient's left leg dysfunction may be more distal.Functional assessment of language reveals Broca's and Wernicke's areas in their expected locations of the inferior frontal and posterior temporal lobes respectively. On one out of the three tested paradigms, language is left dominant. However, on two of the three paradigms, substantial contributions are seen from the right hemisphere, and in particular, Wernicke's area is far more robustly activated on the right than on the left. Findings would suggest that language processing is somewhat more distributed between both cerebral hemispheres than what is typically seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Is there evidence of bleed. Signs and symptoms: Headaches. Non-infused CT brain:Examination demonstrates no evidence of intracranial hemorrhage.Patchy foci of nonspecific low-attenuation in the periventricular and subcortical white matter are present. Although nonspecific the findings are suspected for small vessel disease of indeterminate age. Further follow-up with an MRI is recommended. There is no evidence of edema, mass effect, midline shift or hydrocephalus.High density mass in the sella with extension superiorly into the basal cistern is concerning for pituitary macroadenoma. Dedicated MRI examination of the sella is also recommended for further evaluation. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Pituitary macroadenoma.2.Small vessel disease of indeterminate age.3.Follow-up with an MRI is recommended for above findings.4.No evidence of acute intracranial process.


Instruction: Generate impression based on findings.

Input: Male 59 years old History: atypical meningioma. Grade II meningioma status post resection in 2010 and again in 2016, as well as SRS. There are post-treatment findings related to right parietal craniotomy and radiation therapy. There is interval increase of dural based tumor in the treatment bed region. For example, a lesion along the right lateral parietal convexity measures up to 9 mm in thickness, previously 5 mm, a nodular dural based tumor along the posterior occipital convexity measures up to 10 mm, previously 5 mm, and tumor along the lateral occipital convexity with infiltration of the calvarium measures up to 12 mm in thickness, previously 8 mm. There is persistent high T2 signal and scattered areas of gyriform enhancement in the posterior parietal lobes near the midline, which is not significantly changed. There is no evidence of acute cerebral infarction. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is a partially-empty sella. The skull and extracranial soft tissues are unchanged.

Output: 1.Postoperative findings in the right parietal region with increase in size of multiple foci of residual tumor in the treatment bed. 2.Unchanged treatment effects in the bilateral posterior cerebral hemispheres likely related to radiation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are mild bilateral punctate T2/FLAIR hyperintense foci within the periventricular and subcortical white matter as well as the pons most compatible with chronic small vessel ischemic disease. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There are moderate secretions within the maxillary sinuses with air-fluid levels, right greater than left. The mastoid air cells are clear.MRI ORBITS: There is ectasia of the optic nerves and optic nerve root sheaths. The optic chiasm and optic tracts appear normal. There is flattening of the optic discs. The extraocular muscles are normal and symmetric. The globes appear normal. No retinal detachment or vitreous clouding. The lacrimal glands are symmetric and within normal limits for size. No orbital mass lesion. Note is made of a partially empty sella with CSF signal within the pituitary fossa.

Output: 1.Limited exam as only precontrast images were obtained due to patient intolerance.2.Partially empty sella with ectasia of the optic nerves and optic nerve root sheaths as well as flattening of the optic disks. This constellation of findings can be seen in idiopathic intracranial hypertension (aka pseudotumor cerebri) in the appropriate clinical setting.3.Chronic small vessel ischemic disease. 4.Bilateral maxillary sinus opacification with air-fluid levels, right greater than left, similar to recent CT.


Instruction: Generate impression based on findings.

Input: Pain In Right Leg [M79.604] / Dorsalgia, unspecified [M54.9], Reason for Study: ^Reason: R/O compressed or irritated nerve root History: Right lateral leg pain numbness, originally starting in the lower back now mostly involving the leg For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. There is about 6mm sized renal cyst on the right kidney.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: disc dessication, Schmorl's node on the inferior endplate of the L1 vertebral body. minimal to mild facet joint hypertrophy (left worse than right). no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: disc dessication, bilateral ligamentum flavum thickening, no neuroforaminal narrowing. L4-L5: grade 1 anterolisthesis of L4 on L5 with pseudobulging of disc with disc dessication results minimal to mild spinal canal stenosis. There is 4.4mm x 9.7mm sized fluid filled lesion on the lateral aspect of the right L45 facet joint which may indicate degenerative change related synovial cyst.L5-S1: disc dessication with exuberant osteophytes on bilateral facet joints indicating degenerative facets bilaterally.

Output: 1. Grade 1 anterolisthesis of L4 on L5 with minimal to mild spinal canal stenosis at the level.2. Multilevel various degree degenerative changes of intervertebral discs and facet joints as described above including L45 right side synovial cyst.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with epilepsy. fMRI requested for mapping of language and motor function. Sensorimotor cortical activation maps as expected along the pre- and postcentral gyri.All of the tested language paradigms produced reliable language related cortical activation. Language is left dominant.Broca's area activity is identified within the left inferior frontal lobe, specifically the pars opercularis and pars triangularis. Wernicke's area activity is identified along the left superior frontal sulcus.

Output: Technically successful functional MRI for presurgical planning. Sensorimotor cortical activity maps as expected along the pre- and postcentral gyri. Language-related activity is left dominant. Broca's area is identified at its customary location in the left inferior frontal lobe. Wernicke's area is identified at its customary location along the left superior temporal sulcus.


Instruction: Generate impression based on findings.

Input: 75-year-old male with urinary retention, lower extremity weakness and bowel incontinence. Evaluate for cord compression. Exam is limited by motion degradation. The spine may be scoliotic or this may be positional. There are findings compatible with multilevel degenerative changes involving much of the cervical spine with disc osteophyte complexes and facet degenerative changes. This results in at most moderate to severe spinal canal stenosis involving the C4-5 level which is likely chronic in etiology. Note however that cord signal abnormality cannot be fully evaluated on this limited exam. There are additional degenerative changes in the lumbar spine most prominently involving the L4-5 level where there a disc bulge and facet degenerative changes contribute to moderate spinal canal stenosis.

Output: Multilevel degenerative changes causing up to moderate to severe spinal canal stenosis at the C4-5 level and moderate spinal canal stenosis at the L4-5 level. These findings are felt to be chronic in nature. If there is further concern, dedicated cervical spine MRI and lumbar spine MRI may be obtained on a nonemergent basis.


Instruction: Generate impression based on findings.

Input: 66-year-old man with prostate cancer. Biopsy showed 3+3 prostate adenocarcinoma in the right lateral base, right medial apex and left medial mid gland; 3+4 in the right lateral apex and left medial apex. PELVIS:PROSTATE:Prostate Size: 3.9 x 2.4 x 2.1 centimeters.Peripheral Zone: There is diffuse biliary appearance of the peripheral zone on T2-weighted images and evidence of extensive hemorrhage from previous biopsy. There is an 8 x 5 mm focus of T2 and ADC hypointensity in the left mid gland (series 4 lung, image 51) is suspicious for adenocarcinoma. This lesion may be continuous with another lesion extending to the base and straddling the peripheral zone and transitional zone measuring 14 x 10 mm (series 503, image 284). An additional smaller lesion in the right mid gland (series 4, image 54) may be an additional site of adenocarcinoma.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension.BLADDER: The bladder is moderately distended and without focal lesion.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits for the patient's age.OTHER: No significant abnormality noted.

Output: Foci of signal abnormality in the left mid gland extending to the base are suspicious for prostate adenocarcinoma. A smaller lesion in the right mid gland is also suspicious. No extracapsular extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of chronic suppurative otitis media now with dizziness and headaches in the setting of possible chronic Lyme disease. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a left temporal lobe developmental venous anomaly. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal Auditory Canals: There is mild high T2 signal in the right mastoid air cells region. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable.

Output: 1. Mild scattered foci of T2 hyperintensity in the right mastoid air cells, which may represent a sequela of prior infection. However, assessment of the middle ear is limited on MRI and a temporal bone CT may be useful for further evaluation.2. Left temporal lobe developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: There are unchanged posttreatment findings including right temporal occipital craniotomy with underlying resection cavity, associated foci of susceptibility effect, minimal residual linear enhancement, and unchanged moderate confluent T2 hyperintensity surrounding the resection cavity. There is no increased relative CBV in the postoperative region. There are no separate/new areas of suspicious enhancement. There is an unchanged punctate focus of high diffusion signal with corresponding high ADC signal and small slightly more prominent focus of high T2 signal in the right brachium pontis on series 401 image 7; there is slightly greater prominence of the high T2 signal focus in the right brachium pontis felt to represent evolving encephalomalacia from old tiny infarct. There is no acute infarct. The ventricles are unchanged with ex vacuo dilatation of the right occipital horn. There is no midline shift or herniation. There is mild unchanged T2 hyperintense signal in the right mastoid air cells. There is mild bilateral maxillary sinus mucosal thickening. The skull and extracranial soft tissues are otherwise unremarkable.

Output: Stable postoperative findings without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Ms. Dawson is a 42-year-old woman with newly detected left breast mass. History of benign left breast biopsy in 2015 and benign right breast biopsy in 1992. Family history of breast cancer (mother, maternal grandmother, three paternalaunts). She presents for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Scattered enhancing foci are seen bilaterally, compatible with moderate background parenchymal enhancement, limiting the sensitivity of this examination. None of these foci are more suspicious than the rest. LEFT BREAST: There is a lobulated enhancing mass in the left breast near 9:00 position, measuring approximately 3.2 x 2.5 x 2.6 cm (AP x ML x SI). This mass correlates with the mass seen on recent diagnostic workup, including mammogram and ultrasound. There are innumerable T2 hyperintense non-enhancing cysts present. No additional abnormal enhancement is seen in the left breast. RIGHT BREAST: There are innumerable T2 hyperintense non-enhancing cysts present. No abnormal enhancement is seen in the right breast.AXILLA: No abnormal lymph nodes are identified in either axillary region.

Output: (1) 3.2 cm lobulated enhancing mass in the left breast, corresponding to the findings seen on recent diagnostic workup. An ultrasound-guided biopsy of this mass was subsequently performed and will be reported separately.(2) No MRI evidence for malignancy in the right breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: There is asymmetric prominence of the right cavernous sinus with pre-T1 and T2 images showing soft tissue signal along the medial aspect of the right cavernous sinus with asymmetrically smaller right cavernous carotid artery as compared to the left. This soft tissue enhances postcontrast and measures up to 10 x 6 mm on series 601 image 10. The overall appearance is without significant change.The pituitary gland is not enlarged. There is no abnormal enhancement within the pituitary gland or focal lesion. There is no mass effect on the suprasellar cistern or optic chiasm. The Meckel's caves are symmetric and normal in appearance. The imaged brain parenchyma elsewhere appears unremarkable.There is mild asymmetric ill-defined diffuse enhancement in the left frontal calvarial marrow, incompletely imaged, but probably unchaged. There is no discrete osseous marrow lesion identified. The pre-contrast T1 images show no discrete lesion in the incompletely imaged left frontal calvarium marrow.

Output: 1.No significant change in enhancing soft tissue thickening along the medial aspect of the right cavernous sinus with asymmetrically narrowed right cavernous carotid artery. Differential diagnosis includes meningioma, less likely a pituitary tumor, or perhaps even an anatomic variation.2.No additional discrete pituitary mass identified.3.Stable diffuse enhancement in the left frontal calvarial marrow which is incompletely imaged, favored to represent a benign process such as fibrous dysplasia. This can be further imaged on CT as clinically warranted.


Instruction: Generate impression based on findings.

Input: Ms. Hand is a 41-year-old female with a strong family history of breast cancer including maternal grandmother, paternal grandmother, mother, sister and maternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is revisualization of three circumscribed enhancing masses, consistent with multiple benign fibroadenomata of both breasts. The mass in the right breast 3:00 position now measures 1.1 x 0.7 x 1 cm, previously measured 1.2 x 0.7 x 0.9 cm. The mass in the right breast 12:00 position now measures 1.1 x 0.7 x 0.9 cm, previously measured 1.0 x 0.7 x 0.7 cm, and is also stable. The mass in the left breast 8:00 position now measures 1.4 x 1.1 x 1.2 cm, previously measured 1.5 x 1.0 x 0.9 cm, stable from prior exam. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable benign fibroadenomata of both breasts BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Left sided neck mass below mandible along SCM. US showed solid heterogenous mass. There is diffuse swelling and patchy T2 hyperintensity and enhancement of the left sternocleidomastoid muscle. There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable.

Output: Findings suggestive of left fibromatosis colli.


Instruction: Generate impression based on findings.

Input: 74 year old with history hypertension, coronary artery disease and congestive heart failure presenting after a recent ventricular fibrillation arrest. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 143 ml/m2 (normal range: 65+/-11), the LVEDV is 284 ml (normal range 109+/-23), the LV end systolic volume index is 114 ml/m2 (normal range 18+/-5), the LVESV is 226 ml (normal range 31+/-10), the LV mass index is 65 g/m2 (normal range 67+/-11), and the LV mass is 129 g (normal range 114+/-24). There is global hypokinesis with additional thinning and akinesis of the basal to mid inferior and inferoseptal walls. There is transmural late gadolinium enhancement involving most of the inferior and inferoseptal walls in a pattern consistent with prior myocardial infarction. These segments are unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 127 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 80 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild protruding atheroma in the descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is mild bilateral atelectasis or consolidation at the base of the lungs. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 20%).2. There is a transmural myocardial infarction involving much of the usual territory of the right coronary artery. This territory is unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. 3. Normal RV size with moderately reduced systolic function (RVEF 37%).4. Severe left atrial dilation. 5. Mild protruding atheroma in the descending aorta.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with newly diagnosed base of tongue cancer, compare to outside. A bulky enhancing mass is evident involving the tongue base bilaterally measuring up to 40 mm when assessed in the transverse plane (image 31 series 12). This lesion extends into the floor of mouth bilaterally as well as into the left oral tongue and perhaps a small portion of the right oral tongue as well. The exact boundaries of this infiltrative spread are difficult to assess though the lesion potentially occupies a majority of the tongue. Ulceration of the left oral tongue is demonstrated. The lesion effaces the vallecula and is inseparable from the free edge of the epiglottis. No definite involvement of the supraglottic larynx is seen.Two left level Ib lymph nodes are subjectively prominent but they do not meet imaging criteria for pathologic enlargement. No additional pathologic adenopathy is detected. The salivary glands and thyroid are unremarkable. Bone marrow signal characteristics are unremarkable.

Output: 1.A large mass is evident centered on the tongue base but with extensive infiltration of the floor of mouth and oral tongue.2.No pathologic adenopathy is identified by size criteria.


Instruction: Generate impression based on findings.

Input: History of high-grade obstruction in the ileum status post clinical improvement. Retrocaval ureter with percutaneous nephrostomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in size and morphology without a discrete lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval improvement of right-sided hydronephrosis with a percutaneous nephrostomy catheter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The ileum is adequately distended with oral contrast. The jejunum is suboptimally distended.The small bowel fold pattern is unremarkable.The bowel is normal in caliber without wall thickening, abnormal postcontrast enhancement, or restricted diffusion.There is no surrounding inflammatory changes or fibrofatty proliferation.There is no evidence of persistent luminal narrowing or prestenotic/upstream dilatation to suggest a flow-limiting stricture.Nonspecific small mesenteric lymph nodes are present.No evidence of sinus tract or fistula formation.The colon is normal in appearance.No significant free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of significant active small or large bowel inflammation. No flow-limiting stricture. No evidence of obstruction.Interval improvement in right-sided hydronephrosis with placement of percutaneous nephrostomy.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. At C2-C3, there is no significant spinal canal or neural foraminal stenosis.At C3-C4, there is no significant spinal canal or neural foraminal stenosis.At C4-C5, there is a tiny central disk protrusion with annular fissure causing no significant spinal canal or neural foraminal stenosis.At C5-C6, there is a tiny central disk protrusion with annular fissure causing no significant spinal canal or neural foraminal stenosis.At C6-C7, there is a small central disk protrusion with annular fissure causing no significant spinal canal or neural foraminal stenosis.At C7-T1, there is no significant spinal canal or neural foraminal stenosis.

Output: Tiny central disk protrusions with annular fissures causing no significant spinal canal or neural foraminal stenosis. Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Male, 21 years old. Right knee pain. MENISCI: The medial meniscus is intact. There is blunting of the anterior horn of the lateral meniscus which is consistent with a tear. The posterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is no bone marrow edema. The articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Blunting of the anterior horn of the lateral meniscus consistent with a meniscal tear.


Instruction: Generate impression based on findings.

Input: Former football player with multiple concussions and memory issues, evaluate for structural changes. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, predominantly in the right posterior frontal corona radiata and in the pons consistent with moderate chronic small vessel ischemic changes. There is a focus of susceptibility measuring approximately 4 mm in maximum diameter along the left lateral aspect of the inferior medulla consistent with chronic hemorrhage and nonspecific. The ventricles and basal cisterns are prominent, compatible with mild global parenchymal volume loss which is appropriate for patient's age. There is no midline shift or herniation. There is prominent mineralization involving the basal ganglia which is of uncertain significance in this age group. The major cerebral flow voids are intact. There is mild diffuse paranasal mucosal thickening . The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Moderate chronic small vessel ischemic disease.2. Focus of chronic microhemorrhage in the left lateral medulla which is nonspecific in etiology. No other areas of hemorrhage or traumatic encephalomalacia.3. Mild global parenchymal volume loss which appears age-appropriate.


Instruction: Generate impression based on findings.

Input: 33-year-old female with knee pain, evaluate for AVN MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears within normal limits.There is extensive red marrow replacement sparing only the epiphyses of the distal femur and proximal tibia. Partially visualized heterogeneous signal abnormalities in the distal diaphysis of the femur and proximal diaphysis of the tibia likely represent bone infarcts.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps tendon and patellar tendons are intact.ADDITIONAL

Output: Extensive red marrow replacement sparing the epiphyses and likely bone infarcts in the tibial and femoral diaphyses, as described above.


Instruction: Generate impression based on findings.

Input: Reason: scaphoid fracture History: pain LIGAMENTS: Give the limitations of a non-arthrogram study, the scapholunate and lunotriquetral ligaments appear intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The articular disc of the triangular fibrocartilage complex appears intact, although there is increased signal intensity within the lamina of the triangular ligament at their ulnar styloid attachments which may reflect degeneration or degenerative tearing.TENDONS: There is mild thickening and increased signal intensity within the extensor carpi ulnaris tendon as it courses along the ulnar styloid suggesting mild tendinosis. The flexor and extensor tendons appear intact. BONES: There are small cysts within the dorsal portion of the lunate bone as well as within the capitate, likely degenerative in etiology.ADDITIONAL

Output: 1. No evidence of scaphoid fracture.2. Ganglion volar to the radioscaphoid articulation as described above.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 33 year old male with IBS, palpitations, PVCs and recent fatigue and RV dysfunction. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. The LVEDV is 134 ml (normal range 142+/-34), the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVESV is 70 ml (normal range 47+/-19) and the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9). The LV mass is 96 g (normal range 164+/-36) and the LV mass index is 56 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.There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%. The RVEDV is 144 ml (normal range 142+/-31), RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVESV is 72 ml (normal range 54+/-17), and the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9). No focal RV aneurysm or wall motion abnormality. No evidence of fibro-fatty infiltration. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically imaging indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size with mildly reduced systolic function (LVEF 48%). No evidence of underlying myocardial fibrosis inflammation or infiltration.2. Normal right ventricular size and systolic function (RVEF 50%) without evidence focal aneurysm or wall motion abnormality. No evidence of underlying right ventricular fibrofatty infiltration. No CMR evidence of arrhythmogenic right ventricular dysplasia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Seizure and recent resection of a brain metastasis. There has been recent resection of the right temporal lobe mass with intrinsically T1 hyperintense blood products within the resection cavity, but no residual enhancing tumor. There is persistent extensive surrounding vasogenic edema. There is no significant change in the hemorrhagic heterogeneously enhancing mass in the left parietal lobe that measures up to 32 mm with extensive vasogenic edema. There slight midline shift to the left. The ventricles are unchanged in size and configuration. There are a few scattered punctate nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute infarction. There is trace fluid signal within the mastoid air cells. There are subcentimeter cystic lesions in the skin of the right temporal scalp and bilateral cheeks, which may represent epidermoids.

Output: 1. Recent resection of the right temporal lobe mass without evidence of residual enhancing tumor, although there is persistent extensive surrounding vasogenic edema.2. Unchanged hemorrhagic mass in the left parietal lobe with extensive vasogenic edema.


Instruction: Generate impression based on findings.

Input: Male 56 years old Reason: Outside scan shows 4 cm lesion in left lobe near falciform ligament, 1 cm lesion near gallbladder History: HCV and ETOH cirrhosis ABDOMEN:LIVER, BILIARY TRACT: The liver has an advanced cirrhotic morphology with widened fissures and hypertrophy of the caudate. 1.1 cm hypervascular lesion in segment 5 of the liver on image 153/series 3 is stable. The lesion does not show washout on delayed imaging. However, the lesion shows abnormal signal characteristics on diffusion-weighted imaging.Within the left lateral segment of the liver there is a hypervascular lesion measuring 3.0 cm on image 154/series 13. This lesion also does not show washout. There is a prominent vessel within this lesion. Hepatic and portal veins are patent. Gallbladder contains multiple stones.SPLEEN: Spleen is enlargedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.1 cm segment 5 lesion which shows enhancement but no washout. It does not meet the criteria for HCC but remains suspicious.2.Left hepatic lobe lesion is hypervascular without washout. There is prominent vessel within the lesion and the lesion may be due to the shunt. This can be followed on subsequent imaging to evaluate for change.3.Cholelithiasis


Instruction: Generate impression based on findings.

Input: 58-year-old male patient with history of pancreatic neuroendocrine tumor status post resection and subsequent peripancreatic fluid collection formation. Evaluate collections. ABDOMEN:LIVER, BILIARY TRACT: There is a segment 6/7 hemangioma.SPLEEN: There are multiple splenic cysts. PANCREAS: The lesser sac peripancreatic fluid collection measures approximately 6.9 x 4.4 cm, previously 7.8 x 4.4 cm when compared to the 12/16/2015 CT (image 17, series 9). The collection is changed slightly in orientation now along the more distal and lateral aspect of the pancreas. No suspicious enhancing pancreatic lesion is identified. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A left parapelvic cyst is increased in size measuring 8.1 x 5.6 cm.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: Slightly decreased size of a lesser sac peripancreatic fluid collection compared to the most recent CT.


Instruction: Generate impression based on findings.

Input: Male 16 years old Reason: f/u OCD lesion s/p microfracture History: pain MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There are postsurgical changes related to prior microfracture within the articular cartilage of the lateral femoral condyle, above the anterior horn of the lateral meniscus, with associated new cartilage formation.LIGAMENTS: The posterior and anterior cruciate ligaments are intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Postoperative findings related to prior microfracture for an osteochondral defect in the lateral femoral condyle as detailed above.


Instruction: Generate impression based on findings.

Input: 62-year-old male patient with HCC. Assess liver lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable. The hepatic vasculature is patent.The right hepatic dome lesion measures approximately 1.9 x 1.4 cm (image 31, series 11) and contains heterogeneous proteinaceous/hemorrhagic products. An adjacent peripheral wedge-shaped area of T2 hyperintensity which enhances without washout is likely post treatment related, unchanged.The segment six lesion cavity measures 3.7 x 2.7 cm (image 250, series 11) and contains heterogeneous proteinaceous/hemorrhagic products. There is no suspicious marginal enhancement.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cysts are unchanged. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left superior lumbar fat-containing hernia.OTHER: No significant abnormality noted.

Output: 1.Post-ablation changes of the right hepatic dome and segment 6 without evidence of marginal recurrent or residual disease.2.Cirrhotic liver morphology without new suspicious lesion.


Instruction: Generate impression based on findings.

Input: Poorly differentiated lung adenocarcinoma with a solitary brain metastasis resected on 7/20/2011. There are post-treatment findings in the left frontal lobe region. There is unchanged patchy T2 hyperintensity surrounding the treatment bed and diffusely elsewhere in the cerebral and pontine white matter without associated abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Stable post-treatment findings without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: 60-year-old female with periosteal bone formation seen on recent radiograph No evidence of fracture is visualized. There is patchy red marrow signal within the proximal femurs and pelvis. A lobulated fluid collection extends within the iliopsoas bursa. A small amount of fluid is also present within the joint. There is moderate joint space narrowing, consistent with moderate osteoarthritis. Foci of subchondral signal abnormality in the femoral head are considered likely degenerative in etiology. There is no evidence of avascular necrosis. The labrum is poorly visualized on this non-arthrographic exam.

Output: 1. Moderate degenerative changes as described above without fracture or dislocation.2. Left iliopsoas bursa fluid collection and small amount of fluid within the hip joint. Note that in approximately 15% of asymptomatic patients the iliopsoas bursa communicates with the joint.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of malignant neoplasm of the prostate. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.5 x 4 cm (TR x AP x CC)Peripheral Zone: Extensive lobulated decreased T2 signal intensity within the left peripheral zone. Crossing the midline at the mid gland apex, there is a 2.8 x 1.5 cm T2 hypointense lesion (axial series 901 images of 14-15). This broad-based lesion abuts the capsule, and neurovascular invasion is suggested (axial series 901 image 17). Postcontrast imaging is noncontributory.The right mid peripheral zone demonstrates amorphous linear appearing T2 hypointense signal intensity, and posterolateral capsular invasion is also suspected.Central Gland: No significant abnormality.Seminal Vesicles: Suspicious low T2 signal intensity of the left seminal vesicle.Extracapsular Extension: As above.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent inguinal and sidewall lymph nodes, nonspecific. A left inguinal lymph node measures 1.6 cm (axial series 1601 image 387), and a left external iliac measures 0.9 cm (axial series 1601 image 398).BONES, SOFT TISSUES: Mottled marrow signal intensity that is low on T1 and T2 of the pelvis that is most evident in the bilateral inferior pubic rami (axial series 801 image 4; axial series 901 image 4) and bilateral iliac wings (coronal series 701 image 24).OTHER: No significant abnormality noted.

Output: 1.MRI findings compatible with extensive disease in the mid peripheral zone as described above.2.Mottled low signal intensity of the bone marrow on both T1 and T2. A review of the medical record indicates a history of thalassemia, which is compatible with these findings.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out structural cause for gait instability and nystagmus. Signs and symptoms: As above. Nonenhanced brain MRI:Diffusion-weighted images are severely limited due to extensive left-sided paramagnetic artifact obscuring significant portion of the hemisphere. Beyond the region of artifact no evidence of restricted diffusion. There is also partial effacement of the images on flair and susceptibility MRI series due to left-sided metallic artifact (patient known to have a shrapnel in the face).Examination demonstrates a tiny single focus of nonspecific flair hyperintensity in the right frontal centrum semiovale without enhancement. The finding has questionable clinical significance.The anatomical morphology and signal intensity to brain remains otherwise entirely within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of all major intracranial arterial branches are well visualized and unremarkable. The signal intensity of intracranial venous sinuses are beginning normal.Visualized calvarium and soft tissues of the scalp as well as orbits are unremarkable. Partially visualized paranasal sinuses demonstrate normal pneumatization signal pattern.

Output: 1.Metallic fragment/shrapnel in the left facial region results in diffuse artifact obscuring part of the left hemisphere as detailed.2.Within this limitation this examination is unremarkable. Please see above comments. If there are prior studies available and submitted to radiology department an addendum to this report could be submitted after comparison.


Instruction: Generate impression based on findings.

Input: Foot pain, possible mass Ankle/hindfoot: TENDONS: There is mild increased signal within the peroneus brevis tendon as it courses below the tip of the fibula likely suggesting mild tendinosis and perhaps interstitial tearing. However there is no surrounding tenosynovitis and these findings may not necessarily be of any current clinical significance. The remaining tendons of the ankle are intact.LIGAMENTS: Calcaneofibular ligament appears thickened, possibly from prior sprain. The posterior talofibular ligament also appears slightly thickened which may also reflect prior injury. There is a small lobulated collection of fluid adjacent to the posterior fibers of the posterior talofibular ligament which may represent a small ganglion. The remaining visualized ligamentous structures of the ankle are unremarkable.ARTICULAR SURFACES AND BONE: A small lobulated focus of abnormal signal intensity is noted within the distal fibula and may represent a small cartilaginous rest. There is mild osteoarthritis of the tibiotalar joint with focal cartilage degeneration along the medial aspect of the joint. Increased marrow signal within the medial talar dome may represent a subchondral cyst. ADDITIONAL

Output: 1. Healing fracture of the base of the fifth metatarsal.2. Fourth metatarsal lesion further detailed above may represent an enchondroma now with resolution of the surrounding marrow edema seen on the prior exam.3. No evidence of soft tissue mass within the hindfoot or forefoot.4. Mild tibiotalar osteoarthritis and other ankle findings described above.