Instruction: Generate impression based on findings.

Input: 50 year-old female with change in mental status following craniotomy. Evaluate for hemorrhage. Postoperative changes status post bifrontal craniotomy, with pneumocephalus, surgical hardware, and skin staples evident. Previously described partially calcified lesions along the anterior interhemispheric fissure just right of midline and along the high left frontal convexity are unchanged. There is marked low attenuation within the frontal lobes, right greater than left, corresponding to edema seen on MRI. An area of focal low attenuation is seen in the medial left frontal lobe, concerning for ischemia. Punctate high attenuation in the medial left frontal lobe may represent calcification or hemorrhage, though thrombus within the anterior cerebral artery may have this appearance.A small curvilinear focus of high attenuation is seen in the medial right frontal lobe inferior to the partially calcified lesion, which may represent a small focus of hemorrhage. The degree of leftward midline shift has slightly increased, with ventricular volumes unchanged. The remainder of the cerebral and cerebellar hemispheres and brainstem demonstrate normal morphology and attenuation. Postoperative changes affect the frontal bones, with the remainder of the calvarium and osseous structures appearing intact. There is partial opacification of the left anterior ethmoid air cells, with the remainder the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Focal low attenuation in the medial left frontal lobe, suspicious for anterior cerebral artery territory or venous infarction.2. Extensive postoperative changes with residual tumor and mass effect as described.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for gray/white matter changes. Signs and symptoms: Vegetative state. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. The gray -- white matter differentiation is preserved. The cortical sulci, ventricular system and all CSF cisterns remain within normal. No detectable parenchymal volume loss. In comparison to the prior examination there is no evidence of interval change.Calvarium is intact.Limited views of the orbits, mastoid air cells and middle ear cavities are unremarkable.The visualization of fluid and soft tissue density within the sphenoid sinus with interval worsening since prior exam. This may be secondary to instrumentation an NG tube placement.Considering provided clinical date of follow-up with an MRI examination is recommended.

Output: 1.Essentially unremarkable CT of brain and unchanged since prior examination from 4 -- 26 -- 2010.2.Further follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There are multiple, greater than 10, T2 hyperintensity white matter lesions, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, 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, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: No significant interval change in the intracranial demyelinating lesions, accounting for differences in technique.


Instruction: Generate impression based on findings.

Input: 65yr old male with history of DLBCL evolved from CLL s/p SCT and heart failure presenting for cardiac evaluation. MEDICATIONS: lisinopril, furosemide, carvedilol First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarNo evidence of myocardial infarction. There is no definitive late gadolinium enhancement noted to suggest that there is replacement fibrosis, inflammation, or infiltration. However, the native T1 times are significantly elevated at 1150-1225 ms (nl <1050ms) diffusely, which suggest the presence of diffuse interstitial myocardial fibrosis or edema. Left VentricleThe left ventricle is moderately dilated with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 213 ml (normal range 142+/-34), the LV end systolic volume index is 67 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 91 g/m2, and the LV mass is 148 g. The LV dysfunction is global. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 115 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 89 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a partially loculated pericardial effusion which is moderate in size along the mid to apical RV free wall. There is a much smaller circumferential pericardial effusion. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No evidence of myocardial infarction. There is no late gadolinium enhancement noted to suggest the presence of replacement fibrosis, inflammation, or infiltration. However, the native T1 times are significantly elevated at 1150-1225 ms (nl <1050ms) diffusely, which would suggest the presence of diffuse interstitial fibrosis or edema. 3. Moderately dilated LV size and mildly reduced systolic function (LVEF 48%).4. Normal RV size and systolic function (RVEF 52%).


Instruction: Generate impression based on findings.

Input: Low grade astrocytoma. There are postoperative findings related to biopsy of a heterogenously enhancing stellate-shaped mass centered in the left peritrigonal white matter extending to left pre and postcentral gyri and left thalamus that measures up to approximately 4 cm. The mass also contains areas of susceptibility effect that correspond to calcifications and is surrounded by confluent areas of high T2 signal. Some portions of the mass appear to have gradually increased in size. Furthermore, there is now a small patchy area of enhancement in the right paracentral lobule with surrounding high T2 signal, as well as a punctate focus of enhancement in the left splenium of the corpus callosum in an area of increased high T2 signal and swelling. There are otherwise unchanged T2 hyperintense lesion in the periventricular and subcortical white matter and in the brainstem, which are nonspecific. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings suggestive of gradual progression of the mass centered in the left peritrigonal white matter extending to left pre and postcentral gyri and left thalamus, as well as development of what appears to be additional enhancing tumor in the left paracentral lobule and splenium of the corpus callosum.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for progression of MS. Signs and symptoms: Imbalance. Pre- and post enhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates interval significant decreased size of several of demyelinating plaques in bilateral cerebral hemispheres since prior exam. There is no convincing evidence of any new demyelinating lesions since prior exam. Multiple previously noted enhancing demyelinating plaques demonstrate significant interval decreased size as detailed above. There is persistent trace enhancement in the left anterior frontal cingulate gyrus similar to prior exam (axial post enhanced series 1101 image 16). There is no associated FLAIR or T2 signal abnormality with this finding which is a similar observation is prior study. This tiny foci of enhancement also has remained stable when compared with earlier exams and including MRI exam from 9-3-2011 and likely representing a tiny developmental venous anomaly.The cortical sulci, ventricular system and CSF spaces are unremarkable for stated age.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells.

Output: 1.No convincing evidence of new demyelinating plaque or enhancement.2.Significant interval decreased size of multiple previously noted demyelinating lesions and resolution of enhancement.3.Moderate supratentorial findings of chronic demyelinating disease.4.Tiny focus of parenchymal enhancement without associated FLAIR hyperintensity in the left anterior cingulate gyrus has remained stable since multiple prior exams including study from 2011 and likely representing a tiny developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Clinical question: Secondary cause of memory loss. Signs and symptoms: Memory loss. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate normal anatomical development and morphology of the brain parenchyma. There are mild punctate foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres which considering patient's stated age likely representing microvascular ischemic changes of mild degree. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. Mild prominence of cerebral cortical sulci is noted in bilateral parietal lobes and unremarkable otherwise for patient's stated age.The ventricular system remains within normal and with maintained midline.CSF spaces are unremarkable.Signal void of all major intracranial arterial branches are identified.Unremarkable images through the orbits and with normal appearing calvarium and soft tissues of the scalp.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities are unremarkable.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic small vessel ischemic strokes.3.Mild bilateral prominence of cortical sulci mostly in the parietal lobes and unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Cervical: There is evidence of osseous metastatic disease in the cervical spine with more diffuse marrow infiltration noted involving the C4 vertebral body extending into the posterior elements on the right. This lesion is new since prior MRI cervical spine from 2/20/2014. No evidence of epidural tumor in the cervical spine. No compression fractures in the cervical spine. Vertebral body heights and alignment are maintained. No cord signal abnormality. There are mild degenerative changes in the cervical spine including multilevel facet arthropathy. No significant spinal canal or neural foraminal stenosis is appreciated although motion degradation slightly limits evaluation. Thoracic: There is evidence of multifocal osseous metastatic disease. There is a small osseous lesion involving the the anterior inferior T1 vertebral body. There is a larger lesion involving the dorsal aspect of the T2 vertebral body. Small scattered lesions are seen throughout the thoracic spine more inferiorly as well with larger lesions involving the T8 and T9 vertebral bodies. Posterior element involvement is noted at multiple levels as well. No new compression fractures are demonstrated. Minimal irregularity/compression deformity involving the superior T3 endplate and mild wedging of the T6 and T7 vertebral bodies are unchanged.Compared to 2/20/2014, T8 and T9 lesions appear similar. Small T1 lesion is new/larger. There are multiple small new lesions involving the T2 T3, T4, T5, and T6 levels with posterior element involvement at multiple levels. There is extensive enhancing epidural tumor which extends from the C7-T1 level to the T3-T4 level with significant narrowing of the spinal canal from T1-T2 through the T2-T3 level and deformity of the cord. No cord signal abnormality is appreciated. These findings are new since 2/20/2014.Prominence of the epidural fat in the thoracic spine is again noted narrows the thoracic spinal canal more diffusely. No high-grade stenosis in the thoracic spine at additional levels however is demonstrated. There is narrowing of the left T2-3 neural foramen as well as the right T2-T3 and T9-T10 neural foramina. Otherwise no significant foraminal stenosis is appreciated. Prominent right posterior medial 9th and 10th rib involvement is again noted. Right lower lobe consolidation and small right pleural effusion noted. Please refer to prior chest CT.

Output: 1. Compared to prior cervical and thoracic spine MRI from 2/20/2014, there is progression of metastatic disease with new C4 lesion as well as multiple new upper thoracic lesions.2. There is interval development of extensive epidural tumor which extends from the C7-T1 level to the T3-T4 level with significant narrowing of the spinal canal from T1-T2 through the T2-T3 level with deformity of the cord. No cord signal abnormality is appreciated. 3. Subtle irregularity involving the superior endplate of the T3 vertebral body and mild wedging of the T6 and T7 vertebral bodies are similar to prior. No new pathologic compression fractures.


Instruction: Generate impression based on findings.

Input: 61-year-old male. Cirrhosis. HCC screening, high AFP. ABDOMEN:LUNG BASES: Small subcentimeter nodular opacity in the right lung base. Previously there was nonspecific streaky opacity in this region, which has decreased.LIVER, BILIARY TRACT: Widening of the fissures and mildly nodular contour of the liver consistent with cirrhotic morphology. Cholelithiasis.No suspicious focal hepatic mass.No biliary ductal dilatation. Patent hepatic vasculature.SPLEEN: No significant abnormality noted. Two small splenules are 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: Trace scattered abdominopelvic ascites.

Output: 1. Cirrhosis with no suspicious lesions.2. Small nodular opacity in the right lung base which can be better characterized with CT.


Instruction: Generate impression based on findings.

Input: Cervical spine:6-7 mm cerebellar ectopia is noted with the left demonstrate normal rounded morphology and the right a minimally pointed morphology. Biphasic CSF flow is noted at the level of the cerebellar tonsils.The odontoid tip is mildly retroflexed.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Minimal disc bulge without significant mass effect or resulting stenosis. There is focal right uncinate hypertrophy without significant mass effect on the adjacent neural foramen.C4/5: Minimal disc bulge without significant mass effect or resulting stenosis.C5/6: Mild disc bulge and right uncinate hypertrophy without significant mass effect or resulting stenosis.C6/7: Mild disc bulge and right uncinate hypertrophy without significant mass effect or resulting stenosis.C7/T1: UnremarkableThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.MRI evidence for acute Chiari malformation as described in detail above.. Biphasic CSF flow is noted at the level of the cerebellar tonsils.2.No spinal cord syrinx.3.Mild degenerative changes without significant resulting stenosis.


Instruction: Generate impression based on findings.

Input: Cervical spine disc herniation on left side, sciatica. Lumbago, cervicalgia Cervical spine: Examination of the cervical spine is slightly motion degraded. No abnormal signal is definitively appreciated within the cervical cord. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of normal cervical lordosis with with mild retrolisthesis of C5 on C6 and C6 on C7. Bone marrow signal is benign with signal changes related to degenerative disease. There is loss of disc height throughout the cervical spine, worst at the C6-C7 level. Multilevel degenerative changes, as described below:C2-3: No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing. Bilateral facet arthropathy.C3-4: There is mild spinal canal stenosis with partial effacement of the ventral and dorsal thecal sac. Mild to moderate left and mild right neural foraminal narrowing. Bilateral facet arthropathy.C4-5: There is moderate spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening effacing the ventral and dorsal thecal sac. There is mild bilateral neural foraminal stenosis. There is facet arthropathy on the right with mild surrounding inflammatory changes.C5-6: There is moderate spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening effacing the ventral and dorsal thecal sac. There is moderate to severe bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C6-7: There is moderate spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening effacing the ventral and dorsal thecal sac. There is moderate to severe left and moderate right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C7-T1: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing. Facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of normal lumbar lordosis. Alignment is otherwise within normal limits. There is significant loss of disc height at the L5-S1 level. Bone marrow signal is benign. The conus medullaris is normal in position.There appears to be congenital narrowing of the lumbar spinal canal with superimposed multilevel degenerative changes as described below: L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild to moderate degree of spinal canal stenosis related to examination of disc bulge, ligamentum flavum thickening, epidural fat, and facet arthropathy. There is mild right and mild to moderate left neural foraminal stenosis.L3-L4: There is moderate degree of spinal stenosis stenosis related to disc bulge, facet arthropathy, ligamentum flavum thickening, and epidural fat. There is mild to moderate bilateral neural foraminal stenosis.L4-L5: There is mild to moderate spinal canal stenosis related to ligamentum flavum thickening, facet arthropathy, and mild disc bulge. Effacement of the left lateral recess is also noted. There are small foraminal disc protrusions. There is moderate left and mild to moderate right neural foraminal stenosis. L5-S1: Severe loss of disc height. No significant spinal canal stenosis. Mild facet arthropathy. There is mild to moderate left and mild right neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Moderate degenerative changes throughout the cervical spine with moderate spinal canal stenosis at C4-C5, C5-C6, and C6-C7. There is also multilevel neural foraminal stenosis, worst at C5-C6 where there is moderate to severe bilateral neural foraminal stenosis. Facet arthropathy is also noted at multiple levels which may also be contributing to patient's neck pain.2. Multilevel degenerative changes in the lumbar spine with superimposed on congenital narrowing of the lumbar spinal canal. There is moderate degree of spinal canal stenosis at the L3-L4 levels and mild to moderate degrees of neural foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: 30-year-old woman with right wrist pain. Evaluate right wrist ganglion cyst LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact.TENDONS: No significant abnormality noted. BONES: There is a 2-3 mm round focus within the capitate which features highly T2 and low T1 signal, consistent with a small cyst or benign enchondroma. A punctate focus within the lunate has the same imaging characteristics. No fracture is evident.ADDITIONAL

Output: No evidence of a dorsal ganglion of the wrist.


Instruction: Generate impression based on findings.

Input: 27 years, Female, aphasia, headache. Brain parenchyma is within normal limits for age. No significant parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia; although artifact (related to hair weave) slightly obscures assessment of the left anterior frontal lobe. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Brain MRI is within normal limits. Specifically, no evidence of acute infarct or intracranial mass.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post robotic-assisted laparoscopic prostatectomy on 5/27/2016. His final pathology revealed Gleason 4+5 disease with positive margins at the L peripheral and L apex, 2/19 node involvement on the right with largest lymph node tumor being 15 mm with extranodal invasion, tumor volume 65%, pT3bN1MxR1. Recent PSA is 0.29, post-operatively was 0.11. Preoperatively PSA=11.85 ng/ml PELVIS:PROSTATE:Prostate Size: Patient is status post prostatectomy.Peripheral Zone: Patient is status post prostatectomy.Central Gland: Patient is status post prostatectomy.Seminal Vesicles: Patient is status post prostatectomy.Extracapsular Extension: Patient is status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Left external iliac T2 hyperintense lesion measuring 2.4 x 1.1 cm (series 1901 image 95). This lesion has no internal enhancement and favor lymphocele. Previously seen right external iliac lymph node is not definitely seen on current study and may have been surgically removed. Tiny nonspecific periprostatic lymph node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left external iliac T2 hyperintense lesion without internal enhancement, favor lymphocele. 2.Tiny nonspecific periprostatic lymph node, but no specific evidence of disease recurrence.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: new onset seizure, eval for structural/ischemic abnormality History: 80F with anemia who presented with new onset seizure, currently AA0x3 without focal deficits There is no evidence of acute ischemic or hemorrhagic lesion.There are scattered low somewhat patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Mild to moderate nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 5.6 cm in transverse dimension by 4.3 cm in AP dimension by 3.8 cm in craniocaudal dimension.Peripheral Zone: Ill-defined abnormal signal in peripheral zones bilaterally at level of base. On right, focus of signal abnormality measures approximately 2.2 cm in transverse by 1.4 cm in AP by 0.8 cm in craniocaudal dimensions. On left, focus of signal abnormality measures approximately 1.5 cm in transverse x 1.7 cm in AP by 1.3 cm in craniocaudal dimensions. Corresponding low ADC and T2 hypointense signal seen and associated extracapsular extension and seminal vesicle invasion present. Additional subcentimeter low ADC signal seen in right-sided peripheral zone at level of midgland laterally, nonspecific. Areas of T1 hyperintensity in gland likely reflect postbiopsy hemorrhage.Central Gland: Moderate BPH-related changes. Seminal Vesicles: Invasion present.Extracapsular Extension: Present.BLADDER: Underdistended, making evaluation suboptimal, but no definite bladder invasion delineated.LYMPH NODES: Subcentimeter inguinal lymph nodes with fatty hila, subcentimeter pelvic sidewall nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Colonic diverticulosis.

Output: 1. Areas in prostate base suspicious for malignancy with associated seminal vesicle invasion as described. Additional small signal abnormality in right midgland peripheral zone, nonspecific.


Instruction: Generate impression based on findings.

Input: 6-year-old female with history of GBM status post radiation therapy. Redemonstrated is a large focus of T2 hyperintensity in the posterior pons and extending superiorly into the right cerebral peduncle and inferiorly bulging into dorsal aspect of the upper medulla. Although the transverse aspect has slightly decreased, there is a new focus of T2 hyperintense extension involving previously uninvolved anterior right paramedian pons. As before, there is irregular peripheral enhancement with a large central focus of non-enhancement, associated with susceptibility abnormality. Overall, the peripheral enhancement appears thicker, and more nodular, and there is new enhancement extending into the aforementioned new T2 hyperintense abnormality as well as new enhancement extending into the left cerebral peduncle. As before, there is mass effect with flattening and posterior displacement of the fourth ventricle and mild supratentorial ventricular enlargement which is stable. The cortical sulci remain within normal for stated age and midline is maintained. There is no additional foci of parenchymal signal abnormality or parenchymal/leptomeningeal abnormal enhancement. Expected vascular flow voids are demonstrated. New fluid is present within a few dependent left mastoid air cells, and mild inflammatory change in the right mastoid air cells appear stable.

Output: Redemonstrated is a necrotic pontine mass with a thick irregular rim of enhancement and surrounding edema. Overall, the peripheral enhancement appears thicker, and more nodular, and there is new enhancement extending into a region of new T2 hyperintense abnormality, as well as new enhancement extending into the left cerebral peduncle. The differential diagnosis would include tumor progression versus radiation necrosis.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. There is T1 shortening in the upper thoracic vertebrae compatible with postradiation change. There is minimal loss of height of the upper thoracic vertebral bodies with no associated edema to suggest recent compression fracture. The disk heights are well maintained. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.There is a 10 x 8 mm enhancing lesion involving the posterior inferior aspect of the pedicle at the right T11 level which is nonspecific (best seen on sagittal T1, STIR and sagittal postgad sequences). No associated soft tissue mass.LUMBAR SPINE

Output: 1.10x8 mm enhancing lesion within the right pedicle of the T11 vertebral body is nonspecific, however, metastasis is not excluded.2.No additional spinal lesions, pathologic compression fractures, or epidural or leptomeningeal tumor.


Instruction: Generate impression based on findings.

Input: Locoregional synovial sarcoma of spine (C2-T2) with cardiac extension; pulmonary relapse March 2016; surveillance imaging. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is also a mild effusion within the left mastoid air cells.Spine: There are postoperative findings related to C2-T2 laminoplasty and tumor debulking. There is interval decrease in size of the enhancing left paraspinal tumor with encasement of the left vertebral artery at these levels, with invasion of each neural foramen and minimal extension into the intraspinal epidural space, measuring up to 20 mm in thickness at the C3-4 level, previously 25 mm. There is persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature at the cervico-thoracic junction, but no spondylolisthesis. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. There is associated mild spinal cord flattening in this region, without spinal cord signal abnormality. The posterior paraspinal tissues are unchanged. There are nodules within the partially imaged right lung. There is a small right apical pneumothorax.

Output: 1. Slight interval decrease in size of the treated residual tumor.2. Persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. 3. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. 4. No evidence of intracranial metastases.5. Pulmonary metastases and small right apical pneumothorax. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on findings.

Input: 62-year-old female with bradycardia, slurred speech, and right facial droop. Please evaluate for intracranial process. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Small osseous deformity at the right lamina papyracea is likely from old trauma and appears similar to prior studies from 2009. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: 56 year old female with pulmonary hypertension, interstitial lung disease, sarcoidosis, NIDDM, diastolic hypertension referred for cardiac MRI to assess for cardiac involvement. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%. The LVEDV is 176 ml (normal range 109+/-23), LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), LVESV is 95 ml (normal range 31+/-10), and LV end systolic volume index is 46 ml/m2 (normal range 18+/-5). The LV mass is 97 g (normal range 114+/-24) and the LV mass index is 47 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1000 ms suggestive of absence of underlying diffuse fibrosis or infiltration.There is myocardial iron overload. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 43%, the RVEDV is 148 ml (normal range 110+/-24), the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVESV is 85 ml (normal range 35+/-13), and the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild 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 enlarged and there is enlargement of both right and left pulmonary arteries (MPA: 48mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMediastinal adenopathy 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.The left ventricle is mildly dilated with mildly reduced systolic function. LVEF 46%.2.The right ventricle is normal in size with mildly reduced systolic function. RVEF 43%3.No regional wall motion abnormalities. 4.No late gadolinium enhancement to suggest cardiac sarcoidosis.5.Signs of pulmonary arterial hypertension.


Instruction: Generate impression based on findings.

Input: Altered mental statusClinical question: acute brainstem ischemiaSigns and Symptoms: episode of unresponsiveness There is generalized brain atrophy present with some disproportionate enlargement of the lateral ventricles relative to the sulci.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional high signal foci on T2 and FLAIR MRI are present in the thalami and brainstem.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. Another possibility is it is related to no degenerative process. 2.A moderate degree of Lesions present in the thalami and brainstem are also likely vascular related.3.There is no evidence for acute ischemic cerebral infarction appreciated.4.Ventriculomegaly is a nonspecific finding. Although this could be related to atrophy, it could also be related to normal pressure hydrocephalus.5.Examination is somewhat degraded by patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Male 51 years old Reason: Med Meniscus Tear, Patella Chondromalacia History: Pain, Loss ROM Left knee pain MENISCI: There is small radial tear of the posterior horn/body junction of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is fibrillation and near full-thickness cartilage loss involving the medial patellar facet with a small amount of underlying degenerative marrow signal. Similar but less severe findings are noted along the lateral facet as well as the trochlea.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tear of the posterior horn/body junction of the medial meniscus.2. Moderate joint effusion and synovitis.3. Varying degrees of cartilage loss and thinning of the patellofemoral articulation with areas of near full-thickness loss along the medial facet.


Instruction: Generate impression based on findings.

Input: 63 years, Female, right CSF otorrhea. Evaluate brain. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Partially empty sella is noted which can be seen as a normal variant but can be associated with intracranial hypertension in the appropriate clinical setting. Cerebellar tonsils are low-lying without clear evidence of Chiari I reformation. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is diffuse opacification of the right-sided mastoid air cells. There is osseous defect involving the right tegmen mastoideum and compatible with history of CSF leak. Osseous defect and better seen on recent outside CT from 2/2/2016 as well as prior temporal bone CT from 12/8/2010. Minimal if any protrusion of the brain parenchyma is seen through this right temporal defect. There is asymmetrically increased enhancement of the overlying dura which may be reactive. No edema or clear evidence of encephalomalacia in the right temporal lobe is evident.Thinning of the roof of the left middle ear is also suspected as well as undulation of the left lateral temporal bone surface as well as the left greater sphenoid wing, better appreciated on outside CT and suggesting arachnoid pits. There is minimal opacification of the left-sided mastoid air cells.

Output: 1. Diffuse opacification of the right mastoid air cells with osseous defect involving the right tegmen mastoideum, which is better seen on recent CT. There is evidence of a meningocele at this level. There is minimal if any protrusion of the brain parenchyma through this right temporal bone defect. Dedicated temporal bone MRI can be considered for higher resolution visualization of this region if clinically indicated. There is asymmetrically increased enhancement of the overlying dura which may be reactive. No parenchymal edema or clear evidence of encephalomalacia in the right temporal lobe or elsewhere is appreciated.2. There is undulated appearance the floor of the contralateral left middle cranial fossa including the left sphenoid and left temporal bones with suggestion of "arachnoid pits". There are areas of osseous thinning/dehiscence in the left tegmen tympani. These osseous findings are better appreciated on prior temporal bone CT. 3. Partially empty sella which can be normal variant but can also be seen with intracranial hypertension. 4. Minimal nonspecific left mastoid air cell opacification.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, status post craniotomy for tumor resection. Compared to 2/19/2016, there has been evolution of postsurgical changes with decrease in blood products in the posterior fossa. Compared to 2/19/2016, there has been interval increase in heterogeneously enhancing tissue surrounding the resection cavity. The degree of FLAIR hyperintensity is minimally increased involving the cerebellar vermis and right greater than left cerebellar hemispheres. Partial effacement of the fourth ventricle is again seen. Ventricles remain not significantly changed in size with mild prominence, likely related to volume loss. No new lesions are seen elsewhere in the brain. A nonspecific focus of T2 hyperintensity within the white matter adjacent to the left frontal horn is unchanged. No evidence of significant intracranial mass effect, midline shift, or herniation.

Output: Compared to 2/19/2016 there has been interval increase in heterogeneously enhancing tissue surrounding the cerebellar resection cavity, which given history of recent radiation may reflect posttreatment change, but suggest close follow-up to exclude the possibility of true tumor progression.


Instruction: Generate impression based on findings.

Input: The patient submitted an outside study for review. Submitted for review is an MRI performed on 4/15/2016. For comparison,prior MRI from 10/20/2015 is available. MRI was performed as per outside protocol. No paperwork is submitted however. There is mild background parenchymal enhancement. An extreme amount of fibroglandular tissue is present. There is been significant interval decrease in the degree of abnormal enhancement in the left breast. Clumped discontinuous nonmass enhancement now extends over a total of 5.0 x 2.1 x 2.8 cm in the left inner breast. The overall volume of enhancing tissue is significantly decreased. The biopsy-proven metastatic lymph node is significantly decreased in size, now measuring up to 1.1 cm. No new suspicious enhancing lesion in either breast or axilla.

Output: Significant interval decrease in left breast enhancement since the prior MRI. Left axillary adenopathy is also improved. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 49-year-old male patient with right shoulder pain. There is cyst formation in the humeral head near the insertion of the rotator cuff, as seen on prior MRI. Mild osteoarthritis affects the glenohumeral joint.

Output: Mild osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: evaluate for avm. HIV, history of CNS toxoplasmosis. MRI of the brainHeterogeneous signal present along the medial right parietal lobe with a gyriform T1 signal hyperintensity and T1 hypointensity as well as a 10 x 15mm irregular ring enhancing lesion with eccentrically thickened wall. This ring enhancing component is adjacent to the trigone of the right lateral ventricle. On the T2 imaging there is a surrounding white matter signal change in the mild asymmetry in the size of the trigone of the right lateral ventricle with right larger than left.A small focus of encephalomalacia is present at the right centrum semiovale.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Right vertebral artery is hypoplastic distally and predominantly supplies the right posterior inferior cerebellar artery. The right posterior cerebral artery slightly larger than the left posterior cerebral artery. There is a narrowing of the right posterior cerebral artery as it courses through the right medial occipital lobe lesion.There is fenestration of the right internal carotid artery at the ophthalmic segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is somewhat irregular in appearance which may be a result of its course. The left A1 segment is larger than the right A1 segment. The posterior communicating arteries are readily identified

Output: 1.There is a right occipital lobe lesion which is ring enhancing. Given the patient's clinical history, it is suspected this may represent a reactivation of prior infection such as toxoplasmosis with some dystrophic calcifications. Presence of associated acute hemorrhage is less uclear. A comparison with a prior exam may be helpful. This finding was discussed with Dr Ardelt at the time of this dictation. It is of course concerning at this is immediately adjacent to the right lateral ventricle.2.No evidence for AVM.3.No evidence for intracranial aneurysm. The intercommunicating artery appears somewhat irregular however.4.There is narrowing of the right posterior cerebral artery adjacent to the right occipital lobe lesion.5.Incidental load is made of fenestration of the right internal carotid artery at the ophthalmic segment


Instruction: Generate impression based on findings.

Input: 53 year old female with alcoholic cirrhosis and HCC status post resection presenting with right upper quadrant pain. Evaluate for recurrence. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has nodular contours consistent with cirrhosis. New hyperattenuating focus seen only on arterial phase measures 1 x 1 cm on image 39 series 9. Although no definite washout is identified which favors benignity, continued follow up or MRI is suggested for further characterization of this lesion. The patient has undergone interval resection of a portion of the left lateral segment. There is a small perihepatic fluid collection which is likely postsurgical in etiology. No new lesions are identified.Cholelithiasis and pericholecystic fluid. If there is clinical concern for acute cholecystitis, a right upper quadrant ultrasound may be obtained. 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: Borderline enlarged retroperitoneal lymph nodes are stable.BOWEL, MESENTERY: Appearance of intussusception in the duodenum may be transient and is of uncertain clinical significance. Multiple colonic diverticula with retained hyperattenuating foci likely represent retained contrast. No evidence of obstruction, intra-abdominal free air, or abscess is identified.BONES, SOFT TISSUES: Postsurgical changes are identified in the right anterior abdominal wall from the incision.OTHER: Extensive collateral vessels inferior to the spleen at the splenic hilum consistent with portal hypertension.

Output: 1.New 1 cm enhancing focus in the right lobe of liver seen only on arterial phase without definite washout for which continued follow-up or MRI for further characterization is suggested. 2.Cirrhosis and portal hypertension as described above.3.Cholelithiasis and pericholecystic fluid. If there is clinical concern for acute cholecystitis, a right upper quadrant no may be obtained.4.Postoperative and other findings as described above.


Instruction: Generate impression based on findings.

Input: Nystagmus. There are multiple, greater than 10, T2 hyperintense lesions in the bilateral cerebral white matter, predominantly in a periventricular distribution. Many of the lesions also display T1 hypointensity. There are also T2 hyperintense lesions in the middle cerebellar peduncles and cerebellar white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: The supratentorial and infratentorial white matter lesions are suggestive of a demyelinating disease, such as multiple sclerosis.


Instruction: Generate impression based on findings.

Input: The ventricles are mildly prominent, as are the anterior subarachnoid spaces. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is left mastoid air cell and middle ear fluid opacification. Incidental note is made of a small oval-shaped T2 hyperintense structure along the left lateral supraorbital region, along the adjacent frontozygomatic suture, which measures 11 x 6 mm in greatest axial dimensions on 601/17. This demonstrates dropout of signal on axial fat saturated postcontrast images without enhancement. It demonstrates heterogeneous T1 hypointense signal and mild diffusion restriction.Anterior to the expected location of the anterior fontanelle, just the right of midline, there are some asymmetrically prominent cortical veins along the dural surface, as seen on 1403/75 and 1402/32-33. Fontanelle patency is difficult to assess on MRI. Probable benign enlargement as arachnoid spaces of infancy.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. The right vertebral artery is dominant. There is no evidence of flow-limiting stenosis or aneurysm

Output: 1. Unremarkable contrast enhanced MRI of the brain and noncontrast MRA head.2. Incidental small probable left lateral orbital dermoid/epidermoid.3. Probable benign enlargement of subarachnoid spaces of infancy which should resolve by 2 years of age. Follow-up imaging may be obtained as clinically indicated.4. Anterior to the expected location of the anterior fontanelle, incidental note made of asymmetrically prominent cortical veins to the right of midline. Please correlate with physical exam.


Instruction: Generate impression based on findings.

Input: 24-year-old female with previous oral surgery for recurrent tongue cancer including neck dissection There are new postprocedural changes involving the left neck, including ill-defined enhancement throughout the operative region with associated STIR T2 hyperintensity. However, previously demonstrated prominent left level 1B and level 2A lymph nodes are no longer present.Previously demonstrated nodular enhancement along the dorsal margin of the surgical flap in the right oral tongue has decreased in conspicuity. There is also decreased T2 signal (as best visualized on coronal STIR technique).There is increased T2 signal involving the left oral tongue (as best visualized on coronal STIR technique) suggesting postprocedural changes, however a previously demonstrated 7 mm diameter enhancing nodule in the left sublingual space is significantly smaller and is no longer measurable.Redemonstrated are postoperative findings related to right glossectomy with flap reconstruction and neck dissection. Previously demonstrated enhancing nodules within the right parotid gland have overall decreased in size, although the largest is unchanged measuring up to 14 mm when measured on diffusion imaging at the same location utilized previously (previously 14 mm).There is no new clinically significant lymphadenopathy.Mild mucosal thickening in the maxillary sinuses is unchanged. The osseous structures appear to be grossly intact. The thyroid gland, orbits, and imaged intracranial structures are unremarkable.

Output: 1.There are new postprocedural changes involving the left neck, including ill-defined enhancement throughout the operative region with associated STIR T2 hyperintensity. However, previously demonstrated prominent left level 1B and level 2A lymph nodes are no longer present.2.Previously demonstrated nodular enhancement along the dorsal margin of the surgical flap in the right oral tongue has decreased in conspicuity. There is also decreased T2 signal.3.There is increased T2 signal involving the left oral tongue suggesting postprocedural changes, however a previously demonstrated 7 mm diameter enhancing nodule in the left sublingual space is significantly smaller and is no longer measurable.4.Previously demonstrated enhancing nodules within the right parotid gland have overall decreased in size, although the largest is unchanged.


Instruction: Generate impression based on findings.

Input: Worsening of meningoma causing compression: TIA symptoms. Brain MRI: There is an area of restricted diffusion and high T2 signal in the right frontal lobe that measures up to 20 mm. There are also punctate foci of restricted diffusion in the left frontal lobe. There is a background of chronic lacunar infarcts in the left postcentral gyrus, bilateral basal ganglia, and right corona radiata, as well as scattered foci of cerebral white matter T2 hyperintensity without restricted diffusion. There is a punctate focus of susceptibility effect in the right periventricular white matter, which may represent a chronic microhemorrhage. There is an enhancing, dural-based mass in the left cavernous sinus region, with extension into the left orbital apex, sella, and sphenoid sinus, measuring up to approximately 50 mm overall. There appears to be compression of the left optic nerve. There are postoperative findings related to left pterional craniotomy with left anterior temporal lobe encephalomalacia. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Brain MRA: There is significant loss of flow related enhancement in the left internal carotid artery, with reconstitution distally at the circle of Willis. There may also be mild narrowing of the ophthalmic segment of the right internal carotid artery. There is no evidence of significant steno-occlusive lesions involving the rest of the intracranial arteries. There is no evidence of cerebral aneurysms.Neck MRA: There is relatively diminished enhancement of the left internal carotid artery attributable to downstream compromise of the vessel. There is otherwise no evidence of significant steno-occlusive lesions in the neck arteries.

Output: 1. Bilateral frontal lobe recent infarcts, right larger than left, without hemorrhagic transformation or midline shift, superimposed upon chronic lacunar infarcts and small vessel ischemic disease.2. Left cavernous sinus region meningioma with significant compression of the intracranial left internal carotid artery.3. No evidence of significant steno-occlusive cervical artery lesions.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There are no T2/FLAIR abnormalities. Ventricular size is normal. No evidence of mass effect or edema. There is no midline shift. Basal cisterns are patent. The vascular flow voids are normal. There are no diffusion abnormalities. There is no gross elevation of the optic nerve heads.MRV BRAIN:The deep and superficial venous systems are patent with no evidence of sinus vein thrombosis.

Output: 1. No acute abnormalities. No evidence of mass effect or edema.2. No evidence of superficial and deep venous abnormalities.


Instruction: Generate impression based on findings.

Input: 52 years Female (DOB: 11/3/1963)Reason: ? Nerve root compression History: neck painPROVIDER/ATTENDING NAME: ADAM S. CIFU ADAM S. CIFU 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 with mild reversal of the normal cervical curvature. There is multilevel disc desiccation present.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 is a disc bulge present at this level associated with mild narrowing of the neural foramina bilaterally.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present this level associated with some uncovertebral osteophytes and narrowing of the neural foramina bilaterally.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and endplate reactive change at this level. The endplate reactive change is more prominent on the right versus the left side of the disc. Endplate reactive changes low signal on T1 and high signal on T2. There are endplate and uncovertebral osteophytes present this level. There is narrowing of the neural foramina bilaterally at this level with some encroachment of the exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level associated with endplate and uncovertebral osteophytes and some encroachment of the exiting nerve roots within 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.

Output: 1.There are multilevel degenerative changes present in the cervical spine with encroachment of the exiting nerve roots bilaterally at C5-6 and C6-7 due to osteophytes and disc material.


Instruction: Generate impression based on findings.

Input: Abnormal PET scan with enhancement of cervical lymph nodes, being worked up for possible paraneoplastic syndrome with resultant seizure like spells. There is no evidence of mass lesions or significant cervical lymphadenopathy. For example, a right level 2 lymph node measures 7 mm in short axis and a left level 2 lymph node measures 5 mm in short axis. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids are intact. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: The lymph nodes in the neck are not particularly enlarged.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with bilateral arm tingling from the shoulders to the hands and some motor loss. Assess for spinal stenosis. Straightening of cervical lordosis is seen. No evidence of worrisome marrow replacement is detected. Mild degenerative loss of vertebral body height is seen at C5 and C6. The spinal cord shows normal morphology and signal characteristics as visualized on sagittal imaging. Disc osteophyte formation is evident at most levels but without any significant or high-grade spinal canal stenosis. No cord impingement is suspected.

Output: 1.This examination was terminated early at the patient's request due to discomfort during the scan.2.On the limited images acquired, there is evidence of disc osteophyte disease at multiple levels, but no high-grade spinal canal stenosis or cord impingement is suspected.


Instruction: Generate impression based on findings.

Input: 70 year old female with right shoulder pain. Evaluate rotator cuff. ROTATOR CUFF: There is a focal partial-thickness tearing of the undersurface fibers of the supraspinatus tendon just proximal to its insertion on the greater tuberosity. The tear involves approximately 50% of tendon thickness. The tear propagates slightly along the longitudinal axis of the supraspinatus as an interstitial tear, in total, measuring 6 mm in length. The bursal surface fibers of the supraspinatus tendon are intact. The supraspinatus muscle is intact. There is a small cyst in the greater tuberosity at the site of the insertion of the infraspinatus tendon. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint. There is abnormal signal intensity within the superior glenoid labrum, indicating a tear that propagates down the anterior labrum and is associated with paralabral cyst formation along the anterior glenoid. There is a small amount of fluid within the glenohumeral joint but no frank effusion.BICEPS TENDON: There is increased signal intensity within the long head of the biceps tendon at its transition from the intertubercular sulcus to the rotator interval likely representing degenerative tearing and tendinosis with associated small subchondral cysts in the humeral head.

Output: 1. Small undersurface tear of the supraspinatus tendon as described above.2. Glenohumeral and acromioclavicular joint osteoarthritis with tearing of the glenoid labrum as described above.3. Tendinosis and probable degenerative tearing of the long head of the biceps tendon.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to L5-S1 interbody fusion. The vertebral body and disc space heights are otherwise preserved. There are facet degenerative changes at L4-L5 and L5-S1. There is no significant spinal canal or neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology and the conus terminates at L1-L2. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable.

Output: 1.No evidence of lumbar spine metastasis.2.Postoperative findings related to L5-S1 interbody fusion.3.Mild to moderate facet arthropathy at L4-L5 and L5-S1 without evidence of spinal canal or neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: 65 year old man with history of cirrhosis, paroxysmal atrial fibrillation, CAD s/p CABG in February 2015 (LIMA to LAD, VG to PDA and VG to OM1) with new LV dysfunction noted on echocardiography. He was referred for cardiac stress MR to evaluate for ischemia and viability.MEDICATIONS: atorvastatin, coumadin, dofetilide, metoprolol, nifedipine, fish oil, diovan, nitroglycerin as needed First Pass PerfusionDuring hyperemia, there was a moderate to severe defect in the basal, mid and apical inferoseptum and a moderate defect in the mid inferior wall. The inferoseptal defect was present at rest and appeared mild. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 95 ml/m2 (normal range: 74+/-15), the LVEDV is 180 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 43 g/m2, and the LV mass is 82 g. There is abnormal septal motion consistent with the history of LBBB conduction abnormality and previous surgery. There is also tardokinesis of the mid-distal inferior wall. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. . The overall RV ejection fraction is 51%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 195 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 96 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mild thickening of the valve leaflets. There is at least mild-moderate mitral regurgitation noted.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation, which appears eccentric.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires are present. There is nonspecific esophageal thickening. Cirrhosis again noted. No gross hepatic lesion of the study was not optimized for such an evaluation. 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. At rest there was a mild defect in the inferoseptum which worsened with stress to a moderate to severe perfusion defect in the basal, mid and apical inferoseptum. With hyperemia, there was also a moderate perfusion defect in the mid inferior wall. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly reduced systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 51%).5. At least mild-moderate mitral regurgitation.6. At least mild tricuspid regurgitation.7. Severe left atrial dilation.


Instruction: Generate impression based on findings.

Input: 12-year-old male in auto accident with loss of consciousness Calvarium remains within normal limits and no evidence of posttraumatic fracture. Mastoid air cells are well pneumatized and unremarkable. Limited view of the paranasal sinuses demonstrates complete opacification of left chamber of the sphenoid sinus with no bony fracture which is believed to represent chronic sinus disease.Images through intracranial space demonstrates no evidence of post traumatic findings in particular no evidence of intra-axial or extra-axial hemorrhage is detected. No definitive evidence of edema is present. There is however multiple periventricular and subcortical area of low attenuation which appear old. These findings are suspicious for multiple foci of encephalomalacia which are nonspecific however differentials includes demyelinating disease, multiple areas of encephalomalacia from a prior infectious process or ischemic. There is no evidence of any abnormal intracranial calcification. There are no old films available for comparison. Further evaluation with a dedicated MRI is recommended.

Output: 1.No definitive evidence of any post traumatic findings intracranially or of the calvarium.2.Multiple small foci of low attenuation which appear old and needs further evaluation with a dedicated MRI of brain. Please see above comments.


Instruction: Generate impression based on findings.

Input: History of RCC and metastases. History of horseshoe kidney status post partial resection of the right moiety and left nephrectomy. Status post left distal pancreatectomy. Local recurrence and vascular invasion. ABDOMEN:LIVER, BILIARY TRACT: Stable segment 7 flash-filling hemangioma and small subcentimeter cysts. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: Status post partial distal pancreatectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The patient has a history of horseshoe kidney status post partial resection of the right moiety and total resection of the left moiety. The previously described lesion arising from the mid/inferior pole of the right moiety demonstrates mild interval decrease in size now measuring 4.8 x 2.6 cm (series 602/297) and marked decrease in central enhancement with only residual peripheral enhancement compatible with treatment response necrosis. This extends into the right renal vein and IVC, unchanged.Simple appearing cystic structure inferior to the lesion is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable appearance of the third portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval mild decrease in size of the residual/recurrent tumor involving the mid/inferior portion of the right renal moiety with marked interval decrease in central enhancement compatible with treatment response necrosis. No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 77-year-old female with history of aneurysm, surveillance imaging. History of right MCA stroke and thrombectomy on Jun 8 2012 Brain MRI:No evidence of acute ischemia. Redemonstrated is FLAIR hyperintensity and volume loss involving the right frontal, parietal, and temporal lobes as well as the posterior insula consistent with prior right MCA infarct. Small infarcts involving the right frontal corona radiata and anterior caudate also again seen. Mild FLAIR hyperintensity involving the bilateral periventricular white matter is compatible with chronic small vessel ischemic changes. Chronic right inferior cerebellar infarct is also again seen. These findings are unchanged.Again seen are foci of susceptibility effect adjacent to the central sulcus in the region of the chronic infarct and unchanged indicative of chronic blood products. Additional scattered foci of chronic microhemorrhages in the right frontal lobe and in the right parietal periatrial white matter also unchanged. No intracranial mass or mass-effect. No extra-axial collections. No hydrocephalus. As before, there is diffuse opacification of the left mastoid air cells as well as mucosal thickening involving the right maxillary sinus.Brain MRARedemonstrated is a left PCOM artery aneurysm measuring 3.2 mm at the neck and 6 mm in length. No evidence of interval enlargement. The left posterior communicating artery arises in its medial and inferior aspect. Aneurysm projects posteriorly and inferiorly.There is bulbous appearance at the right superior cerebellar artery origin which is unchanged. There are atherosclerotic changes involving the cavernous and supraclinoid internal carotid arteries with ectasia of the anterior genu of the left cavernous carotid artery. The anterior communicating and bilateral posterior communicating arteries are patent. No additional aneurysmal dilatations or flow-limiting stenoses are evident in the anterior-posterior circulation.

Output: 1.Stable encephalomalacia involving the right frontal, temporal, and parietal lobes consistent with chronic right MCA territory infarct. No new infarcts. 2.Stable multiple foci of chronic microhemorrhage including within the area of prior infarct are unchanged.3.No significant change in left posterior communicating artery aneurysm measuring up to 6 mm in length and 3 mm at the base.4.Persistent opacification of the left mastoid air cells as well as mucosal thickening involving the right maxillary sinus.


Instruction: Generate impression based on findings.

Input: 63-year-old man with history of PSA of 10.7 and 2 prior negative prostate biopsies. PELVIS:PROSTATE:Prostate Size: 5.7 x 4.0 x 6.6 cm.Peripheral Zone: Hazy low T2 signal in the left peripheral zone with mildly decreased ADC signal is felt to be due to artifact or possibly mild prostatitis secondary to biopsy. Unfortunately, an underlying lesion cannot be excluded due to diffuse signal changes.Central Gland: Hyperplastic nodules in the transitional zone are compatible with benign prostatic hyperplasia. Seminal Vesicles: The seminal vesicles are unremarkable.Extracapsular Extension: None.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.Hazy low T2 signal in the left peripheral zone with mildly decreased ADC signal felt to be artifactual or possibly related to mild prostatitis secondary to biopsy. An underlying neoplastic lesion cannot be excluded due to diffuse signal changes.2.Hyperplastic nodules in the transitional zone consistent with benign prostatic hyperplasia.


Instruction: Generate impression based on findings.

Input: CNS recurrence of DLBCL status post 2 cycles of MTR chemotherapy, in need of restaging. There has been interval decrease in size of the infiltrative enhancing mass involving the bilateral basal ganglia, hypothalami, columns of the fornices, and perhaps the anterior commissure, now measuring up to approximately 22 mm, previously 32 mm. There are right transfrontal post-biopsy findings with associated areas of susceptibility effect. There is no evidence of acute infarct. There is decreased effacement of the anterior third ventricle. The lateral ventricles are not significantly changed. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Interval decrease in size of the CNS lymphoma, indicated treatment response.


Instruction: Generate impression based on findings.

Input: Reason: ACL recon assessment. History: right knee pain Evaluation of the knee is slightly limited by metallic susceptibility artifact related to the patient's ACL reconstruction.MENISCI: A small amount of intrasubstance signal is seen within the posterior horn of the medial meniscus, but no discrete tear is identified. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects. There is mild edema of the lateral tibial plateau posteriorly.LIGAMENTS: The patient has undergone ACL reconstruction with expected surgical changes in the distal femur and proximal tibia. The graft appears intact. Low signal intensity anterior to the graft has the appearance of metal artifact rather than arthrofibrosis. The PCL and remaining ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Surgical changes of ACL reconstruction. The graft appears intact.2. Focal edema in the posterior aspect of the lateral tibial plateau may reflect a bone contusion.


Instruction: Generate impression based on findings.

Input: Reason: eval for TFCC tear History: ulnar sided wrist pain The images are slightly limited by patient motion artifact.LIGAMENTS: No contrast extends into the midcarpal joint. There are small foci of increased signal intensity within the scapholunate ligament which may reflect mild degeneration, but we see no findings to suggest a full-thickness tear of the scapholunate or lunotriquetral ligaments.TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast extends from the radiocarpal joint into the distal radial ulnar joint through a tear in the articular disc of the triangular fibrocartilage, situated approximately 2 to 3 mm from its radial attachment.TENDONS: The flexor and extensor tendons appear intact. BONES: There are tiny cysts within the lunate proximally suggesting ulnocarpal abutment.ADDITIONAL

Output: Tear of the triangular fibrocartilage complex and other findings as described above.


Instruction: Generate impression based on findings.

Input: 18-year-old male with a proximal hamstring injury. Assess for stress fracture. Presents with left leg pain. There is peripheral increased signal abnormality along the anterior aspect of the semimembranosus and biceps femoris at the level of the myotendinous junction consistent with a strain. There is a punctate focus of increased fluid signal abnormality within the semimembranosus tendon at the level of its insertion on the left inferior pubic ramus consistent with a small interstitial tear (image 55, series 9). The hamstring musculature and tendons otherwise appear intact. There is no evidence of a full-thickness or near full-thickness tear of the hamstring tendons. The remainder of the visualized musculature of the thigh is normal in appearance. No bone marrow signal abnormality is identified to suggest a stress reaction/fracture.

Output: Findings consistent with a strain of the semimembranosus and biceps femoris muscles as well as a very small interstitial tear of the semimembranosus tendon as described above, without evidence of a full-thickness or near full-thickness tear. No evidence of stress reaction/fracture.


Instruction: Generate impression based on findings.

Input: Reason: left MCA ischemic stroke NIHSS 19 History: NIHSS 19, right sided weakness, global aphasiaFLUOROSCOPY TIME: 115.9 minutesFrontal: 2784.03 mGyLateral: 1909.21 mGyOPERATORS: Greg Christoforidis Left common carotid artery: There is no evidence for carotid stenosis on the basis of NASCET criteria. There is a cobblestone appearance to the left ICA with broad pseudoaneurysms.Left internal carotid arteryThere is opacification of the left anterior cerebral arteries. There is occlusion of the left middle cerebral artery at the distal left mm1 segment with grade 4 leptomeningeal collaterals. The anterior temporal artery is proximal to the occlusion site.Intraprocedural arteriograms:Early on the microcatheter was noted to bulge into the left cavernous sinus, when the microcatheter was placed in the left M2 segment.There was a carotid cavernous fistula that developed during the procedure at the site of a 1 mm aneurysm.There is progressive recanalization of the left middle cerebral artery territory with TICI 2B reperfusion. Initially 70% of the territory reperfused, by the time the CCF was treated 95% of the territory had reperfused.There was progressive occlusion of the left sided direct cavernous carotid fistula.Left internal carotid artery following the procedure:There is recanalization of the left middle cerebral artery including superior and inferior divisions with some slow flow in a couple M5 branches.The cavernous carotid fistula was occluded at the end.Right common iliac artery: No contraindications to closure device.

Output: 1.Left middle cerebral artery distal m1 occlusion.2.Embolectomy with recanalization and reperfusion of the left middle cerebral artery using the Trevo embolectomy device.3.Direct carotid cavernous fistula development at site of a 1mm aneurysm at the ascending portion of the left cavernous internal carotid artery.4.Successful occlusion of left direct cavernous carotid fistula.5.Successful retrieval of prematurely detached embolic occlusion coil.6.Findings were discussed with Dr Cueva at the end of the procedure.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB:8/6/1956)Reason: AMS s/p liver transplant. MR Brain w/o to assess for PRES or other CNS pathology per neuro recs History: as abovePROVIDER/ATTENDING NAME: CHRISTINE TROTTER JOHN F. RENZ The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam T2 and FLAIR signal hyperintensity involving the globus pallidus I has mildly regressed but not resolved.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the sphenoid sinus as well as some mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Susceptibility weighted imaging is degraded by motion artifact. Axial T1 and coronal T2 imaging is degraded by patient motion artifact.

Output: 1.Since the prior exam abnormal signal within the globus pallidus I has regressed. This is nonspecific but could relate to a toxic or metabolic process.2.No new lesions are appreciated intracranially.3.Exam is degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Reason: s/p L rotator cuff repair, eval for healing vs re-tear History: see above. ROTATOR CUFF: Interval postsurgical changes of a rotator cuff repair. Full-thickness tear of the supraspinatus tendon with retraction and fluid in the subacromial subdeltoid bursa, measuring 1.9 cm in AP dimension. Full thickness tear involves the anterior fibers of the infraspinatus tendon. The subscapularis and teres minor are intact. Supraspinatus and infraspinatus fatty muscle atrophy has increased compared to prior.SUPRASPINATUS OUTLET: Fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding, otherwise glenohumeral joint alignment is anatomic. Irregularity of the anterior and posterior labrum compatible with degeneration.BICEPS TENDON: The biceps tendon is intact.ADDITIONAL

Output: 1.Interval postsurgical changes of a rotator cuff repair.2.Full thickness tear of the supraspinatus and infraspinatus tendons with retraction. Increased fatty muscle atrophy.3.Labral degeneration.


Instruction: Generate impression based on findings.

Input: 77 year old woman with ischemic cardiomyopathy. She is referred to evaluated for ischemia and viability.MEDICATIONS: ASA, clopidogrel, enalapril, furosemide, metoprolol, atorvastatin. First Pass PerfusionDuring hyperemia, two perfusion defects were noted: One in the basal anterolateral wall and another involving much of the inferoseptum and inferior walls. Viability/ Myocardial ScarThere was late gadolinium enhancement involving the basal and mid anterolateral and inferolateral walls. The pattern was consistent with a large sub-endocardial myocardial infarction. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 158 ml/m2 (normal range: 65+/-11), the LVEDV is 273 ml (normal range 109+/-23), the LV end systolic volume index is 113 ml/m2 (normal range 18+/-5), the LVESV is 195 ml (normal range 31+/-10). There is global hypokinesis with regional variation.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. Right AtriumThe right atrium is mild to moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation with bileaflet tethering.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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA nodule is noted (1.3x1.4cm) in the posterior aspect of the right lung apex. A smaller nodule is also noted in the left upper lung. These nodules were not present on a CT scan from 2007; however, a previously noted lipoma in the right upper lung is noted once again today. 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. Two perfusion defects are noted during hyperemia. The smaller one involves the basal anterolateral wall, and a larger one involves most of the inferoseptal and inferior walls. The diagnostic sensitivity of vasodilator stress testing in individuals with severe LV dysfunction may be limited.2. A large non-transmural myocardial infarction is noted in the basal and mid anterolateral and inferolateral walls. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.3. Severe LV dilation with severely reduced systolic function (LVEF 29%).4. Moderate RV dilation with moderately reduced systolic function.5. Moderate mitral regurgitation. 6. Severe left atrial dilation.7. Mild dilation of the main pulmonary artery.8. Lung findings as described above. Consider dedicated chest CT imaging if clinically indicated.These findings were conveyed to Dr. Polonsky.


Instruction: Generate impression based on findings.

Input: 48 years, Male, seizures, brain lesion. Examination is limited to sequences for operative planning. Again seen is an expansile mass with T2 hyperintensity and no significant enhancement in the right frontal lobe. Mass is centered at the right middle frontal gyrus and measures 4.8 x 3.8 x 4.6 cm in the AP, transverse, and craniocaudal dimensions. Small areas of central cystic change are noted. There is local mass effect and trace leftward midline shift. No uncal herniation.

Output: Examination for operative planning. There is a 4.8 x 3.8 x 4.6 cm nonenhancing right frontal lobe mass likely representing a glioma, favor low-grade.


Instruction: Generate impression based on findings.

Input: Evaluate for steno-occlusive disease, etiology of TIA: episode of aphasia and amnesia. Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There two punctate fat signal intensity lesions in the midline of the posterior suprasellar cistern and interpeduncular cistern. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small left maxillary sinus retention cyst. There is fluid within the pneumatized left petrous apex. Brain MRA: The vertebrobasilar system is relatively diminutive diffusely. Otherwise, there is no evidence of significant steno-occlusive lesions or saccular aneurysms.Neck MRA: There is a two vessel arch. There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of intracranial hemorrhage or acute infarct. 2. The vertebrobasilar system is relatively diminutive diffusely, but without focal steno-occlusive lesions.3. No evidence of significant steno-occlusive lesions in the major neck arteries.4. Two punctate lipid-containing lesions in the midline of the posterior suprasellar cistern and interpeduncular cistern are compatible with lipomas or dermoids. 5. Left petrous apex effusion.


Instruction: Generate impression based on findings.

Input: 59-year-old female with left shoulder pain and limited range of motion Please note that images are suboptimal due to patient body habitus.ROTATOR CUFF: There is high-grade articular surface partial thickness tearing with regions of full-thickness tearing involving the anterior supraspinatus tendon and posterior fibers of the subscapularis tendon approximately 1 cm from the supraspinatus insertion measuring approximately 1.8 cm in AP dimension. A small amount of fluid is seen in the subacromion subdeltoid bursa. The remaining supraspinatus tendon has diffuse increased T2 signal suggesting tendinopathy. Teres minor and infraspinatus tendons are intact. There is mild generalized atrophy.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: No abnormal marrow edema. The glenoid labrum is grossly intact. There may be mild thickening of the inferior glenohumeral ligament. Small osteophytes are present.BICEPS TENDON: Biceps tendon is intact. ADDITIONAL

Output: 1.Full-thickness tear of the supraspinatus and subscapularis tendons.2.Thickening of the inferior glenohumeral ligament may be secondary to synovitis or fibrosis.


Instruction: Generate impression based on findings.

Input: 13-year-old female with history of a cavernous malformation, status post resection Redemonstrated are changes from prior suboccipital craniotomy for resection of a left anteromedial cerebellar cavernous malformation. Postoperative changes include a resection cavity with a mild amount of adjacent parenchymal hemosiderin staining. Redemonstrated is the associated prominent developmental venous anomaly.The remainder of the brain demonstrates no additional cavernous malformations, or other mass or mass effect. There is mild hypoplasia involving the inferior cerebellar vermis. Brain parenchyma is otherwise unremarkable for age. There is no restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Sella and orbits are within normal limits. The paranasal sinuses and mastoid air cells are clear.

Output: Redemonstrated are changes from prior suboccipital craniotomy for resection of a left anteromedial cerebellar cavernous malformation. Postoperative changes include a resection cavity with a mild amount of adjacent parenchymal hemosiderin staining.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of pain. Left hip: Mild osteoarthritis affects the left hip. There is faint sclerosis of the left femoral head likely representing avascular necrosis which was evident on the prior MRI exam. There is no evidence of subchondral fracture or articular surface collapse.Right hip: Mild osteoarthritis affects the right hip. Alignment is anatomic. There is no specific evidence of avascular necrosis.Pelvis: Redemonstrated are the aforementioned findings of avascular necrosis in the left femoral head and bilateral degenerative changes. There is a right common iliac stent. Surgical clips project over the lower right ischium.Left fifth toe: There is a nondisplaced transverse fracture through the proximal diaphysis of the fifth proximal phalanx in near-anatomic alignment. Mild soft tissue swelling about the toe.

Output: 1.Fifth toe fracture as above.2.Osteoarthritis of bilateral hips with findings suggestive of avascular necrosis of the left femoral head.Findings discussed with Dr. Kang at 1630 on 1/19/15.


Instruction: Generate impression based on findings.

Input: 3-year-old female with a history of epilepsy presents with increased seizure activity. Brain parenchyma is unremarkable for age. No evidence of cortical dysplasia, gray matter heterotopia, or other findings to suggest seizure focus. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Myelination is age-appropriate. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain within normal limits. No findings to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: Left arm and face weakness. Assess for stroke. There is restricted diffusion in the mesial dorsal pons where there is also increased T2 signal compatible with an acute to subacute infarct. Scattered foci of T2 hyperintensity in the periventricular and subcortical white matter compatible with chronic small vessel ischemic changes. This is associated with a small right thalamic and right corona radiata chronic lacunar infarcts. Note is made of a prominent perivascular space in the left insula. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. Note is made of a 13 mm ovoid lesion in the subcutaneous tissues overlying the left zygoma compatible with sebaceous cyst.MRA head:The intracranial carotid arteries demonstrate mild atherosclerotic irregularity. The PCOM arteries are diminutive bilaterally. The V4 segment of the right vertebral artery is completely occluded from the level of the arch of C1. No significant intracranial aneurysm. MRA neck:Conventional arch anatomy. The carotid arteries are widely patent with normal contour and caliber throughout. The left vertebral artery is moderately stenotic at its origin but returns to a normal caliber and contour for the remainder of its course. The right vertebral artery is markedly narrowed and irregular throughout with complete occlusion of its intracranial portion. This is compatible with a dissection of indeterminate age. There is a subcutaneous lipoma incidentally noted in the right posterior paraspinal soft tissues.

Output: 1. Acute to subacute infarct involving the mesial dorsal pons.2. The right vertebral artery is markedly narrowed and irregular throughout with complete occlusion of its intracranial portion. This is compatible with a dissection of indeterminate age.3. Moderate stenosis of the origin of the left vertebral artery which is otherwise normal in caliber and contour. Mild atherosclerotic irregularity of the intracranial internal carotid arteries.4. Chronic white matter small vessel ischemic changes as well as chronic lacunar infarcts in the right thalamus and right corona radiata.


Instruction: Generate impression based on findings.

Input: Reason: new ms plaque History: LLE weakness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disk desiccation present .There is a signal hyperintensity present along the posterior aspect of the spinal cord at the C2 vertebral body level posteriorly and along the midline visualized portions of the cerebellum there is a hypointense lesion on all pulse sequences which appears to be new since the prior exam from 2013 but is present on the recent MRI from yesterday.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. There are left-sided uncovertebral osteophytes present at this level which are associated with some disk material and some encroachment of the left-sided exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes levelAt C5-6 there is no significant compromise to the spinal canal . There are endplate portable osteophytes present at this level with mild narrowing of the neural foramina 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.The vertebral artery flow voids appear to be intact.

Output: 1.A spinal cord lesion at the C2 through body level is stable compared to prior exams. There is no evidence for acute plaque formation appreciated.2.A small hemorrhagic focus in the inferior aspect of the right cerebral hemisphere is more conspicuous than on 2013. Please refer to MRI of the brain to further comments. The pattern of microhemorrhages on MRI is suggestive of hypertensive related microhemorrhages.