Instruction: Generate impression based on findings.

Input: Female 48 years old Reason: Evaluate back hardware from surgery and spinal structure History: LBP with radiculopathy. The vertebral column alignment is within normal limits. There is mild developmental narrowing of the spinal canal with prominence of the dorsal epidural fat. The vertebral body and disc space heights are preserved with the exception of L5-S1. At L5-S1 there is complete loss of disc height as seen previously. There is a round low T1, high T2 focus in the posterior aspect of the L5 vertebral body, likely representing hemangioma, which is stable to slightly increased in size compared to the prior exam in 2013. Mild multilevel facet arthropathy. The vertebral bone marrow signal is otherwise unremarkable. Interspace observations:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is no significant compromise to spinal canal or neural foramina.L5-S1: Evidence of a prior small right laminectomy. Within the L5 vertebral body is a lobulated lesion, which appears to be an atypical hemangioma. This lesion disrupts the posterior cortex of the vertebral body protruding posteriorly into the epidural space approximately 2 mm. Lesion is stable to minimally increased in size compared to prior exam There are posteriorly projecting endplate osteophyte without significant spinal canal stenosis at this level. Small right paracentral extrusion mildly narrows the right lateral recess and contacts the right S1 nerve root. The degree of narrowing is similar compared to prior exam in 2013. Bilateral facet arthropathy. Mild bilateral neural foraminal narrowing.

Output: 1.Degenerative and postsurgical changes of L5-S1 with complete loss of disc height, small right paracentral disc extrusion, and mild bilateral neural foraminal narrowing. There is no central canal stenosis and the overall appearance is not significantly changed.2.Lesion in the posterior L5 vertebral body likely represents an atypical hemangioma. This lesion disrupts the posterior cortex of the vertebral body and has mild epidural extension. This is stable to minimally increased in size compared to the prior exam.


Instruction: Generate impression based on findings.

Input: preop planning There is irregular wall enhancing intra axial mass (20.3mm x 25.2mm x 26mm) with surrounding edema on the right pre central gyrus. There is no other abnormal enhancing lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage.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: Right pre central intra axial mass with peripheral enhancement indicating malignant brain tumor.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out radiculopathy. Signs and symptoms: Cramping of the lower extremities with right sciatica. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column and with unremarkable signal intensity.T11-T12 demonstrate mild degenerative changes and unremarkable otherwise.T12-L1 demonstrate mild degenerative changes and unremarkable otherwise.L1-L2 is unremarkable.L2-L3 demonstrate mild degenerative disc disease and mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis. A shallow right lateral disc-osteophyte is present with resultant mild right neural foraminal compromise and patent left neural foramina.L3-L4 demonstrate mild degenerative disc disease and facet/ligamentum flavum hypertrophy without central spinal stenosis. Degenerative changes however results in mild to moderate right and mild left neural foraminal compromise.L4-L5 demonstrate mild disc disease and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise however hypertrophic changes of posterior elements results in left lateral recess compromise.L5-S1 demonstrate mild disc disease and moderate right and mild left facet hypertrophic changes. No spinal stenosis or neural foraminal compromise. Mild left lateral recess compromise is noted.Incidental note is made of partially visualized cysts in bilateral kidneys (left larger than right) and unremarkable paraspinal soft tissues otherwise.Visualized SI joints are unremarkable..

Output: 1.Mild degenerative disc disease and mild to moderate hypertrophic changes of facets and ligamentum flavum as detailed per level above.2.No evidence of central spinal stenosis at any level.3.Multilevel mild neural foraminal and lateral recess compromise as detailed per level above.4.Partially visualized cyst and bilateral kidneys (left greater than right).


Instruction: Generate impression based on findings.

Input: Clinical question: Prostate cancer and headaches and abnormal bone scan in occipital area. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates normal anatomical morphology and signal intensity brain parenchymal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal.Post enhanced images are negative for any abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits in including axial fat sat post enhanced series.Calvarium demonstrate no convincing evidence of an enhancing metastatic lesion as was seen on prior bone scan. There is also no detectable focus of bony expansion or abnormal epidural enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Pre-and post enhanced brain MRI demonstrate no detectable intracranial abnormalities.2.There is no convincing evidence of an abnormal calvarial enhancement to suggest metastatic lesion.3.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer. The enhancing left cerebellar lesion has decreased in size, measuring up to 11 mm, previously 16 mm. In addition, the surrounding vasogenic edema has diminished. There is unchanged mild nonspecific periventricular white matter T2 hyperintensity. There is no evidence of new intracranial lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: The left cerebellar metastasis has decreased in size and the surrounding vasogenic edema has diminished.


Instruction: Generate impression based on findings.

Input: 82-year-old female with bilateral lower extremity paresthesias, evaluate for cord compression. Right apical mass Please note that exam was terminated due to patient discomfort.There is a paravertebral soft tissue lesion which is hyperintense on STIR images and hypointense on T1 images along the left pleura and neural foramina extending from T6 to T8 with invasion into the spinal canal. The CSF is effaced at these levels and there appears to be mass-effect on the cord. Signal within the cord at these levels is difficult to evaluate and subtle signal abnormalities cannot be excluded. Signal within the remainder of the cord is normal.Multilevel degenerative changes throughout the spine with degenerative marrow signal abnormalities. There is a chronic appearing compression fracture at L1 with endplate deformities at T11 and T12. Mild scoliosis, otherwise alignment is anatomic. Focal areas of increased STIR signal within the T2 and T4 vertebral bodies are suspicious for metastatic foci. There are multilevel disk bulges within the lower lumbar spine, most severe at L4-L5, producing narrowing of the central canal which is incompletely evaluated.Right adnexal lesion with cystic components is partially visualized measuring up to 6.4 cm (501/16). Right apical mass is partially visualized and better evaluated on prior CT.

Output: 1.Left paravertebral lesion from T6 to T8 with extension into the spinal canal through the neural foramina producing compression of the spinal cord. Exam was terminated due to patient discomfort, however dedicated thoracic spine MRI is recommended for further evaluation.2.Lesions within the T2 and T4 vertebral bodies are suspicious for metastatic foci.3.Known right apical mass and left adnexal lesion are partially visualized.4.Multi-level degenerative changes including a mild compression fracture at L1.5.Findings suggest spinal stenosis at L4-5. Please correlate with clinical history.Findings discussed with admitting team, Dr.Kallepalli, at 9:45 a.m. on 1/20/2015.


Instruction: Generate impression based on findings.

Input: 39-year-old male with left knee pain MENISCI: Small cysts are noted anterior to the anterior horn of the lateral meniscus, but we see no underlying meniscal tear. The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is superficial degeneration of the articular cartilage of the lateral facet of the patella. There is also a linear focus of low signal intensity traversing the articular cartilage of the femoral trochlea centrally that may represent a cartilaginous fissure. The articular cartilage of the tibiofemoral compartment appears intact.LIGAMENTS: The ACL appears intact, but there are small linear foci of increased signal intensity between its bundles that may reflect mild mucoid degeneration. There is thickening of the proximal fibers of the MCL with ossification within its proximal fibers at its femoral attachment indicating prior injury, but we see no findings to indicate an acute tear. The PCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: Subjectively, the quadriceps tendon appears slightly thickened with enthesophyte formation at its insertion on the patella, but we see no tear. The patellar tendon appears intact.ADDITIONAL

Output: 1. Patellofemoral cartilage degeneration with a borderline tibial tubercle trochlear groove distance.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Sacral chordoma, restaging Note that the examination is limited by motion artifact, particularly the pre and postcontrast sequences.There are surgical changes of a partial sacrectomy extending from the level of S2 down with displacement of the rectum posteriorly, appearing similar to the prior study. There is fluid signal surrounding the rectum, likely representing a small amount of physiologic free fluid which has decreased from the prior exam and is probably of no significance.Edema-type signal within the bodies of the pubic bones adjacent to the symphysis may be degenerative in etiology but is also less prominent on the current exam.Numerous nodular masses are again noted within the gluteus maximus musculature bilaterally as well as within the adjacent subcutaneous fat of the buttocks bilaterally. Additional nodular masses are situated along the posterior column of the acetabula adjacent to the obturator internus muscles, more so on the left than on the right. These masses are hypointense to skeletal muscle on T1 sequences and heterogeneously hyperintense to skeletal muscle on T2 sequences. Following contrast administration, they demonstrate heterogeneous enhancement. One of the larger masses within the left gluteus maximus muscle again measures approximately 6 cm obliquely on series 9, images 9 through 12. A second mass within the subcutaneous fat between the intergluteal cleft and the medial margin of the left gluteus maximus (series 6 image 29) measures approximately 2.8 x 1.8 cm, similar to the prior exam. A smaller mass within the medial fibers of the right gluteus medius muscle (series 8 image 23) measures approximately 2 x 1.4 cm also similar to the prior exam upon remeasurement (the previous measurement of this lesion [1.5 x 1 cm] is suspected to have been placed erroneously). Multiple additional lesions are seen which appear similar in size and extent to the prior exam and although the enhancement appears more prominent, this may be secondary to technical factors and the timing of contrast administration.

Output: Multiple masses within the posterior soft tissues as described above, representing multifocal chordoma. When compared to the prior exam, overall these lesions appear similar in size and extent.


Instruction: Generate impression based on findings.

Input: MRI brain: There are multiple small foci of restricted diffusion in the right parietal lobe mostly along the postcentral gyrus and superior parietal lobule with associated T2 signal abnormality consistent with early subacute infarcts. There is a linear foci of restricted diffusion with associated T2 signal in the posterior aspect of the middle frontal gyrus involving the left frontal lobe. There are no associated enhancement. There are scattered foci of susceptibility in the left parietal, left frontal, left cerebellum and perhaps a tiny focus in the right cerebellum due to hemosiderin staining from prior hemorrhage.There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There are chronic lacunar infarcts in the left posterior frontal lobe, right parietal lobe and in the bilateral cerebellar hemispheres. Ventricles and sulci are mildly prominent, consistent with mild age-related volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. 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.MRI of the spinal cord: The study is limited due to patient motion and scoliotic curvature of the spine. Also, 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. 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.There are mild scattered spondylotic changes in the cervical spine, most conspicuous at C4-C5 and C5-C6. In the lumbar spine, there is disc bulge at L4-L5.Subsegmental atelectatic changes in the right lung base posteriorly.

Output: 1. Several small foci of restricted diffusion with associated T2/FLAIR signal in the right parietal lobe mostly along the postcentral gyrus and superior parietal lobule consistent with early subacute infarcts. Additional focus of subacute infarct in the left frontal lobe.2. Chronic lacunar infarcts in the left posterior frontal lobe, right parietal lobe and in the bilateral cerebellar hemispheres. Mild chronic small vessel ischemic disease.3. No evidence of metastatic lesions in the brain parenchyma.4. 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. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: There is normal anatomic alignment of the basion, C1 and C2/dens articulations on the neutral, flexion and extension views. There is trace anterolisthesis of C2 on C3 without evidence of dynamic instability. Postoperative findings related to Chiari decompression with suboccipital craniectomy and occiput-C2 posterior fusion are again seen. There is mild loss of T2 disk signal in the C2-3, C4-5 and C5-6 disks without significant herniation, spinal canal or neural foraminal narrowing.There is diminished CSF spaces at the foramina magnum ventrally related to mild retroversion of the dens. Dens abuts the medulla, unchanged from prior, without evidence of impingement on the medulla on the flexion or extension views. Dorsal CSF flow is not seen on the CSF flow sequence secondary to susceptibility artifact from the hardware. T2 sequences however do demonstrate good dorsal CSF space.

Output: 1.Stable postoperative findings of Chiari decompression and occiput to C2 fusion. No MR evidence of dynamic instability.2.No syrinx in the cervical cord.


Instruction: Generate impression based on findings.

Input: 50-year-old female with left hip and groin pain for 2 months with positive impingement signs. Evaluate for left hip labral tear. ACETABULAR LABRUM: There is linear increased signal abnormality traversing the anterior and superior acetabular labrum, extending from the 3 o'clock to the 2 o'clock position, indicating a tear.ARTICULAR CARTILAGE AND BONE: No articular cartilage defects are identified. No bone marrow signal abnormality is seen. No convincing CAM deformity is identified. The largest alpha angle measures 50 degrees.SOFT TISSUES: The imaged musculature is normal in appearance. ADDITIONAL

Output: Anterosuperior acetabular labral tear.


Instruction: Generate impression based on findings.

Input: ORBITS: The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is minimal mucosal thickening within the maxillary sinuses. The midline structures and craniocervical junction are within normal limits. There is questionable mild T2 hyperintensity within the upper cervical spinal cord versus artifact.

Output: 1. Unremarkable brain and orbit MRI. No abnormal T2 signal or enhancement of the optic nerves or chiasm.2. Questionable mild T2 hyperintensity within the upper cervical spinal cord, possibly artifact. Otherwise unremarkable brain and orbit MRI.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for Chiari malformation, syrinx, tether cord: scoliosis. There is moderate thoracolumbar dextroscoliosis centered at T12-L1. There is deformity of the lower spinal cord due to the scoliosis, but the spinal cord signal is unremarkable and the conus medullaris is positioned at the L1-2 level. The cerebellar tonsils are not low-lying. There is no spondylolisthesis. The vertebrae appear to be intact. There is no evidence of mass lesions associated with the spine. There is no significant spinal canal or neural foramen stenosis. The paraspinal soft tissues are unremarkable.

Output: Moderate thoracolumbar dextroscoliosis centered at T12-L1, but no evidence of vertebral segmentation anomalies, spine tumors, or Chiari malformation. Deformity of the lower spinal cord is attributable to the scoliosis, but the conus medullaris is normally positioned at the L1-2 level.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of brainClinical question: h/o 4th ventricular mass and shuntSigns and Symptoms: surveillance The patient is status post ventriculostomy tube with associated shunt placement. The ventriculostomy tube courses through the right occipital lobe into the right lateral ventricle and has its tip against the septum pellucidum.There is a 8 x 6 mm axial dimension and 12 x 7 mm sagittal dimension mass located inferior aspect of the fourth ventricle which appears stable when compared to the previous exam. There is associated susceptibility effect. This lesion is known to be calcified based on the CT scan from 11/8/2007. It is located in the region of the foramen of Magendie.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A fourth ventricular calcified lesion is stable and compared to the prior exam from 11/28/2012 as well as exams dating back as far as 2008.2.The patient's shunt catheter is in stable position. There is no convincing evidence for ventriculomegaly


Instruction: Generate impression based on findings.

Input: Metastatic urothelial cancer with CT scan showing brain lesions, evaluate in preparation for radiation therapy: nausea/vomiting, CT with brain lesions. There is an ovoid lesion in the left frontal lobe centrum semiovale that measures up to 19 mm. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Treatment planning MRI demonstrates a left frontal lobe centrum semiovale lesion that measures up to 19 mm, which likely represents a metastasis.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:2/18/1972)Reason: PRE-OP STEALTH MRI, in CCD at 6am morning of surgery. Please page neurosurgery resident to place fiducials. History: PRE-OP MRI, go to OR after MRIPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is a 10 x 6 mm axial dimension lesion which has a hemosiderin ring around it located along the anterior aspect of the left temporal lobe. On the January exam this measured 21 x 15 mm axial dimensions. At that time the blood products appear to be in the subacute phase.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.The cerebellar tonsils appear to be low lying.

Output: 1.There is a left temporal lobe lesion present compatible with cerebral cavernous malformation. It is smaller on the current exam when compared to the prior.2.The cerebellar tonsils are low lying3.Examinations performed the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke. Signs and symptoms: As above. Nonenhanced brain MRI:Diffusion-weighted images demonstrate no evidence of an acute ischemic stroke.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination for patient's stated age of 32.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits.Unremarkable calvarium and soft tissues of the scalp.Mild chronic sinusitis is noted.Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Reason: h/o suprasellar meningioma History: surveillance There is redemonstration of a homogeneously enhancing slightly lobulated dural based mass along the posterior planum sphenoidale with extension into the suprasellar cistern. It currently measures 1.5 cm transverse x 1.5 cm CC x 2.0 cm AP, compared to previous 1.5 x 1.5 x 1.9 cm, respectively. Comparing to outside remote exam from February 2013, there has been no significant interval change allowing for differences in technique, with only perhaps very slight increased size. There is again significant mass effect upon the optic chiasm and pituitary tissue within the sella. There is abutment of the right cavernous sinus without frank invasion. There is similar degree of abutment of the supraclinoid right internal carotid artery as well as the bilateral A1 segments.The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is no new 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 midline structures and craniocervical junction are within normal limits.

Output: Continued stable appearance of planum sphenoidale/suprasellar enhancing extra-axial mass most compatible with meningioma, with similar degree of localized mass effect on the optic chiasm and pituitary tissue. Compared back to baseline 2013 exams, minimal if any increase in size.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB: 10/3/1950)Reason: evaluate for causes of right paresthesia and weakness History: right paresthesia and weaknessPROVIDER NAME: PELEG M HOROWITZ EDWIN RAMOS MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The right vertebral artery is larger than on the left vertebral artery.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is a small disc bulge associated with uncovertebral osteophytes bilaterally at this level and some mild narrowing of the neural foramina. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level. There is narrowing of the neural foramina bilaterally with some mild encroachment of the exiting nerve roots bilaterally. This encroachment appears to be worse on the right when compared to the left side at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At C5-6 there is loss of disc space height, disc desiccation, disc bulge and endplate and uncovertebral osteophytes associated with effacement of spinal fluid ventral and posterior the spinal cord and mild to moderate degree of spinal stenosis. There is narrowing of the neural foramina bilaterally due to uncovertebral osteophytes at this level associated with encroachment of the left-sided exiting nerve roots.At C6-7 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with the small uncovertebral osteophytes and mild narrowing of the neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal lesions are identified in the thoracic spine.

Output: 1.There are degenerative changes present in the cervical spine worse at C4-5 and C5-6 where there is encroachment of right-sided exiting nerve roots at C4-5 and left-sided exiting nerve roots at C5-6 and mild to moderate spinal stenosis at these levels.2.There is no compromise to the thoracic spinal canal.3.No spinal cord lesions are identified.4.There is no evidence for intracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: Lung cancer staging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a developmental venous anomaly in the left middle frontal gyrus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: History of ileal Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild circumferential low T2-weighted signal wall thickening of approximately 3 cm of the terminal ileum (series 4/21) without associated early enhancement, restricted diffusion or proximal dilatation. During the course of the examination this region demonstrates normal dispensability. The small and large bowel is normal caliber, wall thickness and enhancement. There is no abnormal restricted diffusion. No free fluid collection. No significant fibrofatty proliferation.BONES, SOFT TISSUES: Mild thoracolumbar curvature.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of active bowel inflammation. Stigmata of prior/chronic inflammatory changes of approximately 3 cm of the terminal ileum which demonstrates normal distensibility and no pre-stenotic dilatation.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Old ischemic changes are again identified within the right cerebellar hemisphere. Left supraclavicular adenopathy is no longer evident.C2/3: Mild posterior osteophyte disc complex, mild left facet hypertrophy, and moderate right facet hypertrophy. There is mild bilateral neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is intrinsic abnormal T2 hyperintensity within the cord at this level, extending inferiorly, associated with focal cord atrophy. There is moderate central, moderate to severe left neural foraminal, moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy (right much greater than left). There is subtle intrinsic T2 hyperintensity within the cord as well as focal cord atrophy. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex eccentric to the left causing anterior left hemicord flattening without intrinsic cord signal abnormality. There is also slight ligamentum flavum thickening and bilateral uncinate hypertrophy. There is no central stenosis, however there is moderate to severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex eccentric to the right causes anterior right hemicord flattening without intrinsic cord signal abnormality. There is also ligamentum flavum thickening and bilateral uncinate hypertrophy. There is borderline central, moderate severe left neural foraminal, and severe right neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex, severe ligamentum flavum thickening (left greater than right), and endplate spurring. There is cord flattening anteriorly as well as posterolaterally (bilaterally) with effacement of CSF but no intrinsic cord signal abnormality. Overall, there is moderate central, severe left neural foraminal, and moderate right neural foraminal stenosis.T1/2: Bilateral facet hypertrophy encroaches bilateral neural foramina.

Output: 1.C2/3: Mild bilateral neural foraminal stenosis.2.C3/4: There is intrinsic abnormal T2 hyperintensity within the cord at this level, extending inferiorly, associated with focal cord atrophy, a pattern most suggestive of myelomalacia. There is moderate central, moderate to severe left neural foraminal, moderate right neural foraminal stenosis.3.C4/5: There is subtle intrinsic T2 hyperintensity within the cord as well as focal cord atrophy, a pattern most suggestive of myelomalacia. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.4.C5/6: Moderate to severe bilateral neural foraminal stenosis.5.C6/7: Borderline central, moderate severe left neural foraminal, and severe right neural foraminal stenosis.6.C7/T1: Moderate central, severe left neural foraminal, and moderate right neural foraminal stenosis.7.T1/2: Bilateral facet hypertrophy encroaches bilateral neural foramina.


Instruction: Generate impression based on findings.

Input: Global developmental delay, please evaluate for brain parenchymal abnormalities. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. 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 are secretions diffusely within the paranasal sinuses.

Output: 1. No evidence of gross parenchymal abnormalities.2. Secretions diffusely within the paranasal sinuses may indicate sinusitis.


Instruction: Generate impression based on findings.

Input: Ms. Arlene E Pappalardo is a 59 year old female with a personal history of right breast mastectomy in 2011 for IDC/DCIS followed by radiation and left breast mastopexy. She has no current breast related complaints. Prior MRI showed a left breast intramammary lymph node. MAMMOGRAM: Three standard views and the 2 additional spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Questionable interval increase in size of the focal asymmetry in the right upper outer breast, posterior depth, on the full field views though less so with compression and demonstrates central fat component on spot compression views. This is compatible with the intramammary lymph node which was also characterized as a benign lymph node on the prior MRI in 2013. Postsurgical change including calcified fat necrosis in the left breast is noted.There are no suspicious microcalcifications or areas of architectural distortion identified in the left breast.

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


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, follow up for progression with weakness. Brain: There are numerous T2 hyperintense lesions in the cerebral white matter, although some of the lesions appear to be less conspicuous on T2-weighted sequences. Many of the lesions demonstrate T1 hypointensity, but no associated abnormal enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are unchanged in size and configuration, with evidence of mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.Cervical Spine: The images are degraded by patient motion. There are multiple T2 hyperintense lesions in the cervical spinal cord without evidence of associated enhancement. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Chronic multiple sclerosis lesions with associated cerebral volume loss.2. Multiple demyelinating lesions in the cervical spinal cord without evidence of enhancement.


Instruction: Generate impression based on findings.

Input: 82-year-old male with persistent right shoulder pain. ROTATOR CUFF: There is partial thickness undersurface tearing of the supraspinatus at the level of the insertion on the greater tuberosity involving less than one half of the tendon width. There is bursal surface fraying of the distal supraspinatus at the level of its insertion as well. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is a tiny insertional tear of the anterior fibers of the infraspinatus measuring approximately 3 mm in AP dimension The infraspinatus muscle and tendon otherwise appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a small glenohumeral joint effusion with foci of low signal intensity internally, suggesting a synovitis. Mild osteoarthritis affects the glenohumeral joint. There are subchondral cysts within the humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is circumferential fluid within the tendon sheath of the long head of the biceps indicating a tenosynovitis ADDITIONAL

Output: 1. Partial-thickness tearing and bursal surface fraying of the supraspinatus without evidence of a full-thickness rotator cuff tear or retraction.2. Small glenohumeral joint effusion with findings indicating a synovitis.3. Osteoarthritis of the right shoulder.


Instruction: Generate impression based on findings.

Input: Reason: degenerative disc disease? History: neck pain with neuropathic arm pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature present. There is multilevel disk desiccation.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are uncovertebral osteophytes present at this level right more than left with some mild encroachment of the right-sided exiting nerve rootsAt C4-5 there is loss of disk space height a diffuse disk bulge and endplate and uncovertebral osteophytes resulting in effacement of spinal fluid ventral posterior the spinal cord and some deformity of the spinal cord . There is some posterior ligamentous hypertrophy present. Overall there is a moderate degree of spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal . There are bilateral virtual osteophytes present at this level associated with disk material and encroachment of the exiting nerve roots bilaterally.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.At T1-T2 and T2-T3 there disk bulge is present associated with some minor narrowing of the neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is larger than the left vertebral artery and is suspected to have an aortic arch origin.

Output: 1.There are multilevel degenerative changes present in the cervical spine which are worse at C4-5 where there is a moderate degree of spinal stenosis and bilateral neural foramen encroachment due to degenerative changes as detailed above. There is some encroachment of exiting nerve roots at the C3-4 and C5-6 due to degenerative changes as well.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, with hypogonadism. History of pituitary adenoma. A 3 x 3 x 3 mm well-defined linear focus of hypoenhancement is evident within the midline posterior aspect of the pituitary gland. This lesion is mildly T2 hypointense, and is barely cerebral on T1 precontrast images.The pituitary gland itself is otherwise normal in size and morphology. The pituitary stalk enhances normally and deviates very slightly towards the left. The suprasellar cistern is not compromised.

Output: A 3 mm hypoenhancing lesion is evident within the posterior midline pituitary gland. This would be compatible with the stated history of pituitary adenoma, though based solely on its imaging appearance, a Rathke's cleft cyst can also be considered.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type 1 presenting with back pain. Evaluate for tumor. The lack of intravenous contrast limits evaluation of small lesions.Cervical spine:The vertebral body and intervertebral disc heights are maintained. There is straightening of the cervical lordosis which is likely positional. Mild scalloping of the posterior cervical vertebrae secondary to dural ectasia. No bone marrow signal abnormalities.The spinal cord is normal in morphology and signal throughout. No masses are identified. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.Thoracic spine:The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities.The spinal cord is normal in morphology and signal throughout. No masses are identified. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.Lumbar Spine:The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities. No fracture is evident.The spinal cord is normal in morphology and signal throughout. The conus medullaris terminates at the mid L2 level. No masses are identified. No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: Essentially normal MR spine. No neurofibromas or plexiform tumors are identified. No findings to account for the patient's lumbar back pain.


Instruction: Generate impression based on findings.

Input: 94 years Female (DOB:9/22/1922)Reason: recurrent episodes of dizziness/unawareness; possible TIA History: recurrent episodes of dizziness/unawareness; possible TIAPROVIDER/ATTENDING NAME: DIANE L. ALTKORN DIANE L. ALTKORN MRI of the brainThere is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of T2 and FLAIR signal hyperintensity are present in the cerebellum and brainstem. The lesion in the right middle cerebellar peduncle is associated with susceptibility effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells demonstrate opacities in the right mastoid more than the left. These are nonspecific. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are very small. The right vertebral artery is larger than the left vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female, 19 years old, with new onset persistent frontal and left temporal headache with associated left eye pressure. Also complaining of left pupil asymmetry x2 on two separate occasions. Normal neuro and limited funduscopic and pupillary exam. Prior history of concussion x3 with loss of consciousness. The morphology and signal characteristics of the brain are within normal limits. No focal lesions are seen. No evidence of any large parenchymal or extra-axial enhancement is observed. There is a small incidental left frontal lobe developmental venous anomaly. No findings are seen to suggest any intracranial hemorrhage, including no evidence of microhemorrhage. Diffusion-weighted images are within normal limits. No abnormal extra axial fluid collections are demonstrated. The ventricles are normal in size and morphology. A mucous retention cyst is present in the right maxillary sinus.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with left hemiparesis. Restricted diffusion is evident within the right MCA distribution including a large confluent area involving the right middle frontal gyrus, operculum, and insula. Scattered smaller foci restricted diffusion are also seen more posteriorly and inferiorly within the right parietal and temporal lobes.The areas of restricted diffusion demonstrate corresponding T2 hyperintensity with mild associated edema. There may be slight effacement of the right lateral ventricle, but no significant generalized mass effect is seen. No evidence of hemorrhagic conversion is detected. A few scattered foci of non-diffusion-restricting T2 hyperintensity are seen within the cerebral white matter, likely indicating chronic microvascular ischemic disease.The right ICA flow void is absent through the carotid canal with reconstitution intracranially. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are otherwise normal in size and morphology.Mucosal inflammation is evident in the paranasal sinuses and there are fluid levels within the maxillary sinuses. Patchy fluid opacification is seen in the mastoid air cells.

Output: Acute infarction in the right MCA distribution involving primarily the right middle frontal gyrus, operculum and insula. No evidence of hemorrhagic conversion is seen. No significant generalized mass effect is noted.


Instruction: Generate impression based on findings.

Input: History of AML with possible CNS involvement now with worsening left temporal hemianopsia and headaches. Rule out leptomeningeal disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the right occipital lobe with involvement of the visual cortex, predominantly gyriform areas of susceptibility effect, and ex vacuo dilatation of the right occipital horn. There is also mild encephalomalacia in the left occipital lobe. There are also a few scattered foci of susceptibility effect within the cerebral hemispheres and left cerebellar hemisphere, which are nonspecific, but may represent chronic microhemorrhages. There is no evidence of abnormal intracranial enhancement or acute infarction. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are unremarkable.

Output: Bilateral occipital lobe encephalomalacia, right greater than left, but no evidence of intracranial mass or leptomeningeal disease.


Instruction: Generate impression based on findings.

Input: Male 47 years old Reason: newly diagnosed rectal cancer History: rectal cancer Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Wedge-shaped T2 hypointense foci in bilateral mid gland peripheral zones demonstrating restricted diffusion, particularly on the right. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes outside the mesorectal fascia: At least nine lymph nodes are identified. The largest is in the posterior left mesorectal fascia measuring approximately 2.8 x 2.2 cm (series 5, image 10).BOWEL, MESENTERY: Rectal Tumor:Size: 4.0 x 3.0 x 6.0 cmTumor appearance on T2-weighted images: T2 isointense lesionTumor location: Posterior rectal wall with invasion into the posterior perirectal fat.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 6 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 3 cmCircumference of the rectum involved: 180 degreesRelationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Nonapplicable.MRI T-stage: T3c - Tumor invades >1cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: The tumor extends above the level of the mesorectal fascia. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Indeterminate mid gland peripheral zone prostate lesions. Correlation with PSA is recommended.2.Upper rectal mass with mesorectal lymphadenopathy as described above.


Instruction: Generate impression based on findings.

Input: Female, 23 years old, history of acoustic neuroma status post resection two years ago. Follow-up exam. Deformity of the right squamous and mastoid temporal bone is seen compatible with prior surgical access for resection of a right IAC tumor. On the present study, enhancement is seen within the right IAC measuring 9 mm in length by 5 mm in thickness. This enhancement has increased from the prior examination of 2012 where only minimal if any was present. No extracanalicular extension is seen.The remainder of the brain demonstrates normal signal intensity and morphology. No evidence of pathologic parenchymal or extra enhancement is seen. No significant intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology.

Output: Sequelae of right IAC tumor resection are seen. Since the prior examination from 2012, enhancement within the right IAC has increased. This finding could represent either postoperative granulation or residual/recurrent tumor.


Instruction: Generate impression based on findings.

Input: Female, 61 years old. Left shoulder pain ROTATOR CUFF: There is moderate tendinopathy of the supraspinatus tendon, without discrete tear evident. The supraspinatus muscle appears normal. The infraspinatus, teres minor, and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: There is mild acromioclavicular joint osteoarthritis. There is trace fluid within the subacromial bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is diffuse mild cartilage loss involving the glenohumeral joint as well as osteophyte formation. Within the limits of nonarthrographic exam, there is diffuse irregularity of the glenoid labrum, compatible with degeneration.BICEPS TENDON: The tendon of the long head of the biceps is normal in course and morphology. ADDITIONAL

Output: 1.Supraspinatus tendinopathy without rotator cuff tear identified.2.Osteoarthritis of the glenohumeral and acromioclavicular joints as above.


Instruction: Generate impression based on findings.

Input: 65 year old woman with history of hypertension presents for a stress cardiac MRI to evaluate for ischemic etiology of chest pain.MEDICATIONS: Toprol XL 25mg, Multi-vitamin, COQ10 First Pass PerfusionDetection of perfusion defect during hyperemia was non-diagnostic due to technical limitations related to poor breath-holds and likely displacement of the surface coil.Viability/ Myocardial ScarThere is probably no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 77%, the LV end diastolic volume index is 46 ml/m2 (normal range: 65+/-11), the LVEDV is 74 ml (normal range 109+/-23), the LV end systolic volume index is 10 ml/m2 (normal range 18+/-5), the LVESV is 17 ml (normal range 31+/-10), the LV mass index is 34 g/m2, and the LV mass is 55 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 75 %, the RV end diastolic volume index is 47 ml/m2 (normal range 69+/-14), the RVEDV is 77 ml (normal range 110+/-24), the RV end systolic volume index is 12 ml/m2 (normal range 22+/-8), and the RVESV is 19 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. 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 a trivial pericardial effusion.Extracardiac FindingsThyroid enlargement is noted This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Detection of perfusion defect during hyperemia was non-diagnostic due to technical limitations 2. No obvious prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 77%) without obvious evidence of myocardial fibrosis, infiltration, or inflammation.4. Normal RV size and systolic function (RVEF 78%).5. See extra-cardiac findings.6. Study is technically limited due to poor image quality.


Instruction: Generate impression based on findings.

Input: 45-year-old female with chronic right lower extremity wound with swelling TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Severe degenerative changes at the tibiotalar joint and subtalar joints. No abnormal bone marrow signal to suggest osteomyelitis. ADDITIONAL

Output: No specific evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Ultrasound performed to follow-up on MRI findings: possible satellite lesions. A targeted left ultrasound was performed for the area of known malignancy and potential satellite lesions. The index malignancy is well seen, today measuring 2.1 x 2.1 cm. Additionally, located about 8 mm medial to the index malignancy, at the 11:30 position, is a hypoechoic mass measuring 1.4 x 0.7 cm. This correlates positionally and in size to the superior-medial satellite seen on MRI. At the 9:00 position, a vague hypoechoic area with apical vascularity measuring 5 x 5 mm may be a correlate to the inferior satellite, though this is less certain.

Output: 1.4 cm sonographic finding is a clear correlate to the superior medial satellite lesion. Vague 5 mm hypoechoic area may be a correlate for the inferior satellite lesion. The patient is on schedule for ultrasound-guided biopsy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 42 year-old female with probable hemangioma seen on recent CT examination. ABDOMEN:LIVER, BILIARY TRACT: There is a 1.9 x 1.7 cm fluid signal intensity lesion in the dome of the liver, which demonstrates discontinuous, peripheral nodular enhancement, with progressive enhancement on delayed contrast-enhanced sequences, consistent with a hemangioma, corresponding to the findings on recent CT examination. Additionally, a second smaller hemangioma is identified in segment 4A of the liver.No intra-or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hepatic hemangiomas, as detailed above.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of renal cell carcinoma. Surveillance imaging. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval left nephrectomy.Numerous round right renal lesions of variable size and signal intensity, most likely represent a combination of simple and complicated cysts. Multiple lesions have become larger or have a different T2 signal intensity. Some of the lesions are new. Without intravenous contrast, the possibility of renal cell carcinoma cannot be excluded.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: Numerous right renal cysts as detailed above, for which the possibility of renal cell carcinoma cannot be excluded without administration of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain, evaluate for meniscus tearing History: above MENISCI: There is a full-thickness radial tear of the posterior horn of the lateral meniscus near its root with extension into the body of the meniscus. The posterior root of the lateral meniscus appears thickened which may represent a flipped meniscal fragment (image 17; series 7). There is intrasubstance degeneration of the posterior horn and deformity which may reflect degenerative tearing. There is a horizontal tear of the anterior horn of the lateral meniscus with small parameniscal cyst formation. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus with degenerative subchondral signal abnormality. There is full thickness degeneration of the lateral tibial plateau as well with underlying degenerative subchondral signal abnormality. There is subjective thinning of the medial tibiofemoral compartment. There is a full-thickness articular cartilage cleft along the medial facet of the patella with underlying subchondral signal abnormality. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the lateral meniscus as described above.2. Osteoarthritis of the right knee including full-thickness articular cartilage degeneration most pronounced along the lateral tibiofemoral compartment as described above.3. Moderate size joint effusion with a lobulated Baker's cyst which may reflect a synovitis.


Instruction: Generate impression based on findings.

Input: 59 year old female, with a history of congenital heart disease, s/p tetralogy of Fallot repair, s/p bioprosthetic pulmonary valve replacement. She is referred for cardiac MRI for follow-up evaluation. Left VentriclePostsurgical findings compatible with tetralogy of Fallot repair.The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 61 ml/m2 (normal range: 65+/-11), the LVEDV is 117 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 69 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is borderline flattening of the interventricular septum noted at end-diastolic phase, in retrospectively similar to prior cardiac MRI on 12/24/12 This might be indicative of a mixture of elevated right ventricular volume and pressure overload. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic dysfunction. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 107 ml/m2 (normal range 69+/-14), the RVEDV is 206 ml (normal range 110+/-24), the RV end systolic volume index is 65 ml/m2 (normal range 22+/-8), and the RVESV is 124 ml (normal range 35+/-13). There is apical hypokinesis, unchanged.Right AtriumThe right atrium is normal. 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 ValveThere is a bioprosthetic valve in the pulmonic location generating susceptibility artifact. No significant pulmonic insufficiency was noted.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated as 40 mm, which is stable from prior study.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a 10mm right breast nodule located right of the nipple. This is unchanged compared to prior exam. No mammograms are noted in this PACS. Correlation with physical examination and mammogram is recommended. Small hiatal hernia is noted.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%.2. The right ventricle is mildly dilated with mildly reduced systolic dysfunction.3. Postsurgical findings of repaired Tetralogy of Fallot. There is a bioprosthetic valve in the pulmonic location with stable caliber of the pulmonary artery. No significant pulmonic insufficiency was noted.4. Stable right breast nodule since last MRI; correlation with physical exam and mammography is recommended. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 83 year old male with history hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease and prostate cancer. He has history of coronary artery disease including bypass surgery in 2001 (LIMA to LAD, SCG to OM and LP) and multiple subsequent PCI's. A recent echocardiography showed normal function of the left and right ventricles. Recently was hospitalized due to progressive dyspnea and chest pain. Referred to stress cardiac MRI for further evaluation.MEDICATIONS: aspirin, atorvastatin, budesonide, clopidogrel, insulin, lisinopril, tamsulosin. First Pass PerfusionDuring hyperemia, a perfusion defect was present at the lateral (transmural) and inferolateral (subendocardial) at the base and mid segments. The burden of the ischemia is 5/32 potential segments (16%).Viability/ Myocardial ScarThere is late gadolinium enhancement noted in the base to mid segments of the lateral and inferior walls in up to 50% of the thickness of the myocardium. This finding is compatible with prior myocardial infarction. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 47 g/m2, and the LV mass is 101 g. There are no regional wall motion abnormalities present. Normal myocardial T1-times.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 49 ml/m2 (normal range 82+/-16), the RVEDV is 105 ml (normal range 142+/-31), the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is at least mild-to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsSternal wires were seen. 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. During hyperemia, a perfusion defect was present at the lateral (transmural) and inferolateral (subendocardial) at the base and mid segments. The burden of the ischemia is 5/32 potential segments (16%).2. There is late gadolinium enhancement noted in the base to mid segments of the lateral and inferior walls in up to 50% of the thickness of the myocardium. This finding is compatible with prior myocardial infarction. The rest of the myocardium is viable.3. Normal LV size and systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 53%).


Instruction: Generate impression based on findings.

Input: Clinical question to be answered coned rule out intracranial process. Signs and symptoms: Newborn with apnea. Poor quality exam secondary to extensive motion artifact. No definitive abnormalities detected. However poor quality of examination can obscure subtle findings. Repeat exam or an MRI is recommended. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No definitive calvarial abnormality.

Output: No gross abnormality in this limited examination of brain due to extensive motion.


Instruction: Generate impression based on findings.

Input: 81-year-old female status post fall; evaluate for fracture/dislocation BRAIN:There is no evidence of acute intracranial hemorrhage, mass or edema. Several bilateral lacunar infarctions in the basal ganglia. Multiple nonspecific foci of attenuation are seen in the periventricular and subcortical white matter which may represent small vessel ischemic disease, appearing similar to the previous MRI.Ventriculomegaly out of portion with age-related volume loss and may represent normal pressure hydrocephalus, unchanged. Prominence of the cortical sulci consistent with age-related volume loss. Atherosclerotic calcifications are seen in the internal carotid arteries, most prominently at the carotid bifurcations.The calvaria and skull base are radiographically normal without evidence of depressed skull fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE:There is reversal of the normal cervical lordosis with grade 1-2 anterolisthesis of C3 on C4. There is also grade 1 retrolisthesis of C4 on C5 and of C5 on C6. The vertebral body heights are grossly maintained. Prevertebral soft tissues are grossly unremarkable.Multilevel extensive degenerative changes are seen throughout the cervical spine with uncal vertebral joint hypertrophy, osteophyte formation, disk space narrowing, and neuroforamina narrowing. If high clinical concern for cord or ligamentous injury, MRI may be obtained for further evaluation.

Output: 1. No acute intracranial hemorrhage. No evidence of acute fracture.2. Stable ventriculomegaly. 3. Bilateral lacunar infarcts and likely small vessel ischemic disease of indeterminate age, appearing similar to the previous exam.4. Reversal of normal cervical lordosis extensive multilevel degenerative changes. If high clinical concern for spinal cord or ligamentous injury, MRI may be obtained for further evaluation.


Instruction: Generate impression based on findings.

Input: There are no residual enhancing intracranial lesions. There are unchanged punctate foci of susceptibility effect in the left cerebellar hemisphere, left globus pallidus, and bilateral thalami. There is no mass-effect or significant midline shift. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse cerebral volume loss and extensive areas of T2 hyperintensity within the cerebral white matter. There is also a chronic lacunar infarct in the left caudate head. The skull and extracranial soft tissues are unremarkable. However, there is degenerative spondylosis in the imaged portions of the upper cervical spine.

Output: Post-treatment findings without evidence of residual enhancing metastases.


Instruction: Generate impression based on findings.

Input: Female, 75 years old, with worsening weakness. Evaluate for new CVA, neurosyphilis, demyelination. Brain:Patchy T2 hyperintensity is seen in the periventricular white matter with scattered small foci also evident in the basal ganglia and thalami and in the pons. The pattern and morphology of these lesions are nonspecific. No evidence of parenchymal edema or mass effect seen. No restricted diffusion is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. No pathologic intracranial enhancement is seen. The ventricles and sulci are mildly and proportionately prominent compatible with underlying volume loss.C-spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema, replacement or pathologic enhancement is seen. The visualized spinal cord demonstrates normal signal intensity and morphology and is likewise free of pathologic enhancement. No epidural lesions are detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C5-6: No spinal canal stenosis or neuroforaminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Patchy white matter signal abnormality is seen, predominantly in the periventricular regions and to a lesser extent the basal ganglia, thalami and pons. The pattern and morphology of the lesions are nonspecific. Although demyelination is not excluded from the differential diagnosis, chronic small vessel ischemic disease would be a statistically more likely possibility.2.Mild degenerative findings in the cervical spine with no evidence of significant spinal canal or foraminal compromise. The spinal cord itself is within normal limits.


Instruction: Generate impression based on findings.

Input: 68-year-old female with history of lung cancer with brain metastases presenting with intermittent aphasia concerning for TIA/stroke. Evaluate for hemorrhage or stroke. Extensive low-attenuation is seen within the subcortical and periventricular white matter, compatible with prior therapy for brain metastasis versus small vessel ischemic disease. No intracranial hemorrhage or definite cortical stroke is evident, though contrast enhanced MRI is recommended for further evaluation if clinical suspicion remains high. The remaining cerebral and cerebellar hemispheres and brainstem demonstrate normal attenuation and morphology. The ventricles are midline, with normal alignment morphology. No abnormal extraction fluid collections are evident.The calvarium and other osseous structures are normal in appearance, with no evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Diffuse white matter disease which may be due to prior therapy for brain metastases or small vessel ischemic disease. If clinical concern for acute stroke remains, MRI is recommended.


Instruction: Generate impression based on findings.

Input: 64 year old male with prostate cancer- staging exam. PROSTATE:Prostate Size: 5.5 x 4.4 x 4.5 cm, TR x AP x CCPeripheral Zone: There is a T2 hypointense enhancing lesion in the right mid gland that measures 8 x 7 mm (series 801, image 17).Central Gland: T2 hypointense enhancing lesion in the left anterior prostate close to its inferior margin measures 13 x 9 mm (series 801, image 10). Seminal Vesicles: No significant abnormality noted. Extracapsular Extension: Both lesions described above appear to abut and extend across the capsule. The lesion in the right mid gland also invades the adjacent extracapsular neurovascular bundle. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T2 hypointense enhancing lesion in the left anterior/inferior prostate that appears to abut/extend across the prostatic capsule, suspicious for neoplasm.2.Additional T2 hypointense lesion in the right mid gland that extends across the capsule, with invasion of the adjacent extracapsular neurovascular bundle. Findings are also suspicious for neoplasm at this site.


Instruction: Generate impression based on findings.

Input: Reason: Chiari History: surveillance Again seen are postoperative changes of Chiari decompression. There is mildly diminished CSF space ventrally at the cervicomedullary junction, appearing similar to prior study. There is normal biphasic flow of CSF at the foramen magnum both ventrally and dorsally. No appreciable change in appearance of the cervical spinal cord syrinx. For example the syrinx measures 2 mm at C6 level, also 2 mm previously. Focus of high T2 signal and slight volume loss in the right hemicord at C2-3 level is also unchanged and compatible with myelomalacia. There is unchanged multilevel nerve root expansion with associated neural foramen widening. There is no significant intraspinal extension or associated spinal cord compression. Vertebral body and disc heights are preserved. Cervical lordosis is preserved. Alignment is anatomic. Vertebral body marrow signal is benign.

Output: 1. Again seen are postsurgical changes of Chiari decompression with unchanged appearance of the cervical syrinx and areas of myelomalacia.2. No appreciable change in appearance of the peripheral nerve sheath tumors involving the neural foramina throughout the cervical spine.


Instruction: Generate impression based on findings.

Input: Male, 41 years old. Reason: assess for RTC tear History: left shoulder pain ROTATOR CUFF: There is increased T2 signal along the anterior aspect of the supraspinatus at the musculotendinous junction, compatible with degenerative change and indicating tendinopathy. Additionally, there is a full-thickness tear of the supraspinatus tendon at its insertion. The other visualized rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and glenoid labrum appear normal. A small amount of fluid is seen within the joint.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Full-thickness tear of the supraspinatus tendon at its insertion, without retraction. Additional supraspinatus tendinopathy at the musculotendinous junction.2.Small amount of fluid within the shoulder joint and the subdeltoid/subacromion bursa.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with brain metastases, radiosurgery planning. Postoperative findings are seen compatible with tumor resection from the left frontal region. A rim-enhancing structure at the operative site is unchanged. Edema in the surrounding parenchyma is also unchanged.Multiple intracranial lesions are redemonstrated without significant interval change. These include a lesion at the posterior medial right temporal lobe, along the inferior left temporal lobe, and multiple lesions in the cerebellum. No new intracranial lesions are appreciated.

Output: 1.Stable postoperative findings in the left frontal region.2.Multiple other metastatic lesions are redemonstrated without significant interval change. No new lesions are appreciated.


Instruction: Generate impression based on findings.

Input: Male, 15 days old, history of ECMO, assess for hypoxic ischemic injury. Brain parenchymal morphology is within normal limits. The degree of gyral development as well as the pattern of white matter myelination are appropriate for the stated age. No evidence of focal signal abnormality is seen including no evidence of restricted diffusion.The corpus callosum is fully formed and intact. The pituitary region is normal. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation of the brain. Specifically, there is no evidence of hypoxic-ischemic injury or any other acute abnormalities.


Instruction: Generate impression based on findings.

Input: Orbits: Previously seen multiple small enhancing lesions involving the bilateral extraocular muscles have resolved. Small enhancing lesion involving the right frontal scalp appears decreased in conspicuity although there remains mild residual enhancement in this region. Small lesions in the right infratemporal fossa and left masticator space also appear to have resolved. Previously seen enhancing lesion in the right malar region is no longer definitively appreciated although there is artifact in this region on the current study which limits assessment. No new lesions. Bilateral globes and retrobulbar fat are unremarkable. Bilateral optic nerves are normal in signal.Brain: No evidence of intracranial mass or parenchymal edema. No abnormal parenchymal or meningeal enhancement. No extra-axial collections. Ventricles and sulci are within normal limits.There are punctate foci of susceptibility in the left cerebellar hemisphere as well as the right posterior paramedian frontal lobe. The left cerebellar focus was present previously. The right posterior frontal focus was not definitively present on prior study although this may reflect technique differences.There are frothy secretions within the left maxillary sinus as seen on recent CT. There is also mucosal thickening involving the left frontal sinus and mild bilateral ethmoid opacification. There is overall improvement in paranasal sinus opacification since recent CT from 12/3/2016.There is mild opacification of the bilateral mastoid air cells which is new since prior MRI from 9/23/2016.

Output: 1. There is no evidence of active infection or leukemia involving the brain.2. There are two punctate foci of susceptibility effect in the right posterior frontal lobe and in the left cerebellum. These may represent chronic microhemorrhages or mineralization and although nonspecific may represent sequela of treated infection.3. Images of the orbits demonstrate interval resolution of the previously seen small enhancing lesions in the extraocular muscles. Additional lesions involving the maxillofacial soft tissues have also resolved or nearly resolved. Please see additional comments above.


Instruction: Generate impression based on findings.

Input: 39 year old male with a history of left ventricular hypertrophy, syncope, SVT, atypical chest pain. Negative coronary angiogram. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%. There is mild concentric hypertrophy(IVSd=11 mm). The LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 79 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 115 g (normal range 164+/-36). 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. Native pre-contrast myocardial T1 relaxation time ranges between 950-1050 ms (normal), extra-cellular volume fraction is normal (27%), T2-ratio is 1.6 (normal), global relative enhancement ration is 1.1 (normal). No evidence of myocardial iron overload based on normal T2-star relaxation time. All of these suggest that there is no underlying myocardial fibrosis, inflammation, or infiltration. Left AtriumThe left atrium is normal in size (75ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 110 ml/m2 (normal range 82+/-16), the RVEDV is 258 ml (normal range 142+/-31), the RV end systolic volume index is 60 ml/m2 (normal range 31+/-9), and the RVESV is 140 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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 left ventricular size and normal systolic function (LVEF 58%) with mild concentric left ventricular hypertrophy. No evidence of underlying myocardial fibrosis inflammation or infiltration based on multiple quantitative myocardial tissue characterization parameters.2. Normal right ventricular size with mildly reduced systolic function (RVEF 46%). 3. Mild right atrial dilationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 75-year-old woman with history of pancreas divisum and recurrent pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. Slight dropout of signal on opposed phase imaging suggests fatty infiltration of the liver. Patient is status post cholecystectomy. There is no intrahepatic pancreatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is pancreas divisum with a santorinicele (401/17). The main pancreatic duct is dilated up to 5 mm. On post secretin images, there is normal exocrine function of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts noted. The right kidney appears normal.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: Pancreas divisum with santorinicele and dilated main pancreatic duct, but no exocrine abnormality on post-secretin images.


Instruction: Generate impression based on findings.

Input: There is a small focus of acute infarction in the left temporal lobe on series 501 image 208. There are additional punctate foci of acute infarction in the left occipital lobe on series 501 image 214. There are also small punctate foci of restricted diffusion in the central pons (series 501 image 206). There are other foci of increased DWI signal without definite corresponding decreased ADC signal or T2 hyperintensity in the left frontal and parietal lobes, which may represent less acute ischemia. There are foci of punctate susceptibility effect in the bilateral cerebellar hemispheres, vermis, pons, left thalamus, and left frontal lobe probably representing chronic microhemorrhages. There is diffuse confluent vasogenic pattern T2 signal abnormality in the subcortical and periventricular white matter in both supratentorial and infratentorial brain representing chronic hypertensive changes as they correspond to confluent hypodensity on prior remote CT as well. There is unchanged bifrontal encephalomalacia, left greater than right with expected ex vacuo dilatation of the frontal horns. There is a small left frontal bone defect with foci of susceptibility representing osseous fragments, unchanged from prior CT. The ventricles and sulci are unchanged.

Output: 1.Small to punctate foci of acute infarction in the left temporal lobe, left occipital lobe, and the central pons.2.Diffuse vasogenic pattern T2 confluent signal abnormality consistent with background chronic hypertensive encephalopathy as they were present on prior remote CT as well. Superimposed acute findings related to posterior reversible encephalopathy syndrome may be present in the cerebellar hemispheres bilaterally due to possible mild mass effect suspected in the cerebellar hemispheres, although it is difficult to distinguish the acute findings from the background of extensive chronic hypertensive findings.3.Bifrontal encephalomalacia, left greater than right, with small left frontal calvarial defect and tiny foci of bone within the left frontal region of encephalomalacia, unchanged.Findings were discussed with cardiology intern Dr. Zhang over the telephone at 5:10 p.m. today.


Instruction: Generate impression based on findings.

Input: Male 51 years old Reason: ? SLAP tear, ? Rotator cuff tear History: pain ROTATOR CUFF: Rotator cuff is intact.SUPRASPINATUS OUTLET: There is a type I acromion. No significant abnormality.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the anterior superior labrum most consistent with degeneration. No discrete tear of the labrum. Bone island is situated within the glenoid anterior humeral head.BICEPS TENDON: The biceps tendon is situated in the bicipital groove. No significant abnormality. ADDITIONAL

Output: Irregularity of the anterior superior labrum consistent with degeneration without discrete tear.


Instruction: Generate impression based on findings.

Input: 49-year-old female with right knee pain, history of right knee arthroscopy with medial and lateral partial meniscectomies, grade 3 chondromalacia of the patella was chondroplasty, extensive microfracture of the patella, medial femoral condyle and lateral tibial plateau (6/4/2015) MENISCI: Linear intrasubstance signal abnormality within the posterior horn of the medial meniscus extending to the femoral articular surface consistent with a tear. Interval increase in degree of extrusion of the body of the medial meniscus. Intermediate signal within the inner edge of the body of the medial meniscus reflective of a radial tear.New globular intermediate signal within the anterior horn of the lateral meniscus extending to the femoral articular joint may represent degenerative tearing.ARTICULAR CARTILAGE AND BONE: Grade IV chondromalacia of the medial tibiofemoral compartment with joint space narrowing, bulky osteophytosis, subchondral sclerosis, and thinning of the articular cartilage. Focal fissuring/laminar tearing is noted along the posterior medial femoral condyle. Focal full-thickness signal abnormality in the posterior medial femoral condyle cartilage with underlying subchondral edema type signal.Grade 1-2 chondromalacia of the lateral tibiofemoral compartment with focal full-thickness chondral defect of the tibial articular cartilage measuring 7 mm in the AP dimension, worsened in the interval. A focal delamination defect is present along the medial aspect of the femoral trochlea. Edema type marrow signal is noted within and around the lateral tibial spine.Grade 2-3 chondromalacia of the patellofemoral compartment worst along the patellar ridge. Postsurgical appearance of microfracture of the lateral facet of the patella.LIGAMENTS: The cruciate ligaments are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.New tearing of the body and posterior horn of the medial meniscus with interval increase in degree of extrusion. 2.New globular intermediate signal within the anterior horn of the lateral meniscus extending to the femoral articular joint may represent degenerative tearing.3.Focal fissuring/laminar tearing is noted along the posterior medial femoral condyle is new. Focal delamination defect is present along the medial aspect of the femoral trochlea.4.Worsened focal full-thickness chondral defect in the lateral tibial articular cartilage measuring 7 mm in the AP dimension.5.Severe osteoarthritis affects the right knee, worst at the medial tibiofemoral compartment. 6.Interval resolution of joint effusion. Interval decrease in size of Baker's cyst now containing a 7 mm loose body.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is mild increased signal within the medial meniscus representing intrasubstance degeneration however there is no discrete medial or lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There are areas of partial-thickness and perhaps full-thickness articular cartilage loss within the medial femoral condyle, particularly posteriorly. There is focal edema within the medial femoral condyle posteriorly and the overlying tendon of the head of the gastrocnemius appears thickened, suggesting tendinosis. There is a small adjacent cyst/ganglion and mild soft tissue edema as well. There is partial thickness degeneration of the articular cartilage of the medial facet of the patella with associated degenerative marrow signal. The lateral compartment appears normal. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Mild intrasubstance degeneration of the medial meniscus without evidence of medial or lateral meniscal tear.2. Cartilage degeneration as described above. 3. Focal edema within the medial femoral condyle posteriorly which may be secondary to overlying tendinosis of the medial head of the gastrocnemius.4. Edema within Hoffa's fat pad and slight lateral patellar translation, the combination of which may represent a patellar tracking abnormality.


Instruction: Generate impression based on findings.

Input: Evaluation of mass in R parietal lobe found on CT scan of OSH. Seizures, altered mental status. There is an ill-defined infiltrative T2 hyperintense lesion in the inferior right temporal lobe predominantly involving the white matter. However, there are scattered foci of signal abnormality also involving the cortex extending into the insula and to the parieto-temporal junction. A T2 hyperintense lesion is present in the posterior medial right thalamus. The right amygdala and hippocampus appears thickened and mildly T2 hyperintense. There is no obvious postcontrast solid nodular enhancement. However, there is substantial sulcal enhancement both in the vicinity of the mass and rather diffusely in the right cerebral hemisphere. At least some of this enhancement appears to be related to increased vascularity however leptomeningeal enhancement is not entirely excluded. There is effacement of the temporal horn of the right lateral ventricle, otherwise the ventricles appear nondistended. No definite acute intracranial hemorrhage is identified. There is no midline shift.

Output: There is an ill-defined T2 hyperintense process involving the right temporal lobe, insula, parieto-temporal cortex, posterior right thalamus,and questionably the medial temporal structures. Although there is no definite solid nodular enhancement, there is significant sulcal enhancement some of which is at least in part related to increased vascularity in the region. Although the differential considerations are broad and include neoplastic as well as nonneoplastic etiologies, the possibility of a malignancy, including higher grade primary brain tumors, would need to be considered.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Glioblastoma treated with Avastin+/- AMG 386. There are post-treatment findings, include right temporooccipital craniotomy with an underlying resection cavity. There is no significant interval change in the degree of linear enhancement and confluent T2 hyperintensity surrounding the resection cavity, accounting for differences in technique. There are minimal residual punctate foci of restricted diffusion along the margins of the resection cavity. There is no evidence of acute territorial infarct. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. The skull and scalp tissues appear unchanged. The orbits and paranasal sinuses appear unremarkable.

Output: No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Male, 27 years old. SCT patient with swollen painful wrist. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is grossly intact.TENDONS: The tendons of the wrist are normal. BONES: There is edema type signal throughout the lunate, which may reflect avascular necrosis. This area of abnormal signal does not appear to enhance. There is a mild negative ulnar variance.ADDITIONAL

Output: Bone marrow edema of the lunate likely reflects avascular necrosis.