Instruction: Generate impression based on findings.

Input: Left shoulder pain. Rotator cuff tear? ROTATOR CUFF: There is a full-thickness, near-complete tear of the supraspinatus tendon from its insertion on the greater tuberosity; I suspect that a small portion of degenerated tendon anteriorly extends to the tuberosity. There is up to 1 cm of retraction of the torn tendon. The tear measures approximately 2 cm in AP dimension, involving the infraspinatus tendon anteriorly; the infraspinatus tendon posteriorly can be followed to its insertion on the greater tuberosity. Thickening and increased signal intensity of the supraspinatus and infraspinatus tendons indicates tendinosis. There is mild to moderate fatty atrophy of the infraspinatus along its myotendinous junction. The supraspinatus muscle appears relatively normal. Although the teres minor tendon can be followed to its insertion on the greater tuberosity, there is moderate fatty atrophy of the teres minor muscle. There is thickening and increased signal intensity of the subscapularis tendon distally indicating moderate tendinosis and perhaps undersurface fraying. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. A small amount of fluid is present within the subacromial/subdeltoid bursa, with strands of intermediate signal intensity in the bursa likely reflecting synovitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the glenohumeral joint. Tiny osteophytes suggest minimal osteoarthritis. Intermediate signal intensity within the superior labrum likely reflects degeneration and degenerative tearing.BICEPS TENDON: There is mild increased signal intensity within the tendon of the long head of the biceps reflecting mild tendinosis. ADDITIONAL

Output: Full-thickness rotator cuff tear involving the supraspinatus and infraspinatus, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Two months old baby boy with sudden cardiac arrest. Recent stroke on MRI, recent seizure activity, check for progression of stroke. Signs and symptoms: Seizures. A well demarcated area of low attenuation in the right posterior temporal region is again identified and with no definitive interval change.A very subtle low-density involving the cortex and subcortical white matter of left posterior temporal and occipital region is suspected. This finding is very subtle and it may also represent an artifactual beam hardening finding. Follow-up with a repeat CT or an MRI is recommended. There is no definitive evidence of any mass effect with this finding. No evidence of any intracranial hemorrhage. Ventricular system and subarachnoid space remains identical to prior study. All CSF cisterns remain widely patent.New since prior examination is thickening of the soft tissues of the scalp on the left side in the posterior parietal region.

Output: 1.Stable area of low attenuation in the right posterior temporal lobe since prior study.2.Artifact or a new area of low-attenuation in the left posterior temporal occipital region as detailed. Follow-up with a CT or an MRI is recommended.3.Stable ventricular system and CSF cisterns.4.No evidence of intracranial hemorrhage.5.Edema of left posterior parietal scalp.


Instruction: Generate impression based on findings.

Input: 67 years Female (DOB:1/19/1949)Reason: dysarthria History: dysarthriaPROVIDER/ATTENDING NAME: ANTON M CHIVU MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is small. The posterior communicating arteries are very small. The vertebral arteries are similar in size. There is extracranial origin of the left posterior inferior cerebellar artery present.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for intracranial or extracranial cerebrovascular occlusive disease.2.No evidence for acute ischemic cerebral infarction.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Low back pain for months with extension and gymnastics. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild disc bulge and superimposed tiny central disc protrusion at L5-S1. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Mild disc bulge and superimposed tiny central disc protrusion at L5-S1. No spinal canal or neuroforaminal stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: patient with posterior epidural and paraspinous fluid collection. Please aspirate for sampling. 42 yo female Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the fluid collection. Following needle removal images obtained demonstrate no complications . A small amount of air was present in the remaining cavity.

Output: Paraspinous fluid collection aspiration under CT guidance.


Instruction: Generate impression based on findings.

Input: 48-year-old female with pain in the left knee The images are suboptimal secondary to patient body habitus.MENISCI: There is blunting of the posterior horn of the medial meniscus consistent with a tear. The posterior horn of the medial meniscus is also abnormally small and approximately the size of the anterior horn. There is perhaps mild extrusion of disc material medially but there is no fluid between the meniscus and the medial lateral ligament.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the hyalin cartilage involving the medial femoral condyle and this is likely the cause of the adjacent abnormal bone marrow signal in the distal posterior medial femur and proximal posterior medial tibial plateau. Within the posterior medial tibial plateau is a little focus of decreased T1 and increased T2 signal abnormality with a raspberry configuration and which most likely represents a benign endochondroma. There is also uniform narrowing of the patellar cartilage but no focal defects.LIGAMENTS: There is mild increased signal involving the medial collateral ligament which may indicate a mild strain. The remaining cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact. A Baker's cyst is incidentally noted. There is mild increased T2 signal abnormality in stranding involving the soft tissues adjacent to the medial compartment.ADDITIONAL

Output: 1.Tear of the posterior horn of the medial meniscus.2.Marked thinning of the posterior medial tibial and femoral surface articular cartilage with adjacent bone marrow signal changes.3.Mild increased signal involving the medial collateral ligament indicating possible mild medial collateral ligament strain.4.Uniform narrowing of the patellofemoral cartilage but no focal defects.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with left facial palsy and cranial nerve VI palsy, status post AVM resection in 9/25. Postoperative findings are redemonstrated compatible with prior left suboccipital craniectomy and lesion resection from the left pontomedullary junction. A pseudomeningocele is partially visualized within the left posterior neck soft tissues, having become somewhat larger and better organized than on the prior examination. This collection does not appear to exert mass effect upon the brainstem in any way.At the level of the pontomedullary junction on the left, a hemosiderin stained region of tissue is again seen measuring approximately 14 x 12 mm on T2-weighted images (image 10 series 1001). This lesion is similar in size to that noted on the prior examination, but demonstrates less internal bubbly T2 hyperintensity. A curvilinear enhancing structure is seen coursing along the right margin of the lesion, similar to that noted on a prior exam, likely representing a small venous structure or DVA. No significant edema is evident surrounding the lesion.A 2 mm focus of susceptibility is evident along the right lateral ventricular margin which appears to be new when compared to prior examinations. No other new findings are seen. No additional areas of significant parenchymal signal abnormality are detected. Diffusion-weighted images are within normal limits. The pattern of contrast enhancement is otherwise unremarkable. Ventricular size and morphology are stable and normal.

Output: 1.Expected findings status post left suboccipital approach for resection of a lesion from the left pontomedullary junction. A pseudomeningocele within the posterior soft tissue operative bed has become somewhat larger and better organized than on the prior examination, but no significant mass effect is exerted upon the brainstem.2.Hemosiderin staining of the left pontomedullary junction appears similar in overall size to the prior examination which may reflect a combination of postoperative change and/or residual lesion. Bubbly internal T2 hyperintensity has decreased in prominence. No significant parenchymal edema is identified. A small likely venous structure or DVA is again seen traversing the right margin of the lesion similar to prior.3.A punctate focus of susceptibility appears to be new along the lateral margin of the right lateral ventricle. This is nonspecific. No other new or concerning intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Left hip pain There is abnormal signal intensity within the left inferior pubic ramus with early adjacent periosteal new bone formation compatible with stress fracture. There is mild edema within the adjacent musculature but the remaining adductor muscles are otherwise normal as is the prepubic aponeurotic complex. No additional fractures are identified.There is mild signal intensity seen within the hamstring origins bilaterally, left greater than right, perhaps reflecting mild degenerative tendinopathy although this is not necessarily of any clinical significance.Seen on a single sagittal image (1 of 76) is linear signal intensity partially separating the anterior superior labrum from the underlying acetabulum which may represent a labral tear. This is incompletely evaluated on this study and is also not necessarily of any clinical significance. The hip joints otherwise appear normal as do the sacroiliac joints.The remaining soft tissue structures are within normal limits.

Output: Stress fracture of the left inferior pubic ramus with other findings as described above.


Instruction: Generate impression based on findings.

Input: Right renal lesion noted on CT 7/31/2015. ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilation status post cholecystectomy.SPLEEN: T2 hyperintense focus in the inferior spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously described indeterminant right inferior pole cyst on CT demonstrates intermediate signal without enhancement compatible with a hemorrhagic or proteinaceous cyst. There are additional bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach and colon are distended with food and stool respectively.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Findings compatible with a right inferior pole hemorrhagic / proteinaceous renal cyst.


Instruction: Generate impression based on findings.

Input: 64-year-old male with a possible brain biopsy and limited for presence of intracerebral hemorrhage Status post open brain biopsy changes with foci of pneumocephalus and left parietal burr hole. There is a high density focus in the superior medial aspect of the left postcentral gyrus compatible with intraparenchymal hemorrhage. Extensive hypo-attenuation involving predominantly the left parietal lobe with extension into the posterior left frontal lobe, anterior aspect of the left occipital lobe and splenium of the corpus callosum associated with ill defined lesions and mass effect on the occipital horn of the lateral ventricle that were better visualized on prior MRI. The extension of the ill defined hypoattenuation to the corpus callosum is highly suggestive of a glioblastoma multiforme, versus less likely CNS lymphoma. The basal cisterns are normal in size and configuration.The orbits are unremarkable. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Postsurgical changes with small expected high density left postcentral gyrus intraparenchymal hemorrhage. 2.Ill-defined hypoattenuation ill defined lesions predominantly involving the left parietal lobe were better visualized on recent MRI. The extension into the splenium of the corpus callosum is highly suggestive of GBM versus CNS lymphoma.


Instruction: Generate impression based on findings.

Input: 22-year-old male with pain. Clinical ACL tear. MENISCI: There is linear branching signal abnormality within a diminutive posterior horn of the lateral meniscus which extends to the tibial and femoral articular surfaces consistent with a complex tear. The anterior horn appears intact. There is linear signal abnormality within the posterior horn of the medial meniscus which extends to the tibial articular surface near its root consistent with a complex tear with both horizontal and longitudinal components. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality within the medial femoral condyle, the posterior aspect of the medial tibial plateau, and the posterior aspect of the lateral tibial plateau consistent with bone contusions. There is focal full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus.LIGAMENTS: There is complete disruption of the proximal and mid substance fibers of the ACL, consistent with the clinical concern for ACL tear. There is increased signal abnormality within the lateral collateral ligament proper indicating a sprain. The medial collateral ligament appears intact. The PCL appears intactEXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complete rupture of the ACL.2. Tears of the medial and lateral meniscus. 3. Bone contusions and focal full-thickness articular cartilage degeneration as described above. 4. Large joint effusion and findings suggestive of disruption of the joint capsule as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: A 23 year old male with sickle cell anemia and frequent blood transfusions referred to cardiac MRI to assess left ventricular function and iron overload. Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 190 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 88 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 120 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Measured T2* is 34 for the myocardium and 14 for the liver. The myocardial T2* is consistent with no evidence of myocardial iron overload. There is evidence of iron in the liver.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 116 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 103 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 54%2. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%3. No evidence of myocardial iron overload.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for DJD, cervical stenosis. Signs and symptoms: Neck pain shooting down the right hand. Unenhanced simple MRI:There is normal signal intensity and alignment of vertebral column.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate asymmetric right-sided uncovertebral hypertrophy with resultant moderate right neural foraminal compromise (axial T2 series 7 image 18 sagittal T2 and T2 stir image 6). Mild central bulge of the disk and additional partial effacement of ventral subarachnoid space and subtle flattening deformity of the cord and results in mild central spinal stenosis. Tiny T2/T2 stir hyperintensity within the fundus of the disk in the midline is consistent with an annular fissure (sagittal T2/T2 stir image 8 and axial T2 series 7 image 19.C4 -- C5 demonstrates a mild right-sided uncovertebral hypertrophy with resultant mild right neural foraminal compromise and unremarkable otherwise.C5 -- C6 demonstrate mild lesion at this disease, mild loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in moderate bilateral (right greater than left) neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate minimal degenerative changes without spinal stenosis or neural foraminal compromise.C7 -- T1 is unremarkable.Uppermost visualized thoracic cord demonstrate a tiny focus of cord hyperintensity visible only on sagittal T2 stir image 7 measuring approximately 3 mm in size. There are no axial images acquired at this level. Finding cannot be identified on sagittal T1 or T2 weighted images. Although possibility of an artifact cannot be excluded follow-up with a dedicated MRI of thoracic spine is recommended.

Output: 1.There is mild central spinal stenosis only at C3 -- C4 secondary to degenerative disease.2.Mild degenerative changes of cervical spine with resultant moderate right neural foraminal compromise at C3 -- C4, mild right neural foraminal compromise at C4 -- C5 and moderate bilateral ( R>L ) neural foraminal compromise at C5 -- C6 levels.3.Tiny midlie annular fissure at C3 -- C4 is noted.4.There is a tiny focus of cord hyperintensity visible only on sagittal T2stir at T3 level and follow-up with dedicated thoracic MRI is recommended. Please see above comments. Normal signal intensity of the cervical cord.


Instruction: Generate impression based on findings.

Input: Clinical question: Pituitary microadenoma. Signs and symptoms: Cushing's disease. Pre- and post enhanced pituitary MRI:Examination is degraded due to motion artifact. Multiple sequences were repeated however without significant improvement.Within these limitations there is no convincing evidence of a pituitary mass. However suboptimal quality of images precludes detection of subtle small pituitary lesions. Pituitary gland demonstrate fairly homogeneous pattern of enhancement and with normal enhancement of the pituitary stock in midlinePituitary gland measures approximately 3.2 mm in the midline.No detectable abnormality within the basal cistern or the hypothalamic region. No detectable abnormality of the cavernous sinuses.Extensive sphenoid and ethmoid sinus disease with intense mucosal enhancement is noted.Additional axial fat sat post enhanced images of entire brain is also acquired which demonstrate a small right posterior temporal-occipital cortical enhancement (series 1701 image 11 through 13) which could represent a focus of enhancing subacute stroke or infection/inflammatory process. There are no prior exams for comparison. Follow-up with dedicated brain MRI with contrast is recommended. There is no additional detectable foci of parenchymal or leptomeningeal enhancement.

Output: 1.Suboptimal exam due to motion artifact without improvement after repeat sequences.2.Within this limitation there is no convincing evidence of pituitary mass. Please see above comments.3.Incidental note is made of a small focus of cortical or leptomeningeal enhancement in the right posterior temporal/occipital region. Finding could represent an enhancing subacute ischemic stroke or representing a focus of leptomeningeal enhancement of unknown etiology. Recommend follow-up with dedicated pre and postcontrast enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Full term infant. Respiratory insufficiency and abnormal involuntary movements. Evaluate for infarct. There is minimal T1-hyperintense, T2-hypointense material layering in the posterior horns of the lateral ventricles consistent with blood products as there is prominent susceptibility. There is a similar intensity subdural hemorrhage posteromedially in the the posterior fossa, more pronounced on the right with a maximum thickness of 4 mm, without resultant mass effect on the brain. Trace subdural blood products are also identified along the tentorium cerebelli and posterior falx. All of these show susceptibility artifact.A 3 mm but somewhat elongated focus of T1-hyperintense, T2-hypointense signal in the left parietal periventricular white-matter without susceptibility artifact may represent sequela of prior insult. The brain parenchyma otherwise shows no significant abnormality. Myelination is appropriate for age. There is no mass effect or midline shift. The ventricles and the other CSF-containing spaces are normal in size.Mild diffuse T2 hyperintensity throughout the scalp especially near the vertex likely reflects residual caput succedaneum. Scalp swelling is slightly more focal in the right parieto-occipital scalp and may represent minimal subgaleal effusion. There is no displaced skull fracture.

Output: 1.Minimal intraventricular hemorrhage without hydrocephalus.2.Minimal posterior fossa subdural blood products without mass effect on the brain, likely birth related.3.Minimal intraparenchymal left parietal hemorrhage.4.Mild caput succedaneum and probable small right parieto-occipital subgaleal effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: Daily and nocturnal headaches. Evaluate suspected right frontal lipoma. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates normal anatomical variation all cavum septum pellucidum and Vergae without change since prior exam. The anatomical morphology and the signal intensity of the brain parenchyma otherwise remains within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Negative post enhanced images.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Calvarium demonstrate a punctate focus of fatty signal intensity within the marrow space in the right frontal skull without change since prior exam or any clinical significance.

Output: 1.No detectable acute intracranial process.2.Unremarkable pre-and post enhanced brain MRI and without change since prior exam.3.Tiny focus of fatty signal intensity within the right frontal skull without change since prior exam from 2010 and of no clinical significance.


Instruction: Generate impression based on findings.

Input: Hepatitis C cirrhosis, cholangiocarcinoma with ascites consistent with atypical cells. Status post right hepatectomy October 8, 2014. Exploratory laparotomy, lysis of adhesions and radiofrequency ablation of the right hepatic lobe January 6, 2016. ABDOMEN:LIVER, BILIARY TRACT: There is decreased size of a fluid-filled cavity measuring 7.5 x 4.5 cm (series 41, image 27), consistent with prior partial right hepatectomy. At the site of prior enhancement along the right hepatectomy margin, there is persistent nodular enhancement, though decreased in size compared to prior, measuring 1.9 x 1.4 cm (series 12 2, image 296), previously 2.2 x 1.4 cm. Comparison is limited due to differences in technique and modality. There is a new area of T1 hyperintensity within the hepatic dome, presumably blood products related to recent ablation. SPLEEN: Subcentimeter T2 hyperintense nonenhancing splenic lesion, probable cyst, not visualized on prior, probably due to technique. Mild splenomegaly.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: Soft tissue thickening along the anterior abdominal wall, possibly postsurgical. No suspicious osseous lesion. OTHER: Small right pleural effusion. Small volume ascites.

Output: 1.Interval radiofrequency ablation of segment 8, with decreased but persistent enhancing nodular tissue along the right partial hepatectomy margin, suspicious for residual tumor and follow-up recommended.2.Ventral abdominal soft tissue thickening, nonspecific and may be postsurgical. Small ascites and right pleural effusion.


Instruction: Generate impression based on findings.

Input: BRAIN:No intracranial mass or mass-effect. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are a few scattered periventricular and subcortical white matter T2 hyperintensities which are nonspecific. 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. CERVICAL SPINE:There are postoperative changes of C3 through C7 laminoplasty which are new from the prior MRI but similar to the CT of 7/15/2014. There is interval increase in CSF space dorsally. There is anterior fusion from C5 through C7 with anterior plate and screws. Evaluation of this region is limited due to susceptibility artifact. There are intervertebral spacers at C5-C6 and C6-C7. Desiccation and C3-C4 is unchanged. Mild straightening of the cervical spine appear similar to the prior exam. Subtle increased T2 signal from C4-6 is again seen and may suggest mild gliosis. No new cord signal abnormality.C1-C2: No spinal canal stenosis or neuroforaminal narrowing.C2-C3: Small central posterior disk osteophyte complex without spinal canal or neuroforaminal stenosisC3-C4: Small left central posterior disk osteophyte complex. Mild narrowing of the spinal canal, improved from the prior exam. No neuroforaminal stenosis.C4-C5: Central posterior disk osteophyte complex with mild ligamentous thickening. Mild impression on the ventral cord again seen with increase in CSF space dorsally related to decompressive surgery. Moderate to severe right and mild left neuroforaminal stenosis. C5-C6: Small central posterior disk osteophyte complex. There is mild effacement of the ventral thecal sac, however central canal narrowing seen previously has improved. Moderate left and mild right neuroforaminal narrowing, unchanged.C6-C7: Mild thickening of the posterior longitudinal ligament. No significant central or neuroforaminal stenosis.C7-T1: No significant central or neuroforaminal stenosis.Right paraspinal cysts at the level of the right lung apex is unchanged.

Output: 1. Postsurgical changes of C3 through C7 laminoplasty and anterior fusion of C5 through C7 with overall improvement in caliber of the spinal canal post laminoplasty. 2. There is mild indentation of the ventral cord at C4-5 as was seen previously. Subtle increased T2 signal from C4-6 is again seen and may suggest mild gliosis. No new cord signal abnormality. 3. Moderate neural foraminal stenosis on the right at C4-5 and on the left at C5-6 as seen previously.4. Few scattered periventricular and subcortical white matter T2 hyperintensities which are nonspecific and favored to represent mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Lung cancer, with brain metastasis. Status post palliative radiotherapy in 2014 and status post 4 months erlotinib treatment for EGFR L858R mutation. Evaluate response. There is no intracranial mass or abnormal enhancement to suggest metastatic disease. Minimal enhancement along the frontal horn margins is favored to be vascular. There is no acute infarct or intracranial hemorrhage. No evidence of intracranial mass effect, midline shift, or herniation. Diffuse confluent T2-hyperintensity in the cerebral white-matter has not significantly changed since the previous examination and possibly reflect previous treatment. The ventricles remain enlarged as well as the other CSF-containing spaces, reflecting global brain volume loss.The major intracranial vascular flow voids remain preserved. Right mastoid fluid has improved since the previous examination. Left mastoid fluid remains minimal. There is no gross orbital abnormality.

Output: 1.No intracranial mass or abnormal enhancement to suggest metastatic disease are appreciated.2.Extensive cerebral white-matter abnormality is not significantly changed and compatible with posttreatment related change.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of recurrent prostate cancer. PELVIS:PROSTATE:Prostate: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No MR evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Brain metastasis s/p SRS- surveillance exam History: Brain metastasis s/p SRS- surveillance exam 53 years Female (DOB:11/10/1963)Reason: Brain metastasis s/p SRS- surveillance exam History: Brain metastasis s/p SRS- surveillance examPROVIDER/ATTENDING NAME: STEVEN J. CHMURA RIMAS V. LUKAS Right basal ganglia lesion shows interval increase in size (from 17 mm to 31 mm) and surrounding edema also appear to be slightly increased in its extent since prior scan.In addition, the degree of midline shift measured on axial scan at the level of foramen of Monro has been increased from 9 to 13 mm.Right cerebellar hemispheric hemorrhagic lesion is again seen, unchanged since prior scan.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. Interval increase in size of the right basal ganglia lesion as well as the extent of surrounding edema and the degree of midline shift toward left side.2. Unchanged right cerebellar hemispheric hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: A 70 year old female with persistent atrial fibrillation and anomalous pulmonary venous connection drainage from the right lung to the superior vena cava. Referred to cardiac MRI to evaluate the anatomy before a decision about atrial fibrillation ablation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 123 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 48 g/m2, and the LV mass is 81 g. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement.There is no intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is mildly dilated with preserved systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 169 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 82 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Interatrial septumOn series 1501, cine imaging of 1 view (image 400) is suggestive of a small intra-atrial defect with possible left to right shunting at the expected location of the fossa ovalis. First pass imaging was performed and shunting was not demonstrated. Confirmation with echocardiography and/or contrast injection prior to atrial ablation may confirm a small defect in this location.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation visualized. Mitral ValveThe mitral valve opens widely. A small mitral regurgitation jet is visualized. This was not quantified.Pulmonic ValveThe pulmonic valve opens widely. There is no pulmonic regurgitation visualized. Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. The left pulmonary artery and lobar branches are normal in caliber and course. The right lobar pulmonary arteries are tortuous and small in caliber.Venous AnatomyThere is an anomalous right superior pulmonary vein that drains high into the superior vena cava. This vein is approximately 14 mm as it drains into the superior vena cava. The drainage point into the superior vena cava is approximately 1.7 cm inferior to the inflow of the right brachiocephalic vein. No additional anomalous pulmonary vein drains into the superior vena cava.The SVC and IVC are normal in size and drain normally into the right atrium. Pulmonary VeinsThe two left pulmonary veins drain normally into the left atrium. There is one normally sized superior pulmonary vein that drains into the superior left atrium. No inferior left pulmonary vein is present.Qp:QsThe calculated Qp:Qs is 1.7.PericardiumThere is no pericardial effusion.There is a focus of high signal at the infralateral pleural surface which may represent sequestration or hypoplastic right lower lobe. There is right-sided volume loss with a history of hypoplastic right lung.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is is 67%. There is no late gadolinium enhancement.2. The right ventricle is mildly dilated with preserved systolic function, the RVEF is 51%. 3. On one axial cine view, there is suggestion of a small interatrial defect with left to right shunting at the valve of the fossa ovalis. This was not well demonstrated on first pass imaging. No evidence of superior sinus venosus shunting was identified. However, in the setting of anomalous right superior pulmonary vein, a small superior sinus stenosis defect cannot be entirely excluded. Both areas of potential shunting can be further evaluated with echocardiography and/or direct contrast injection left pulmonary vein ablation. 4. The two left pulmonary veins drain normally into the left atrium. One right superior pulmonary veins drains into the superior left atrium. No right inferior pulmonary vein drains into the left atrium. There is an anomalous right superior pulmonary vein that drains high into the superior vena cava. There is a question of a right apical pulmonary AVM with a high signal focus (possible nidus) in the right apex that provides the anomalous pulmonary vein. This can be better evaluated with a CT PE thorax.7. The calculated Qp:Qs is 1.7.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI images of the sella demonstrate a focus of relative hypoenhancement centered within the right pituitary gland measuring 16 mm transverse by 13 mm craniocaudal by 14 mm AP dimensions. This partially enters the right cavernous sinus, however without associated right cavernous carotid encirclement or narrowing. It also displaces the pituitary stalk to the left. Compared to be 2014 study, there has been significant decrease in size, and it no longer approaches the optic apparatus.Evaluation of the brain demonstrates the ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are essentially clear.

Output: MRI images of the sella demonstrate a focus of relative hypoenhancement centered within the right pituitary gland measuring 16 mm transverse by 13 mm craniocaudal by 14 mm AP dimensions. This partially enters the right cavernous sinus, however without associated right cavernous carotid encirclement or narrowing. It also displaces the pituitary stalk to the left. Compared to be 2014 study, there has been significant decrease in size, and it no longer approaches the optic apparatus.


Instruction: Generate impression based on findings.

Input: Diagnosis: Quadriplegia, C5-C7 incompleteClinical question: s/p spinal cord bxSigns and Symptoms: weakness The cervical vertebral bodies are appropriate in overall alignment and height. The patient is status post recent multilevel laminectomies at C5, C6, C7. There is redemonstration of a T2 hyperintense mass extending from the C5-6 disc space level down to the T1 vertebral level. There is some heterogeneous enhancement associated with this lesion which is eccentric towards the right half of the spinal cord. The spinal cord is enlarged at the level of the tumor. There is no spinal fluid surrounding the spinal cord at the levels of the tumor.There are signal changes and contrast enhancement along the paravertebral musculature extending from approximately C1 down to T1 which are probably related to partial operative effects.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is loss of disc space height, endplate reactive change, central disc protrusion, endplate and uncovertebral osteophytes and narrowing of the neural foramina bilaterally and encroachment of exiting nerve roots. The endplate reactive changes are high signal on T2 and display enhancement following gadolinium administration.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. There are endplate and uncovertebral osteophytes present at this level associated with a disc bulge associated with endplate reactive change.The vertebral artery flow voids appear to be intact.

Output: 1.The patient is status post recent laminectomies in the lower cervical spine. There are associated postoperative changes present.2.There is a mass redemonstrated which is centered in the lower cervical spinal cord and eccentric to the right side. Differential considerations include astrocytoma and ependymoma.3.There are multilevel degenerative changes present in the cervical spine associated with the encroachment of exiting nerve roots bilaterally at C5-6. Spinal stenosis at the C5-6 level has been alleviated compared to the prior exam.


Instruction: Generate impression based on findings.

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

Output: Negative nonenhanced CT of brain.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain. Signs and symptoms: Low back pain and spasms. Nonenhanced brain MRI:T12 -- L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.At L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Tiny annular fissure far laterally on the right (sagittals T2/T2 stir image 12).L2 -- L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum and moderate right facet hypertrophy changes. Constellation of changes result in mild central spinal and right neural foraminal compromise.L4 -- L5 demonstrate mild disk disease, mild (right greater than left) facet and ligamentum flavum hypertrophy is present. Although there is subtle flattening deformity of the thecal sac secondary to ligamentum flavum hypertrophy there is no central spinal stenosis in the AP axis. Mild compromise of the lateral recess of the canal bilaterally is noted.L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate to significant asymmetric right-sided ligamentum flavum and facet hypertrophy changes are present. Constellation of changes results in mild right neural foraminal compromise and no central spinal stenosis. Examination at this level also demonstrates a tiny central annular fissure is appreciated on sagittal T2 stir series 50 on image 8.

Output: 1.Degenerative changes at the L3 -- L4 with resultant mild central spinal and right neural foraminal stenosis.2.Degenerative changes at the L4 -- L5 results in compromise of the lateral recesses bilaterally. Mild compromise of transverse axis of thecal sac however no spinal stenosis in AP axis.3.At L5 -- S1 asymmetric right-sided facet and ligamentum flavum hypertrophy results in mild right neural foraminal compromise.4.Tiny annular fissures in the midline at L5 -- S1 and far right at L1 -- L2 as detailed.


Instruction: Generate impression based on findings.

Input: 52-year-old female with pain and weakness. Evaluate post rotator cuff repair one year ago. Evaluation of the greater tuberosity and adjacent soft tissue is limited due to metallic susceptibility artifact from orthopedic hardware.ROTATOR CUFF: At the 12:00 position, a thin supraspinatus tendon can be followed from the myotendinous junction to the greater tuberosity at the vicinity of aforementioned orthopedic hardware. This intact portion of the tendon measures approximately 1.5 to 2 cm in AP dimension. We suspect that there is delamination of the undersurface fibers of the supraspinatus with retraction to the level of the glenohumeral joint, but this may represent pre-existing undersurface tearing rather than postoperative tearing. There is a fluid-filled gap along the anterior margin of the remaining supraspinatus tendon insertion compatible with a full-thickness tear of the anterior fibers of the supraspinatus, but again we are uncertain if this represents a pre-existing tear or tear which occurred following surgery. There is mild atrophy of the supraspinatus muscle. The infraspinatus muscle and tendon appear intact, although there is perhaps mild fatty infiltration along the myotendinous junction. The teres minor muscle and tendon appear intact. Subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is mild widening of the acromioclavicular joint indicating prior surgery. There is a small amount of fluid within the subacromial bursa. There is anterior spurring of the acromion process.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. We see no evidence of joint effusion. Branching intermediate signal intensity within the superior labrum as well as attenuation of the posterior labrum may reflect degenerative tearing.BICEPS TENDON: The biceps tendon is noted anterior to the proximal humeral diaphysis but this disappears within the bicipital groove, presumably representing prior tenotomy.

Output: 1. Fibers of the thinned supraspinatus tendon can be traced to their insertion on the greater tuberosity. There appears to be delamination of the undersurface fibers of the supraspinatus tendon, with retraction proximally, as well as full-thickness tearing of the anterior most fibers of the tendon. However, we cannot state with certainty if this represents pre-existing tearing or tearing that is occurred since surgery.2. Postoperative changes of the greater tuberosity, acromioclavicular joint, and biceps tendon as described above.3. Degeneration of the glenoid labrum.


Instruction: Generate impression based on findings.

Input: Reason: pain History: right hip pain ACETABULAR LABRUM: There is linear increased signal in the anterior superior labrum, which is consistent with a tear. Incidental note is made of anterior extravasated contrast, which is likely of no current clinical significance.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Tear of the anterior superior labrum as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Seizure workup. Please performed on the post enhanced images; patient already had the nonenhanced exam. Signs and symptoms: As above. Post enhanced brain MRI:Examination demonstrates no evidence of abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.There is normal enhancement of intracranial venous sinuses.Supratentorial ventriculomegaly is again noted without change.

Output: No detectable abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized)Unspecified ptosis of eyelid. Paralytic strabismus, fourth or trochlear nerve palsyL ptosis, L leg weakness, L-sided sensory deficit since this amevaluate steno-occlusive disease.Mild nonproliferative diabetic retinopathy MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 and FLAIR sequence hyperintense focus centered in the left centrum semiovale measuring 15x6mm axial dimensions as well as several punctate foci of signal hyperintensity in the left frontal and parietal subcortical white matter and left sided periventricular white matterNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left A1 segment is small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is medium sized. The left posterior cerebral artery has fetal origin. The left p1 segment is medium sized. The vertebral arteries are similar in size. There is extracranial origin of the left PICA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The LCCA originates from the innominate artery.

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.There is lesion in the left centrum semiovale associated with several punctate lesions in the left periventricular and subcortical white matter which are most likely vascular related possibly from prior small ischemic event now in a chronic stage.


Instruction: Generate impression based on findings.

Input: 89 years, Female, altered mental status, unable to walk. There are multiple foci of restricted diffusion in the right frontal lobe including the right forceps minor, centrum semiovale and along the cortex of the right superior and middle frontal gyri consistent with acute infarct. Again seen is evidence of multiple prior infarcts including relatively larger areas of encephalomalacia involving the left posterior temporal and occipital lobes, which is new/much larger than prior from 10/20/2004. There is also extensive encephalomalacia involving the right cerebellar hemisphere which has evolved compared to prior study. Multiple chronic infarcts involving the midbrain, pons, left cerebellar hemispheres, basal ganglia and thalami are also noted, some of which were acute at the time of prior study from 2004. There is also more diffuse confluent T2/FLAIR hyperintensity in the periventricular and subcortical white matter which is compatible with chronic small vessel ischemic disease.There are foci of susceptibility compatible with chronic hemorrhage involving the left cerebellar hemisphere parenchyma as well as along the surface of the encephalomalacic right cerebellar hemisphere. No intracranial mass or mass effect. There is global parenchymal volume loss. No hydrocephalus or extra-axial collections. There is ex vacuo dilatation of the left lateral ventricle. Paranasal sinuses and mastoid air cells are grossly clear. Evidence of intraocular lens replacement. Chronic fracture deformity involving the right medial orbital wall better seen on recent CT. Bone marrow signal and extracranial soft tissues are otherwise unremarkable.

Output: 1. Several foci of acute infarct involving the right frontal lobe as described above.2. Numerous chronic supratentorial and infratentorial infarcts, some of which were acute at the time of prior study from 10/20/2004.3. Chronic blood products involving the bilateral cerebellar hemispheres.Dr. Ali discussed findings with Dr. Raychaudhuri at 10 am on 8/27/2015.


Instruction: Generate impression based on findings.

Input: 65-year-old male with HCC status post TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. An ablation cavity is noted within segment six of the liver measuring 4.3 x 4.0 cm. T1 hyperintensity within the ablation cavity is again noted. There is no evidence of an arterially enhancing lesion.Cholelithiasis. The common bile duct is normal in caliber.The hepatic vasculature is patent.SPLEEN: Splenomegaly measuring 19 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered gastrohepatic ligament, periportal, and aortocaval lymph nodes. Mildly enlarged right cardiophrenic lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination as described in the technique section above.2.Segment six lesion cavity without evidence of recurrent or residual disease. No new suspicious liver lesions.3.Cirrhotic morphology with splenomegaly.


Instruction: Generate impression based on findings.

Input: Clinical question: possible lumbar hemangiomaSigns and Symptoms: lumbar hemangioma Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. There is mild anterior subluxation of L4-L5 and left lateral translation of L2 on L3. The conus medullaris on sagittal imaging is grossly intact. There is sigmoid curvature to the lumbar spine. Within the sacrum there is a predominantly T2 hyperintense lesion which displays a low but of enhancement and has a spiculated pattern. Part of the lesion is hyperintense on T1. This sacral lesion is 28 x 14 mm greatest sagittal dimensions on the current exam than on the prior exam was 21 x 12 mm sagittal dimensions indicating that it has mildly enlarged.There is a similar signal characteristic lesion present within the T11 vertebral body measuring 15 x 11 mm sagittal dimensions which previously measured 11 x 8 mm sagittal dimensions the previous exam.There is redemonstration of endplate reactive changes at L2-3 where there are Schmorl's nodes present. These endplate reactive changes are lower signal on T1 and higher signal on T2 and have not changed substantially since the prior exam. They do demonstrate enhancement following contrast administration. There is mild left lateral translation of L2 on L3 present. This was also present on prior exam and does not appear to have changed substantially.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy at this level and a mild degree of anterior subluxation of L4 on L5 as well as a small left lateral recess disc protrusion. These findings were also present on the previous exam and have not changed substantively. There is some mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The right ureter and right renal pelvis are larger than on the prior exam. There a mass present in the pelvis which measures approximately 5 cm in diameter. It is eccentric towards the right side and appears to impress on the right ureter.

Output: 1.There is redemonstration of a multilevel degenerative changes present in the lumbar spine which have not changed significantly since 2009. This is associated with left lateral translation of L2 on L3, mild anterior subluxation of L4 on L5 and a sigmoid curvature to the lumbar spine as well as some encroachment of the left-sided exiting nerve roots at L4-5 within the neural foramen.2.There is sacral lesion and a T11 lesion present which have mildly enlarged since the prior exam from 2009. These could represent atypical hemangiomas.3.Findings suggest a right-sided hydroureter and hydronephrosis. There appears to be a mass in the pelvis which is incompletely visualized on this exam which impresses on the right ureter. Additional imaging of the pelvis may be of further benefit in evaluating this. Please refer to the MRI of the pelvis from 9/4/2015 for further comments on this.4.An email was sent to Dr Schwartz with the above findings.


Instruction: Generate impression based on findings.

Input: Postoperative changes from small left prior burr hole are seen, with rounded area of peripheral susceptibility likely relating to previous biopsy. There is redemonstration of a stable area of T2/FLAIR hyperintensity involving the left superior frontal gyrus with mild associated cortical thickening anteriorly, with signal abnormality extending into the left frontal centrum semiovale and periventricular white matter. There is a prominent area of central cystic degeneration. Anterior to the cystic area within the thickened cortex there is a small area of enhancement which appears slightly increased from prior examination (series 1302, image 152-155) especially the medial component. The ventricles are nondilated. The cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. Enhancement and osseous thickening along the medial right orbital roof is again noted, possibly representing an area of fibrous dysplasia. There is a left maxillary sinus retention cyst.

Output: There is slight increased foci of enhancement along the anteromedial margin of the cystic area of degeneration in the left frontal lobe suspicious for tumor progression.


Instruction: Generate impression based on findings.

Input: Ms Wachowski is a 59-year-old female with history of right breast lumpectomy for DCIS/IDC in 2009, followed by radiation and hormonal therapy. Personal history of benign MRI-guided biopsy of the left breast in 2009. No family history of breast cancer. Asymptomatic patient presenting for annual follow-up. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. A linear marker is placed on the scar overlying the right breast. There are stable post-lumpectomy changes present in the right breast, including architectural distortion, increased density, benign dystrophic calcifications and surgical clips. Biopsy clip marker within the left inner central breast is redemonstrated from prior benign MRI biopsy. There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breasts.

Output: Stable postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Female 63 years old Reason: evaluate for osteomyelitis History: necrotic 1st toe with draining ulcer There is increased STIR signal in the distal tuft of the great toe with corresponding confluent low T1 signal consistent with osteomyelitis. There is no enhancing fluid collection to suggest abscess. There is increased STIR signal in the adjacent soft tissues consistent with edema. There is also edema type signal in the soft tissues about the metatarsals.

Output: Findings compatible with osteomyelitis involving the distal tuft of the great toe.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of head, face and neck [C76.0], Reason for Study: ^Reason: eval for vasogenic edema History: known brain mets, nausea, vomiting Brain MRIMotion artifact degraded exam quality.In particular, previously seen enhancing parenchymal nodular lesions at the right temporal lobe mesial aspect, right cerebellar hemisphere and left occipital lobe are not this conspicuous as prior. However, there are subtle enhancing lesions seen on the same locations thus could represent unchanged/stable nodular enhancing lesions.However, on FLAIR/T2 images, the left occipital lobe shows increased signal intensity which may represent post radiation changes of the left occipital lobe lesion more likely. Differential diagnosis could include localized venous congestive encephalopathy based on the findings of distal superior sagittal sinus thrombosis.Soft tissue lesions which is occlusive for the distal superior sagittal sinus to the level of Torcular Herophili appear to be stable. There is no evidence of prominent cortical veins on post contrast scan.Soft tissue mass on the midline occipital scalp is again seen, unchanged since prior scan.Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter are unchanged and indicate non specific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. The gray-white matter differentiation is normal. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Right sphenoid sinus mucosal thickening is seen.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate occlusion of the distal Superior Sagittal Sinus (SSS). However, proximal SSS, bilateral transverse sinus and bilateral sigmoid sinuses appear to be normal and patent. Visualization of the deep venous system including bilateral internal cerebral veins, vein of Gallen and straight sinus appear to be patent without evidence of occlusive lesion.

Output: 1. Interval development of left occipital lobe FLAIR/T2 high signal intensity. This finding more likely represent post radiation changes. Differential diagnosis though less likely include localized venous congestive encephalopathy.2. Unchanged distal SSS occlusion, midline occipital area scalp mass and although not as conspicuous as prior multiple brain parenchymal enhancing lesions since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.4. Occlusion of the distal SSS on MRV. However, other cranial venous drainage system appears to be patent with no evidence of occlusive lesion. 5. Due to significant motion artifacts, precise evaluation for new enhancing nodule is not possible.


Instruction: Generate impression based on findings.

Input: History of renal cancer status post nephrectomy. Presents for surveillance scan. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense hepatic foci are unchanged and are likely cystsSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy without evidence of local recurrence. No regional lymphadenopathy.The left kidney is normal in appearance without a suspicious lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Stable small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with subacute left-sided weakness and history of multiple sclerosis. Brain:Multiple new T2 hyperintense lesions are seen scattered through the cerebral hemispheres, the brainstem and cerebellum. A number of these lesions demonstrate either solid or rim enhancement. No evidence of significant parenchymal edema or mass effect is observed. Brain volume is within normal limits. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. Ventricular size and morphology are within normal limits.Cervical spine:Multiple scattered T2 hyperintense lesions are seen within the cervical spinal cord. The largest lesion is located dorsally and spans approximately 13 mm at the C4-5 level. This lesion does not enhance, but several of the smaller lesions at the cervico-medullary junction and at C3 do enhance.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is seen. The spinal canal and neural foramina are patent. No disc degeneration is seen.Thoracic spine:Multiple T2 hyperintense lesions are demonstrated through the thoracic spinal cord including large lesions at T5-6 and T10 which measure up to 15 mm in length. Both of these lesions, and several smaller lesions, demonstrate enhancement on postcontrast images.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is seen. The spinal canal and neural foramina are patent. The intervertebral discs are normal.

Output: 1.Multiple new and enhancing lesions are evident within the brain compatible with interval progression of demyelinating disease and with the presence of actively inflamed lesions.2.No prior examination is available for comparison in the spine. However, numerous enhancing and nonenhancing spinal cord lesions are also demonstrated.


Instruction: Generate impression based on findings.

Input: 73 year old female who is status post left lumpectomy for ILC, resulting in positive surgical margins. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a post-surgical seroma cavity in the left lateral breast, measuring 68 x 64 x 42 mm (AP x LR x CC). At the anterior-inferior margin of the seroma, there is an irregularly shaped enhancing mass, measuring 11 x 13 x 11 mm, which is suspicious for residual lesion.No abnormal enhancement is seen in right breast. Mild post-surgical changes are seen in the left axilla.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Status post lumpectomy in the left breast. A residual tumor is suspected at anterior-inferior margin of the seroma.2. No MRI evidence of malignancy in the right breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 58-year-old with personal history of right breast cancer status post lumpectomy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. There is mild motion artifact, though the exam remains diagnostic. No suspicious enhancement is seen in either breast. Postlumpectomy change in the right breast again noted. Low T2 non-enhancing masses bilaterally, more on the left, are stable. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of left breast ILC status post mastectomy. There is heterogeneous amount of fibroglandular tissue in the right breast. The patient is status post left mastectomy.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast or left chest wall. Scattered non-suspicious foci are present in the right breast, none with suspicious kinetics. These foci are most similar to her oldest comparison MRI from 2013. No abnormal axillary lymph nodes are identified in either axillary region. Post surgical change is noted in the left axilla.

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


Instruction: Generate impression based on findings.

Input: Large liver mass on outside imaging ABDOMEN:LIVER, BILIARY TRACT: Large T2 hyperintense mass replacing nearly the entire right hepatic lobe, internal heterogeneity and septations seen, measures 17.8 x 13.3 x 20.7 cm (series 3, image 18; series 7, image 17). The mass is T1 hyperintense and exerts mass effect upon the right kidney. Additional T2 hyperintense/T1 hypointense nonenhancing foci are noted throughout the liver, likely cysts. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Large cystic mass replacing the right hepatic lobe with imaging characteristics suspicious for a biliary cystadenoma/cystadenocarcinoma (particularly given the internal heterogeneity of the structure evident on T2 imaging) or a giant biliary hamartoma, no associated enhancement seen.


Instruction: Generate impression based on findings.

Input: Small lung cancer with brain metastasis. Confusion and slurred speech. The numerous contrast-enhancing lesions which are predominantly distributed along the cortical surface have progressed since the previous examination, as well as the vasogenic edema associated with some of the lesions. The lesions are most coalescent along the left sylvian fissure, where they are also associated with increased subjacent vasogenic edema and slight mass-effect on the adjacent structures. For example, one of these lesions now measures transaxially 2.4 cm x 1.8 cm compared to 2.0 cm x 1.0 cm previously. Some of the lesions in the occipital lobes are not clearly appreciated on prior and may be new. There is no midline shift or brain herniation. The lesions are associated with mild diffusion restriction, probably reflecting their dense cellularity. The nonspecific periventricular T2/or hyperintense signal in both cerebral hemispheres remain unchanged and probably reflect a combination of microvascular ischemia and treatment effect.The orbits are grossly unremarkable. There is no destructive skull lesion.

Output: 1.Since previous MRI of March 2016, there has been progression of intracranial metastatic disease with enlargement of numerous intraparenchymal lesions which are predominantly along the cortical surface. There is also mild increase in the associated vasogenic edema, particularly in the left insular region. There is no midline shift or herniation.2.Unchanged periventricular cerebral white-matter T2-hyperintensity probably represents chronic microvascular ischemia and treatment effect.


Instruction: Generate impression based on findings.

Input: Right knee pain No fracture or malalignment. No joint space narrowing. Moderate to large joint effusion. Please see recent prior knee MRI for details.

Output: No fracture or malalignment.


Instruction: Generate impression based on findings.

Input: Multiple sequences are motion degraded. Given this caveat:Brain:Within the bilateral globus pallidus there are foci of restricted diffusion with matching ADC hypointensity, T2 hyperintensity, without T T1 signal change.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. Cervical spine:There is a linear focus of T2 hyperintensity within the cervical cord just inferior to the cervicomedullary junction measuring up to 8 mm in craniocaudal dimension without mass effect.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized paraspinal contents are unremarkable.C2/3: No significant stenosisC3/4: No significant stenosisC4/5: Mild to moderate right neural foraminal stenosisC5/6: Mild bilateral neural foraminal stenosisC6/7: No significant stenosisC7/T1: No significant stenosisThoracic spine:There are bilateral pleural effusions.There are no acute fractures or subluxations. Marrow signal intensity is benign throughout. The spinal cord is normal in signal.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates disc bulge abutting the cord without stenosis. 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 a left paracentral disc protrusion abutting the cord without stenosis. 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. Lumbar spine:Increased T1 hyperintensity within L5 as well as the sacrum suggests previous radiation therapy to the region.The left kidney is atrophic, as demonstrated on previous abdomen CT exams.There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level.L1/2: Asymmetric bulge to the left and bilateral facet hypertrophy without stenosis.L2/3: Asymmetric bulge to the left, ligamentum flavum thickening, and facet hypertrophy. There is mild left neural foraminal stenosis with adjacent nerve root abutment lateral to the neural foramen.L3/4: Disc bulge, ligamentum flavum thickening, and facet hypertrophy, without stenosis.L4/5: Asymmetric bulge to the right with a prominent annular tear, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild right neural foraminal stenosis with adjacent nerve root abutment lateral to the neural foramen.L5/S1:Mild disc bulge and bilateral facet hypertrophy. There is moderate left neural foraminal and mild right neural foraminal stenosis.

Output: 1.Multiple sequences are motion degraded.2.Acute to subacute ischemia within the globus pallidus bilaterally. The differential diagnosis for this most likely includes a metabolic or toxic etiology, and less likely hypoxic.3.Tiny syrinx within the cervical cord just inferior to the cervicomedullary junction.4.Bilateral pleural effusions.5.No cord or conus compression.6.Mild degenerative changes of thoracic spine without significant stenosis.7.Increased T1 hyperintensity within L5 as well as the sacrum suggests previous radiation therapy to the region.8.L2/3: Mild left neural foraminal stenosis with adjacent nerve root abutment lateral to the neural foramen.9.L4/5: Mild right neural foraminal stenosis with adjacent nerve root abutment lateral to the neural foramen.10.L5/S1:Moderate left neural foraminal and mild right neural foraminal stenosis.11.No MRI evidence of osseous spinal metastatic disease.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:4/21/1963)Reason: r/o lesions, hx of left visual loss History: same as abovePROVIDER/ATTENDING NAME: ANTHONY T. REDER MINDY ALYCE SCHWARTZ The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Apparent FLAIR signal hyperintensity involving the midportion of the midbrain extending into the superior cerebellar peduncles was also present on the previous exam. It is not associated with T1 hypointensity and is not associated with T2 hyperintensity suggesting this may represent artifactNormal 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: Findings are suggestive of artifact within the midbrain which could obscure an underlying abnormality. The appearance is stable.


Instruction: Generate impression based on findings.

Input: Severe migraines and family history of cerebral aneurysm. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive lesions or cerebral aneurysms.


Instruction: Generate impression based on findings.

Input: Redemonstrated are lesions of low susceptibility signal, a few with corresponding T1 hypointensity and less conspicuous central T2 hyperintensity dispersed throughout the brain, which are unchanged from the previous study except for the lesion seen previously in the left frontal lobe which has increased in size from 4 mm to 7 mm demonstrating new perilesional edema and enhancement.Punctate nonspecific foci of T2 and FLAIR high signal are again seen in the corona radiata and the centrum semiovale, unchanged from the previous study.The ventricles and sulci are within normal limits. The basilar cisterns remain patent. There is no midline shift or mass effect. 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 mild mucosal thickening in the maxillary sinuses. The left parotid gland is again diminutive in volume, which may be postoperative or post treatment in nature.

Output: 1.A left frontal lobe lesion has increased in size with new perilesional edema and new enhancement. The constellation of these features are worrisome for progression of a metastasis and less likely changes within a cavernoma.2.The remainder of the previously identified lesions are unchanged.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with history of multiple myeloma, as well as herpes zoster, with confusion and unsteady gait. Assess lytic lesions and mass described on recent CT. Also evaluate for CNS myeloma involvement and CNS herpes zoster. Bone marrow signal characteristics are diffusely heterogeneous including both the calvarium and the visualized upper cervical spine.An enhancing mass is centered on the floor of the right middle cranial fossa with both intracranial and extracranial components measuring up to 21 mm in thickness. This lesion indents the adjacent anterior temporal lobe, but the interface between brain and tumor remains smooth and there is no evidence of parenchymal enhancement or edema to suggest brain invasion at this time.Numerous additional smaller areas of pathologic marrow enhancement are seen, none of which is associated with any large or significant intracranial or extracranial components.The dura along the bilateral convexities and along the right temporal bone is mildly and smoothly thickened, likely a reactive phenomenon to the overlying bony disease.No areas of pathologic parenchymal enhancement are seen. No parenchymal edema is detected. Mild periventricular T2 hyperintensities are a nonspecific finding. Diffusion weighted images are within normal limits.No abnormal extra-axial fluid collections are seen. No evidence of intracranial hemorrhage is detected. The ventricular system is normal in size and morphology.The skin of the right frontal and periorbital regions may be slightly edematous but this is an equivocal finding.

Output: 1.Diffuse abnormality of the bone marrow compatible with the stated history of multiple myeloma.2.A localized tumor deposit is evident centered on the floor of the right middle cranial fossa. This lesion has both extracranial and intracranial components. The intracranial component indents the adjacent anterior temporal lobe but without clear evidence of brain invasion.3.Smooth dural thickening likely reflects a reactive process to the overlying bony disease. No additional areas of significant intracranial tumor are suspected.4.No specific findings are seen to suggest active herpetic encephalitis or other acute abnormalities.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate for bleeding, characterize hypoattenuating genu lesion seen on CTSigns and Symptoms: R eye pain/R sided headache, bilateral blurred vision x1-2 daysDiagnosis: Headache Headache MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small 6 mm focus of diffusion restriction present along the right superior temporal gyrus near to the junction with the inferior parietal lobule. There is a more subtle 2.5 mm focus of diffusion restriction present along the right inferior parietal lobule close to the junction with the occipital lobe. These can also be identified on the FLAIR MRI images.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR punctate hyperintense foci are present in the thalami. Patchy T2 and FLAIR hyperintense lesions are present in the brainstem.There is a heterogeneous focus of T2 and FLAIR signal hyperintensity along the genu of the corpus callosum eccentric towards the left side measuring approximately 30 x 10 mm axial dimensions. It is low signal on T1-weighted imaging but heterogeneous. It does not enhance following gadolinium administration. It does not appear to be associated with any significant diffusion restriction. There is no associated susceptibility effect appreciated.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1.There is a heterogeneous looking lesion along the genu of the corpus callosum. It is not associated with any contrast enhancement. It is nonspecific. Differential considerations include demyelination as well as a low-grade glioma and prior injury.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. Additional lesions are present in the brainstem as well as the thalami.3.There are small foci of diffusion restriction present in the right superior temporal gyrus and adjacent inferior parietal lobule. The possibility that these are related to microinfarcts is raised. These correspond to the territory of the right angular artery.


Instruction: Generate impression based on findings.

Input: 69 year old man with PVC initiated VT/VF, referred for cardiac MRI for evaluation of scar burden prior to ablation. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 242 ml (normal range 142+/-34), the LV end systolic volume index is 85 ml/m2 (normal range 25+/-9), the LVESV is 176 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). LV dysfunction is global with regional variation.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 35%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 62 ml/m2 (normal range 31+/-9), and the RVESV is 129 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.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 grossly normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProminent left chest ICD artifact is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 27%.2. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 35%.3. The presence or absence of late gadolinium enhancement could not be determined in this study. Although gadolinium was administered, only one post-contrast image was acquired and the patient refused to complete the study due to discomfort in left chest wall. Subsequent exam suggested musculoskeletal cause of discomfort. No evidence of ICD problems by exam and interrogation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 52-year-old female with proximal weakness of the lower extremities. Evaluate for progression of fatty atrophy or gadolinium enhancement within the muscles. Left femur:Again seen is severe fatty atrophy of the quadriceps musculature with relative sparing of the rectus femoris, appearing similar to the prior study. There is mild to moderate fatty atrophy of the semitendinosus, appearing similar to the prior study. There is severe fatty atrophy of the remaining hamstring musculature appearing similar to the prior study. There is relative sparing of the adductor musculature as well as the sartorius. There is no enhancement of the remaining musculature to indicate inflammation. The bone marrow signal intensity is within normal limits.Right femur:Again seen is severe fatty atrophy of the quadriceps musculature with relative sparing of the rectus femoris appearing similar to the prior study. There is severe fatty atrophy of the hamstring musculature appearing similar to the prior study. There is relative sparing of the adductor musculature as well as the sartorius. There is no enhancement of the remaining musculature to indicate inflammation. There is a small knee joint effusion as well as mild synovitis of the knee joint. The bone marrow signal intensity is within normal limits.

Output: Severe fatty atrophy of the anterior and posterior musculature of the thighs appearing similar to the prior study. We see no definite progression of atrophy nor do we see gadolinium enhancement to suggest active inflammation.


Instruction: Generate impression based on findings.

Input: 46 year old female with newly diagnosed multivessel coronary artery disease after admission for non-ST elevation myocardial infarction. Risk factors included hypertension, hyperlipidemia. She is referred for cardiac MRI for assessment of viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 131 ml/m2 (normal range: 65+/-11), the LVEDV is 254 ml (normal range 109+/-23), the LV end systolic volume index is 95 ml/m2 (normal range 18+/-5), the LVESV is 185 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There is hypokinesis of the basal anterolateral wall, the mid anteroseptum, anterior, anterolateral, and inferolateral walls; and the entire apex. The majority of the left ventricle is free of myocardial infarction and viable. However, there is a small transmural myocardial infarction involving the basal to mid anterolateral wall which is not likely to be viable. There is a non-transmural myocardial infarction involving the mid anterior and anterolateral walls which has an intermediate probability of viability. A small apical anterior transmural myocardial infarction is noted and this segment is not viable. Additionally there is a mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern of late gadolinium enhancement is not typical for prior myocardial infarction and suggests the presence of a concomitant non-ischemic cardiomyopathy. No left ventricular thrombus is noted. The pre-contrast native myocardial T1 relaxation times are elevated (~1200 ms) which suggests presence of underlying fibrosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 59 ml/m2 (normal range 22+/-8), and the RVESV is 115 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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 mildly dilated. Venous AnatomyThe SVC and IVC are dilated and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall bilateral pleural effusions are 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 severely dilated with severely reduced systolic function (LVEF 27%).2. The right ventricle is mildly dilated with mildly reduced systolic function (RVEF 41%).3. The majority of the left ventricle is free of myocardial infarction and viable. However, there is a small transmural myocardial infarction involving the basal to mid anterolateral wall which is not likely to be viable. There is a non-transmural myocardial infarction involving the mid anterior and anterolateral walls which has an intermediate probability of viability. A small apical anterior transmural myocardial infarction is noted and this segment is not viable. Additionally there is a mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern of late gadolinium enhancement is not typical for prior myocardial infarction and suggests the presence of a concomitant non-ischemic cardiomyopathy. 4. Biatrial enlargement. 5. The SVC and IVC are dilated.6. Moderate tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 77-year-old female with history of lung cancer and probable metastases in left anterior pons Previously described on the recent MRI left anterior pons hemorrhagic lesion appears hyperdense on the nonenhanced CT and it is associated with extensive areas of hypoattenuation involving the pons, mid brain, cerebellum, left thalamus, and posterior limb of the internal capsule. There is no evidence of other hemorrhagic foci in the brain parenchyma. There is no evidence of extra axial fluid collection/hemorrhage or midline shift. The ventricles and basal cisterns are normal in size and configuration.Again noted diffuse calvarial diploic widening, coarsened trabecula and thick cortices with focal areas of sclerotic lesions that are stable compared to prior examination compatible with Paget's disease. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Stable hyperdense lesion in anterior pons associated with extensive vasogenic edema corresponding to the hemorrhagic lesions seen on recent MRI. No other foci of intraparenchymal high density suggestive of hemorrhage are identified.2.Paget's disease involving the skull.


Instruction: Generate impression based on findings.

Input: 62-year-old female with abdominal pain, fever, chronic cystitis, self-catheterization. Status post appendectomy. Creatinine is 1.7. This examination is limited by the absence of intravenous contrast. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is extensive fat stranding surrounding the right kidney. In the right midpole region there is a faintly seen cystic mass which measures approximately 4 cm in diameter. CT or MRI examination with contrast would be required to further delineate this potential lesion. There is mild right hydronephrosis and hydroureter. No renal calculus are present. There are several small calcifications in the course of the distal ureter and in the pelvis, but these cannot be convincingly demonstrated to be within the ureter. There is a left midpole faint hypodensity measuring approximately 1.8 cm in diameter which may be a simple cyst. The left kidney is otherwise within normal limits. The findings in the right kidney are most likely due to pyelonephritis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXAE: No significant abnormality notedBLADDER: There is a small amount of air within the bladder compatible with history of self-catheterization.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted

Output: Fat stranding, mild hydronephrosis and hydroureter of the right kidney compatible with pyelonephritis. No definite evidence of renal stones. Bilateral renal cortical hypodensities are faintly seen, but cannot be further characterized without IV contrast. Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Known numerous CCM lesions with history of 3 craniotomies for lesion resection: headaches and seizures. There a postoperative findings related to left parietal craniotomy for resection of a left parietal cavernous malformation with unchanged diffuse susceptibility effect along the surgical cavity margins and confluent surrounding T2 hyperintensity. There are also unchanged posteroparietal findings in the left posterior fossa. There are numerous remaining supratentorial and infratentorial cavernous malformations, which are unchanged. For example, the largest remaining supratentorial lesion is located in the left anterior frontal lobe, which measures up to approximately 20 mm, and the largest infratentorial lesion is in the right cerebellar hemisphere, which measures up to 8 mm. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No significant interval change in the postoperative findings and numerous remaining cerebral cavernous malformations.