Instruction: Generate impression based on findings.

Input: Female, 58 years old, with GBM, IDH wild type. Findings related to multiple prior surgeries are again seen in the right temporal lobe. Again seen is a large rim-enhancing lesion occupying a majority of the anterior temporal lobe with extension into the insula and basal ganglia. On comparison with the immediate prior examination, the overall dimensions of this lesion have not significantly changed. The thickness of the enhancing rim has in some areas decreased which may reflect progressive necrosis.Generalized mass effect related to this lesion is unchanged. There is a stable midline shift to the left of approximately 6 mm. T2 hyperintensity spreading into the adjacent tissues reaching as high as the superior parietal lobule has improved in some areas. No new intracranial enhancing lesions are seen. Faint enhancement and diffusion restriction along the right atrial ependyma is probably unchanged. The size and shape of the ventricular system are unchanged. Periventricular T2 hyperintensity along the left lateral ventricle is unchanged and may be related to treatment.

Output: The overall size of a large peripherally enhancing mass occupying the anterior right temporal lobe with extension into the insula and basal ganglia has not significantly changed from the immediate prior examination. The thickness of the enhancing rim has decreased which may indicate progressive necrosis. T2 hyperintensity surrounding this lesion has improved in some areas. No new intracranial lesions are appreciated.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Subdural hemorrhageClinical question: Evaluate previously seen hemorrhageSigns and Symptoms: 2 yo M with subdural hemorrhage MRI of the brainThere is diffusion restriction present along the left cuneus.There is a left subdural collections present adjacent to the left frontal, parietal and temporal lobe which includes blood products and air with air fluid level present. It measures up to 15 mm in thickness.The patient is status post left sided craniotomy. There is a drainage catheter present at the medial most aspect of the collection which is better visualized on a recent CT of the head. The posterior aspect of the intracranial portion of the catheter (17mm) is in the subdural space and the majority of the anterior aspect (88mm) is subarachnoid. The catheter is best visualized on the coronal images.There is 3mm shift of the midline towards the right.There is a thin subdural hematoma present along the posterior aspect of the falx cerebri, tentorium and adjacent to the right occipital lobe.There is diffuse enhancement along the leptomeninges.There is subgaleal fluid present along the parietal bones bilaterally.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.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.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 no significant compromise to the spinal canal or neural foramina.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.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.There is a left subdural hematoma present with mass effect and midline shift. 2.The drainage catheter at the left craniotomy site is mostly subarachnoid in location.3.There is diffusion restriction present along the left cuneus suggestive of an acute infarction.4.There is a thin subdural hematoma present along the posterior aspect of the falx, tentorium and adjacent ot the right occipital lobe.5.There is diffuse leptomeningeal enhancement present which is non-specific. This could be reactive to the above findings, though would not be possible to differentiate from leptomeningeal disease such as meningitis.6.Status post left sided craniotomy with associated postoperative changes.7.No evidence for compromise to the cervical spinal cord.8.MR venogram of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Recent motor vehicle accident. Neck stiffness and decreased range of motion. Also, low back pain and stiffness with history of spondylolisthesis. The examination is mildly limited by patient's body habitus.CERVICAL SPINE:Included brain is notable for a partially empty sella which might be an incidental finding unless there are other manifestations of elevated intracranial pressure.Sagittal alignment is notable for straightening, which may reflect patient positioning. The vertebral bodies are preserved in height. Marrow signal is benign. There is disc desiccation at all levels. The spinal canal is preserved other than shallow ventral indentations by discs as described below. There is no epidural hematoma. The spinal cord shows normal shape and signal. STIR imaging shows no increased signal in the adjacent soft tissues.C2-C3: There is no spinal canal or neural foraminal stenosis.C3-C4: Shallow central ventral indentation of the thecal sac by small disc-osteophyte complex but no significant stenosis. There is mild right neural foraminal narrowing by uncovertebral arthropathy.C4-C5: There is shallow ventral indentation of the thecal sac by small disc-osteophyte complex but no significant stenosis. There is uncovertebral and facet arthropathy but no significant foraminal stenosis.C5-C6: Similarly, there is shallow ventral indentation of the thecal sac by disc-osteophyte complex but no significant spinal canal stenosis. There is mild right neural foraminal stenosis related to uncovertebral and facet arthropathy.C6-C7 and C7-T1: There is no significant spinal canal or neural foraminal stenoses.Included on sagittal imaging only are T1-T2, T2-T3 and T3-T4 levels, which show no significant spinal canal or foraminal stenoses.LUMBAR SPINE:There is transitional anatomy with 5 lumbar type vertebral bodies as well as a sixth lumbarized segment labeled S1 for the purposes of this study. Sagittal alignment is notable for an 8 mm/grade 2 anterolisthesis of L5 relative to S1 with bilateral L5 pars defects. There is increased fatty signal in the marrow along the endplates and along pars interarticularis defects. This is associated with severe disc height loss. The vertebral bodies are preserved in height. In addition to the severe fatty endplate reactive changes at L5-S1 levels, there is degenerative mild-to-moderate height loss at L1-L2 associated with type II/fatty degenerative marrow changes subjacent to the endplates anteriorly. The spinal canal is preserved at the other levels. The conus medullaris tip lies at L1-L2 level. The conus medullaris shows normal signal and shape.T11-T12 is included only on sagittal imaging without significant spinal canal or neural foraminal stenosis.T12-L1: There is no significant spinal canal or neural foraminal stenosis.L1-L2: Degenerative disc and osteophyte flattens the anterior aspect of the thecal sac but causes no significant spinal canal stenosis. Also there is mild facet arthropathy but no significant neural foraminal stenosis.L2-L3, L3-L4 and L4-L5 mild facet arthropathy but no significant spinal canal or neural foraminal stenosis.L5-S1: The spondylolytic anterolisthesis and associated advanced disc/endplates and facet degenerative changes result in effacement of the right lateral recess but no significant central spinal canal stenosis. There is also severe right and moderate left neural foramen stenoses.

Output: 1.There is no MR evidence of traumatic injury in the cervical spine.2.Cervical spine demonstrates minimal degenerative changes without significant spinal canal stenosis and only mild right foraminal stenoses as described above. 3.Lumbar spine: Please note variant anatomy with a lumbarized transitional segment labeled S1 for the purposes of this study. As numbered there is grade 2 spondylolytic anterolisthesis of L5 relative to the lumbarized S1 associated with severe right and moderate left neural foraminal stenoses. There is also effacement of the right lateral recess at this level without significant central canal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Stroke. Nonenhanced CT of brain:The examination demonstrates fairly extensive supratentorial periventricular and subcortical low-attenuation with no associated mass effect. There is also suspected low-attenuation of corpus callosum. Although the above findings are nonspecific they could represent very advanced to small vessel disease of indeterminate age. Findings remain identical to prior study from 6 -- 2 -- 2010. Follow-up with an MRI examination is recommended to exclude other possibilities. Multiple prior studies and including patient MRI examination from 2009 demonstrated similar findings.An old right posterior temporal -- parietal cortical stroke is again identified and no change.Images through posterior fossa demonstrate suspected low-attenuation in the pons consistent with old lacunar strokes.There is no evidence of hemorrhage or acute cortical stroke. The ventricular system remains within normal range of size.

Output: 1.Stable exam since prior study.2.Extensive White matter findings likely secondary to advanced to small vessel disease of indeterminate age.3.Old right posterior parietal -- temporal cortical stroke. Local nor strokes of pons.


Instruction: Generate impression based on findings.

Input: Male; 68 years old. Reason: 67 yo male with hx of pancreas cyst; please do MRCP to evaluate for abnormalities History: pancreas cyst ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in inferior aspect of uncinate process abutting third portion of duodenum is not significantly changed, measuring 2.3 x 2 .2 cm, previously 2.5 x 2.5 cm (series 6, image 35). No enhancing or nodular component. No clear connection with the pancreatic duct is evident.The largest of these is located in uncinate process and measures 1.3 x 1 .1 cm, previously 1.1 x 1.1 cm (image 40; series 8). There is an additional fluid signal intensity lesion in the body of the pancreas, which measures 11 x 8 mm, which appears unchanged when compared to the most recent MRI examination dated 1/14/2014, however, when compared to a earlier MRI dated 7/30/2010, this appears slightly increased in size, previously measuring approximately 4 x 5 mm. Additional smaller cystic lesions are also not significantly changed. No pancreatic ductal dilation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Status post median sternotomy.

Output: 1. No significant interval change in size of the reference cystic lesions within the uncinate process abutting the duodenum, which may represent a side branch IPMNs.2. No significant interval change in size of the additional smaller cystic lesions throughout the pancreas, when compared to the most recent study dated 1/14/14. However, a cystic lesion in the body of the pancreas appears slightly increased in size when compared to a more remote study dated 7/30/2010, with measurements provided above.3. Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: 42-year-old male with colon cancer with metastases to the liver ABDOMEN:LIVER, BILIARY TRACT: There is a large hypoenhancing lesion in the left lobe of liver measuring 6.2 x 6.1 cm (series 11, image 170). Segment six lesion measuring 4.5 x 3.2 cm (series 11, image 117). Additional smaller lesions are also present in hepatic segment 7/8 and segment 6.Common bile duct is normal in caliber. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent gastrohepatic ligament lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Metastatic disease to the L4 vertebral bodyOTHER: No significant abnormality noted.

Output: 1.Masses in the liver compatible with metastatic disease.2.Osseous metastasis the L4 vertebral body.3.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 23 year old woman with shortness of breath when lying on right side and possible shunt noted on echo. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 65 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 76 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. The pattern spares the endocardium and is not consistent with prior myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as prior myocarditis. No ventricular septal defect is noted.Left AtriumThe left atrium is normal in size. No atrial septal defect are noted. The inter-atrial septum is deviated to the right, suggesting increased left atrial pressures. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 161 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). There is extrinsic compression of the right ventricular outflow tract by the below described anteriorly-located esophagus. There is no obvious evidence of flow acceleration in the RVOT to suggest that the compression is hemodynamically significant; however, correlation with Doppler echo is suggested. 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. There is a modest amount of mitral valve billowing. 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 (30 mm).Venous AnatomyThe right-SVC and IVC are normal in size and drain normally into the right atrium. A large hepatic vein travels anteriorly over the dome of the liver into the IVC , rather than through the hepatic hilum. There is a persistent left SVC which drains into the coronary sinus. ShuntNo atrial septal defect, ventricular septal defect, or anomalous pulmonary venous drainage is noted. There is a persistent left superior vena cava which drains into the coronary sinus, which is a normal variant. No large pulmonary AVMs are noted. The Qp/Qs is 1.05PericardiumThere is a small pericardial effusion.Extracardiac FindingsThe esophagus travels in between the heart and the sternum. It is significantly dilated and has an air-fluid level. Additionally, it appears to be extrinsically compressing on the right ventricular anterior free wall, this is related to patient's history of esophageal surgery. Trace bilateral pleural effusions are needed. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function (LVEF 54%). There is a non-myocardial infarction pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls. The pattern suggests an underlying fibrosis, inflammatory, or infiltrative process such as prior myocarditis. 2. The right ventricle is normal in size with normal systolic function (RVEF 58%). There is extrinsic compression of the right ventricular outflow tract by the anteriorly-located esophagus. There is no obvious evidence of flow acceleration in the RVOT to suggest that the compression is hemodynamically significant; however, correlation with Doppler echo is suggested. 3. There is a persistent left superior vena cava which drains into the coronary sinus (normal variant). A large hepatic vein travels anteriorly over the dome of the liver into the IVC , rather than through the hepatic hilum. 4. There is no significant shunt as suggested by Qp/Qs of 1.05. 5. Mildly dilated pulmonary artery. 6. Moderate tricuspid regurgitation.


Instruction: Generate impression based on findings.

Input: 59 year-old man with newly diagnosed heart failure, LVEF severely reduced on echocardiogram and normal coronaries is sent for MRI to evaluate for possible myocarditis. Left VentricleThe left ventricle is moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 132 ml/m2 (normal range: 74+/-15), the LVEDV is 323 ml (normal range 142+/-34), the LV end systolic volume index is 115 ml/m2 (normal range 25+/-9), the LVESV is 282 ml (normal range 47+/-19), the LV mass index is 100 g/m2 (normal range 85+/-15), and the LV mass is 246 g (normal range 164+/-36). There is global hypokinesis. Hyperenhancement noted on T2 stir imaging in the basal inferior, inferolateral and lateral walls suggestive of acute myocardial inflammation. This could be consistent with active myocarditis. There is no hyperenhancement noted in the septum in the region where an RV biopsy would be performed. There is also hyperenhancement of the pericardial space and possibly pericardium in this area. Loculated small collection of pericardial fluid noted also in the same area. There is patchy basal inferior, infero-lateral and mid-lateral late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is not consistent with myocardial infarction and could be consistent with myocarditis . Native myocardial T1 time 1090 msec.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 109 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumLoculated, basal pericardial effusion. Hyperenhancement on T2 stir of the basal pericardial sac suggestive of pericarditisExtracardiac FindingsInterstitial changes noted in the lungs. Minimal bilateral pleural effusions. 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 moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%. There is global hypokinesis.2. Hyperenhancement noted on T2 stir imaging in the basal inferior, inferolateral and lateral walls suggestive of acute myocardial inflammation. This could be consistent with active myocarditis. There is patchy basal inferior, infero-lateral and mid-lateral late gadolinium enhancement suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is not consistent with myocardial infarction and could be consistent with myocarditis.3. No hyperenhancement noted in the septum in the region where an RV biopsy would be performed.4. The right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 37%5. Biatrial enlargement6. Loculated pericardial effusion noted at the base of the LV. Hyperenhancement on T2 stir imaged suggestive of pericarditis.7. See extra-cardiac findings. 8. The constellation of findings in this study are highly suggestive of myo-pericarditis.


Instruction: Generate impression based on findings.

Input: 49-year-old male with right shoulder pain, evaluate for labral tear ROTATOR CUFF: There is thickening of the supraspinatus tendon with intermediate signal intensity compatible with tendinopathy. There is no evidence of tear and the supraspinatus muscle is intact. The infraspinatus, teres minor, subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is no evidence of labral tear. The glenohumeral joint is unremarkable.BICEPS TENDON: The biceps tendon appears normal throughout its course.ADDITIONAL

Output: 1. Findings compatible with tendinopathy of the supraspinatus tendon with no evidence of tear.2. No evidence of labral tear as clinically questioned.


Instruction: Generate impression based on findings.

Input: 28 year old with BRCA 1 mutation. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is a new non mass enhancement in the left breast at middle 10:00 position, measuring 15 x 10 x 11 mm (AP x LR x CC). In addition, a smaller non-mass enhancement is present at middle 12:00 position in the left breast, measuring 8 x 4 x 9 mm.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: New suspicious non mass enhancement in the left breast. Diagnostic mammogram and ultrasound study is recommended. If no correlation is detected on mammogram or ultrasound, MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: A 55 year old male with cardiac amyloid diagnosed by PYP scan which confirmed a wild type TTR amyloid. Echocardiography showed normal left ventricular ejection fraction with reduced strain, left ventricular hypertrophy. Referred to cardiac MR for further evaluation Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 193 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 88 g/m2 (normal range 85+/-15), and the LV mass is 176 g (normal range 164+/-36). There is diffusely concentric hypertrophy up to 15mm. Based on myocardial tagging, there is mild hypokinesis at the base. There is a large amount of late gadolinium enhancement which is also worse at the base than the apex. It is present circumferentially along the endocardium throughout most of the heart and in some areas it is nearly transmural. The LV cavity and myocardium null at nearly the same time suggesting the presence of abnormal "gadolinium kinetics". The native myocardial T1 time is severely elevated in some regions (range 1075ms to 1265ms). These findings are diagnostic for cardiac amyloidosis. No evidence of iron overload. No intracavitary thrombus was noted.Left AtriumThe left atrium is severely dilated (166ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 180 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 57%. There is moderate concentric hypertrophy.2. There is extensive late gadolinium enhancement, abnormal gadolinium kinetics, and severely elevated native myocardial T1 relaxation times. All of these are strongly suggestive of the diagnosis of cardiac amyloidosis. 3. The right ventricle is normal in size and systolic function, the RVEF is 60%. 4. There is moderate biatrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 31 years old Reason: Characterization of retroperitoneal mass History: None associated ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Subcentimeter T2 hyperintense focus in the left lateral segment of the liver shows no central enhancement and may represent a small cyst.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology and signal. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are normal in morphology. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is a T2 hyperintense retroperitoneal mass centered in the aortocaval region but primarily over the IVC. It measures 5.3 x 4.2 cm (image 47/series 5). There is brisk enhancement with areas of central necrosis.Along its anterior aspect it abuts the ileum and portion of transverse colon. Along its posterior aspect, it abuts the IVC and aorta. The right ureter passes along its right posterior lateral margin. Along its medial aspect it abuts the superior mesenteric vein.Along its lateral aspect it abuts the small bowel. There are small left para-aortic lymph nodes.Its superior margin terminates inferior to the uncinate process of the pancreas.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: Mild body wall anasarca.OTHER: Right adnexal cyst. Small cervical nabothian cysts.

Output: 1.Findings of the retroperitoneal mass anterior to the IVC. Differential considerations include extra adrenal pheochromocytoma, paraganglioma, spindle cell neoplasm and tumor of nerve cell origin. Dimensions of the mass and regional extension as detailed above.2.No definite evidence of metastatic disease in the upper abdomen.


Instruction: Generate impression based on findings.

Input: Reason: Eval of OM of pelvis (ischial tuberosity) compared to CT. Establish baseline OM for comparison post abx History: Stage 3 decub ulcer with tracking to the bone. Pt is paraplegic and can't feel the area. There is a 2.2 x 4.6 cm peripherally enhancing fluid collection in the left ischioanal fossa/left posteromedial thigh with a sinus tract extending deep to the ischium, correlating with the abscess described on recent CT. There is extensive inflammation/edema of the adjacent soft tissues. There is a focal area of T1 hypointense, T2 hyperintense marrow signal that also demonstrates enhancement within the posterior aspect of the ischium. There is sclerosis of the left ischium representing chronic changes.An additional T2 hyperintense focus in the left inferior pubic ramus and is related to stress reaction rather than osteomyelitis. There are prominent inguinal lymph nodes bilaterally.

Output: 1. Small enhancing focus in the left ischium (adjacent to the tract ) is consistent with acute on chronic osteomyelitis.2. Stress reaction of the left inferior pubic ramus.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:T2/flair signal abnormalities in the right posterior parietal and right cerebellar hemisphere. The cerebral and cerebellar hemispheres and the brain stem are normal morphologically. No restricted diffusion is seen to suggest acute infarction.Intracranial vascular flow voids are normal caliber.The ventricles are normal volume and the midline is maintained. No abnormal extra axial fluid collections, mass, acute infarction or intracranial hemorrhage.MRA Head and Neck : Right dominant vertebral artery, a normal variant. The vertebral, left and right carotid basilar, ACA, MCA, PCA, posterior and anterior communicating arteries demonstrate no evidence of stenosis, obstruction or dissection. Head CT: Encephalomalacia in the right posterior parietal and right cerebellar hemisphere likely corresponds to regions of prior stroke. The cerebral and cerebellar hemispheres and the brain stem are normal morphologically.The ventricles are normal volume.No abnormal extra axial fluid collections, mass, acute infarction or intracranial hemorrhage.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CTA: Right dominant vertebral artery, a normal variant. The vertebral, left and right carotid basilar, ACA, MCA, PCA, posterior and anterior communicating arteries demonstrate no evidence of stenosis, obstruction or dissection.

Output: Old strokes in the right posterior parietal and right cerebellar hemisphere.No acute intracranial pathology.Unremarkable CTA and MRA of the head and neck.


Instruction: Generate impression based on findings.

Input: Cuff tear Examination is limited by the patient's body habitus which limits usage of optimal coil. ROTATOR CUFF: There is suspected full-thickness tearing of the distal anterior fibers of the supraspinatus tendon however there is no significant retraction. There is also somewhat irregular appearance of the distal fibers of the subscapularis tendon which may reflect partial tearing. SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is no evidence of full-thickness detachment. Subchondral cystic changes are noted at the greater tuberosity.BICEPS TENDON: The intra-articular portion of the biceps is poorly seen which may be partially technical in nature or related to intrasubstance degeneration. ADDITIONAL

Output: 1. Limited examination secondary to the patient's body habitus.2. Suspected full-thickness tear of the distal anterior fibers of the supraspinatus tendon without significant retraction or muscle atrophy. Irregularity of the distal subscapularis tendon may could also reflect partial tearing.3. Poor visualization of the intra-articular long head of the biceps tendon which may be in part technical in nature or related to intrasubstance degeneration/partial tearing.


Instruction: Generate impression based on findings.

Input: Female, 10 years old. Previous cerebellar abnormality on imaging, compare with previous evaluate for change. Seizures, new onset HA There is no evidence of intracranial hemorrhage, mass, or acute infarct. Mild asymmetric prominence of the right cerebellopontine angle cistern of CSF signal intensity with mild flattening of the right cerebellum is not significantly changed from prior. There is no diffusion restriction. Otherwise, the ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or herniation. There is no abnormal parenchymal or meningeal enhancement. The major cerebral flow voids are intact. There is enhancement and near complete opacification of the right sphenoid sinus and right ethmoid air cells, as well as moderate right maxillary sinus mucosal thickening. Adenoid hypertrophy is noted.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Unchanged mild asymmetric prominence of the right cerebellopontine angle cistern likely relates to a small arachnoid cyst.3.Prominent paranasal sinus thickening/opacification involving the right maxillary sinus, ethmoid air cells, and sphenoid sinus. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: History of ataxia and vertigo, for the last 4 days. Assess for stroke. BRAIN MRI:There is no acute infarct. There is a tiny focus of susceptibility effect in the left frontal centrum semiovale which may represent hemosiderin staining or calcification. There is no associated edema or perceptible abnormality on the STIR sequences. There is no intracranial hemorrhage otherwise.Confluent periventricular and punctate deep and subcortical white-matter T2 FLAIR hyperintensities are present in both cerebral hemispheres. These are nonspecific but most likely reflect mild chronic microvascular ischemia. Focal CSF intensities in the left putamen and the medial aspect of the temporal lobes probably represent perivascular spaces and/or small cysts, which may be a normal variant. There is no space-occupying brain lesion. There is no midline shift or brain herniation. The ventricles and the other CSF-containing spaces are mildly expanded, reflecting mild global brain volume loss. The flow voids of the major intracranial vessels are preserved, reflecting gross patency.Minimal nonspecific opacification of the mastoid air cells. There is a small retention cyst in the right maxillary sinus. In addition, there is mild mucosal thickening in the right maxillary sinus and bilaterally in the frontal and the anterior ethmoid sinuses. These findings are also nonspecific. Orbits are notable for changes of previous bilateral cataract surgery. There is no destructive skull lesion.CRANIAL MRA:There is no flow-limiting stenosis of the major intracranial arteries. Minimal contour irregularity within the intracranial vasculature may represent mild atherosclerotic disease and/or related to technique. There is no definite aneurysm. NECK MRA:Aortic branching pattern is conventional. There is no significant stenosis of the common and cervical internal carotid arteries. There is mild irregularity of the vessel outline at the carotid bulbs, left more than right, which probably reflects atherosclerosis without significant stenosis. The vertebral arteries are also conventional in anatomy and preserved in caliber.

Output: 1.There is no acute infarct, intracranial mass, or mass effect. 2.Mild chronic small vessel ischemic changes in the brain. There is a tiny focus of susceptibility in the left frontal lobe compatible with a chronic microhemorrhage and nonspecific. 3.There is no significant stenosis in the intracranial circulation or the extracranial circulation in the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with hx of left lid ptosis, developed solitary fibrous tumor of the superior maxillary sinus with invasion into the orbit. S/p subtotal resection.Signs and Symptoms: left eye ptosis and and diplopia. MRI orbits:There is a mass which is centered along the inferior aspect of the left orbit which extends to involve the superior aspect of the maxillary sinus and inferior aspect of the left orbit. It previously measured 43 x 40 the millimeters coronal dimensions and now measures 35 x 32 mm coronal dimensions. It previously involved the majority of the left maxillary sinus. It is now smaller. The patient is status post left-sided paranasal sinus surgery. Some mucosal thickening is present in the left maxillary sinus. The mass is visually contiguous with the optic nerve sheath complex and abuts the left eye. There is anterior displacement of the left eye. The distance between the atraumatic line and the lens of the left eye is approximately 22 mm. The optic nerve is displaced superiorly; the inferior rectus muscle and inferior oblique muscle are displaced superiorly. The mass abuts the left medial rectus muscleA small left parotid well-circumscribed lesion measuring 5 mm in diameter is bright on T2-weighted imaging it is unchanged compared to the prior exam.There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1.There is a large mass centered along the floor of the left orbit which involves left maxillary sinus and of the left orbit with intraconal extension which is smaller in size on the current exam when compared to the previous exam. It displaces the left eye, left optic nerve and left inferior rectus and inferior oblique muscles.2.Findings raise the question of proptosis related to the patient's above described mass.


Instruction: Generate impression based on findings.

Input: Reason: AA. History: AA. There is redemonstration of postoperative changes of previous left frontal craniotomy for tumor resection, with slight increased posterior extent of T2/FLAIR hyperintensity along the posterior aspect of the left superior frontal gyrus abutting lateral margin of the anterior body the left lateral ventricle. There is progressive ex vacuo dilatation of the left lateral ventricle. Areas of extra-axial enhancement along the surgical bed again are unchanged. Previously seen nodular enhancement along the anterolateral aspect of the resection cavity has further decreased in prominence, essentially imperceptible on the current exam. However, there is an area of ill-defined subtle nodular enhancement which is again seen along the anterior aspect of the resection cavity on 1300/138. This is not significantly changed allowing for differences in technique.The ventricles and sulci are stable. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Interval further evolution of postoperative from previous left frontal lobe mass resection. No definite evidence of tumor recurrence or progression.2. Mild further interval increase in T2/FLAIR hyperintensity along the left superior frontal gyrus white matter extending to the left frontal horn may represent post-treatment changes given recent irradiation.3. Previously described nodular enhancement along the anterolateral aspect of the resection cavity is essentially resolved, with a small adjacent area of ill-defined nodular enhancement more anteriorly appearing similar to prior exams. Continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Past medical history significant for recurrent meningioma status post resection on 4/2/15, hypertension, fibroids, PUD, CAD, and obstructive lung disease who presents with recurrent falls. Left-sided weakness with right-sided visual field deficit. Brain: There are postoperative findings related to recent biparietal craniotomy with scattered pneumocephalus and dural thickening and enhancement. There are mild foci of susceptibility effect in the brain parenchyma surrounding the surgical cavity, which may represent blood products. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter of the bilateral posterior frontal, parietal and occipital lobes, which may represent vasogenic edema, as well as unchanged left parieto-occipital encephalomalacia. There is no convincing evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a partially empty sella. There is persistent right tympanomastoid fluid. MRV: There is lack of signal in the posterior superior sagittal sinus. The other dural venous sinuses are grossly intact.

Output: 1. Postoperative findings related to recent partial resection of the posterior falcine meningioma with persistent areas of enhancement diffuse along the surgical margins, which may be treatment-related, although residual tumor cannot be excluded.2. A portion of the posterior superior sagittal sinus has been resected and small amounts of residual tumor may infiltrate the margins of the dural sinus.3. Interval resolution of ischemic changes along the surgical margins without convincing evidence of acute infarction. 4. Persistent bilateral parieto-occipital lobe signal abnormality may represent edema.5. Persistent right tympanomastoid fluid may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: 85 years Male (DOB:4/4/1931)Reason: r/o stroke History: right sided weaknessPROVIDER/ATTENDING NAME: DAVID G BEISER DAVID G BEISER MRI of the brainThere is diffusion restriction present along the left parietal lobe involving left postcentral gyrus and some the adjacent left superior parietal lobule extending down to the level of the insula and a small portion of the left temporal lobe.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility weighted imaging there are are several periventricular punctate foci of signal loss present which are nonspecific and in isolation of unknown clinical significance.. Additionally within the left sylvian fissure at the left M1 M2 junction there is a focus of blooming artifact. This corresponds to blood supply to the patient's area of diffusion restriction. Additionally there is intravascular signal hyperintensity on FLAIR imaging on a branch of the left middle cerebral artery.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left A1 segment is larger than the right A1 segment. In general the time of flight signal is diminished. There appear to be fewer vessels in the left sylvian fissure compared to the right sylvian fissure and the left M1 segment appears slightly smaller than the right M1 segment. The left angular artery is identified but is diminutive relative to the contralateral side. Additionally the left posterior parietal artery is not readily identified.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the right posterior cerebral artery. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is an 70% stenosis at the origin of the left vertebral artery. The left vertebral artery is smaller than the right vertebral artery.

Output: 1.Findings are compatible with acute ischemic cerebral infarction involving the left parietal lobe including the left postcentral gyrus, some of the adjacent left superior parietal lobule, some of the left posterior insular cortex and small portion of the left temporal lobe.2.Findings are suspicious for occlusion of at least one branch of the left middle cerebral artery most likely the M2 and M3 junction. If this is isolated to the left posterior parietal artery is suspected within the infarct would appear to be near-complete.3.70% stenosis at the origin of the left vertebral artery.4.Findings were discussed with the neurointensive care unit fellow at the time of the exam. Discussion also centered around intervention. It decided based on the fact of the patient's NIH stroke scale score improved from 19 to 11 and the fact that it appeared that the much of the left middle cerebral artery territory was patent that intervention was not warranted.


Instruction: Generate impression based on findings.

Input: Neck pain with paresthesia. There is a posterior disc-osteophyte complex that is eccentric to the right and mild disc space narrowing at C5-6 with associated moderate right neural foramen stenosis and minimal right spinal canal narrowing. Otherwise, there is no significant spinal canal or neural foramen stenosis at other levels of the cervical spine. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: A posterior disc-osteophyte complex at C5-6 is associated with moderate right neural foramen stenosis and minimal right spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: Right lower extremity hyperreflexia and acute weakness. Evaluate for stenosis (cord or nerve impingement). Alignment of the cervical spine is anatomic. Bone marrow signal is benign with T1 hyperintense foci such as at the T2 vertebral body compatible with hemangioma or focal fat. No suspicious osseous lesions are seen.The spinal canal shows mild to moderate narrowing at the C3-C4 and C5-C6 levels as described below. Examination is motion degraded however no definite cord signal abnormality is appreciated.Multilevel degenerative changes, as described below:C2-C3: Small central/right paracentral disc-osteophyte complex indents the anterior aspect of the thecal sac and touches the spinal cord. The neural foramina are open.C3-C4: Left more than right facet and uncovertebral proliferative change results in mild bilateral foraminal narrowing. There is also ligamenta flava thickening contributing to mild to moderate spinal canal narrowing. Prominent left-sided facet arthropathy.C4-C5: Disc-osteophyte complex and uncovertebral hypertrophy causes mild canal narrowing and mild to moderate left foraminal stenosis. Left-sided facet arthropathy is evident.C5-C6: There is a disc extrusion that mild to moderately narrows the spinal canal. There is left more than right uncovertebral proliferative change which contribute to narrowing of the left neural foramen.C6-C7 and C7-T1: There is no significant spinal canal or foraminal narrowing.

Output: Multilevel cervical spondylosis associated with mild to moderate spinal canal stenosis at C3-C4 and C5-C6. Examination is motion degraded however demonstrates no convincing cord signal abnormality. Foraminal narrowing is also suboptimally evaluated due to motion but is evident at multiple levels as detailed above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Recent laser ablation of the corpus callosum. There has been interval laser ablation of the corpus callosum via right transparietal and transfrontal approaches. There is expected peripheral restricted diffusion associated with the ablation zones, but no evidence of acute territorial infarction. There is no evidence of gross intracranial hemorrhage. There is no midline shift.

Output: Expected findings related to interval laser ablation of the corpus callosum.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for spinal anomalies, Chiari, syrinx, tethered cord. Signs and symptoms: Scoliosis. Nonenhanced total spine MRI:Evaluation of the cervical spine demonstrate no evidence of Chiari malformation or cervical syrinx.There is normal anatomical development of vertebral column.There is a central broad-based bulging disk and C5 -- C6 which results in effacement of the ventral subarachnoid space, flattening deformity and posterior displacement of the cord and central spinal stenosis. CSF flow study at the level of foramen magnum demonstrate normal biphasic flow through the foramen magnum both anterior and posterior to the cord. Biphasic flow is also noted through the fourth ventricle and the aqueduct.Evaluation of thoracic spine demonstrate a metal demarcated centrally located fluid signal intensity extending from T11 inferiorly to T12 -- L1 disk level. It measures maximum of approximately 1.9 mm caliber. The finding could represent a prominent central canal or a tiny syrinx. The finding does not extend into the conus which terminates at the L1 -- L2 disk level.There is no convincing evidence of segmentation anomaly. No evidence of central spinal stenosis or any significant neural foraminal compromise. Mild asymmetric hypertrophy changes of posterior elements secondary to sclerosis is present.Evaluation of the lumbosacral spine demonstrate no evidence of segmentation anomaly.There is normal signal intensity of cauda equina and in particular no evidence of fatty filum detected.There is distinct anterior movement of the lower thoracic cord, conus and proximal cauda equina on prone sagittal T2-weighted images when compared with supine series.

Output: 1.Examination demonstrates no evidence of Chiari malformation or tethered cord as is questioned clinically.2.Tiny focus of T2 hyperintensity in the center of the cord extending from T11 to T12 -- L1 level without extension to the conus. Finding could represent a prominent central canal or a tiny syrinx. There is normal termination of the cord and L1 -- L2 disk level.3.There is anterior movement of the lower cord, conus and proximal cauda equina on sagittal prone series compared to supine.4.There is normal signal intensity of cauda equina.5.There is no detectable segmentation anomaly of the vertebral column, no spinal stenosis or neural foraminal compromise


Instruction: Generate impression based on findings.

Input: Reason: Please evaluate for temporal or mesial temporal seizure focus in patient with complex partial epilepsy and bilateral temporal discharges History: Complex partial seizures with head turn to right, stiffening, secondary generalization; language and social delays; active L>R temporal/occipital discharges Brain parenchyma appears within normal limits. No evidence of intracranial mass or mass effect. No findings to suggest cortical dysplasia, gray matter heterotopia, or other findings to suggest seizure focus. No diffusion abnormality or evidence of hemorrhage. Ventricles are normal in size. The hippocampi are symmetric bilaterally without atrophy, signal abnormality, or loss of internal architecture. The midline structures and posterior fossa structures appear within normal limits. The major cerebral flow voids are intact. Moderate mucosal thickening of the sphenoid and left maxillary sinus. Mild mucosal thickening of the left frontal, ethmoid and right maxillary sinus. Bone marrow signal and extracranial soft tissue structures are otherwise unremarkable.

Output: No structural abnormalities to suggest possible seizure focus are appreciated. No findings to suggest mesial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: Acute disseminated encephalitis and encephalomyelitis, with worsening headache. There are postsurgical findings related to right frontal approach stereotactic biopsy of the pontine enhancing lesions. There is significant interval improvement in the foci of enhancement within the pons. There are no new enhancing foci are significant abnormality. There are unchanged mild scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval improvement of the pontine lesions, status post biopsy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Decreased range of motion, check for cuff injury Mild osteoarthritic changes, largely involving the glenohumeral articulation. Mild sclerosis and small osteophytes. The overall shape of the humeral head appears grossly intact, however mild rotation of the shoulder on the AP projection creates a mild distortion. Specifically no superimposed acute abnormality observed. Acromiohumeral distance is within normal range, allowing moderate sensitivity for chronic rotator cuff injury, however in less acute or subacute injury. MRI can be considered if suspicion remains high and further characterization is needed.Incomplete visualization of marked scoliosis and distortion of the upper thoracic spine, consider dedicated imaging, yet grossly unchanged from 2014 imaging.

Output: Mild shoulder osteoarthritis with more pronounced degenerative and alignment changes involving the lower cervical and upper thoracic spine, incompletely visualized.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified kidney, except renal pelvis [C64.9], Reason for Study: ^Reason: Metastatic renal cancer, increasing dizziness, r/o brain mets History: dizziness There is replacement of fatty marrow of clivus with T1 low signal intensity lesion which shows mild enhancement on Gad. Similar lesions are seen on calvarium especially frontal bone. Considering multiple vertebral metastasis, these lesions could represent metastatic lesions. Thus, additional imaging study such as bone scan can be considered for further imaging evaluation.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Bilateral maxillary sinus retention cysts.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement indicating brain parenchymal metastasis.3. Heterogenous bone marrow signal intensity involving clivus and skull as described above indicating possible metastatic lesions. Further imaging evaluation such as bone scan can be considered.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: MNG, right lobe nodule biopsied and showed PTC. Please ultrasound lateral neck for lymph nodes. History: MNG, right lobe nodule biopsied and showed PTC. Please ultrasound lateral neck for lymph nodes. RIGHT LOBE MEASUREMENTS: 1.3 x 2.5 x 5 cmLEFT LOBE MEASUREMENTS: 6 x 3.4 x 6.4 cmISTHMUS MEASUREMENTS: 9 mmRIGHT LOBE: There are multiple solid nodules in the right thyroid lobe largest measuring 1.6 x 1.9 x 2.3 cm near the isthmus. There is a 1.2 by 1.7 centimeter, round, homogeneous hypoechoic lesion posterior to the inferior right thyroid lobe which may represent an exophytic nodule versus a parathyroid adenoma.LEFT LOBE: A large solid nodule measuring 5.7 x 6.2 cm replaces the left lobe of the thyroid.ISTHMUS: Bilateral nodules in both isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral solid thyroid nodules. There is an exophytic nodule posterior inferior to the right lobe of the liver which may represent a thyroid nodule versus a parathyroid mass.


Instruction: Generate impression based on findings.

Input: 66-year-old female with left breast cancer status post lumpectomy, chemotherapy, decreased ejection fraction, chest pain and fatigue.MEDICATIONS: anastrozole, cranberry extract, docusate, omeprazole. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LVEDV is 124 ml (normal range 142+/-34), the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVESV is 62 ml (normal range 47+/-19), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LV mass is 56 g, the LV mass index is 35 g/m2. There are no regional wall motion abnormalities present. The native myocardial T1 relaxation time is within normal limits (1025ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RVEDV is 124 ml (normal range 142+/-31), the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVESV is 57 ml (normal range 54+/-17), and the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.No perfusion defects/ "ischemia" present during hyperemia.2.No prior myocardial infarction. The entire myocardium is viable.3.Normal LV size with mildly reduced systolic function (LVEF 50%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4.Normal RV size with normal systolic function (RVEF 50%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain MRI:The lateral ventricles are prominent with irregular borders associated with white matter volume loss and a very thin corpus callosum.Assuming a 4 month old gestational age brain (correcting for 28 weeks prematurity in this 7-year-old male), there is diffuse hypomyelination.There is a punctate focus of susceptibility hypointensity at the expected location of the right terminal matrix, and questionably in the similar location on the left. Additionally, there is evidence for old hemorrhagic products layering within bilateral occipital horns.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 acute cerebral, brainstem or cerebellar infarction. 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. Complete spine MRI:Bibasilar atelectasis is presumed secondary to the patient's sedated status.There are no fractures or subluxations. The marrow signal is benign. The cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in appropriate position. The conus is normal in signal and morphology and terminates at L2. The visualized paraspinal contents are unremarkable. There are no segmentation anomalies or stenoses.

Output: 1.The lateral ventricles are prominent with irregular borders associated with white matter volume loss and a very thin corpus callosum consistent with periventricular leukomalacia.2.Diffuse hypomyelination for age.3.There is a punctate focus of old hemorrhage at the expected location of the right terminal matrix, and questionably in the similar location on the left. Additionally, there is evidence for old hemorrhagic products layering within bilateral occipital horns.4.Negative complete spine MRI.


Instruction: Generate impression based on findings.

Input: 86 year old man with LV dysfunction referred to assess for viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 18%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 265 ml (normal range 142+/-34), the LV end systolic volume index is 116 ml/m2 (normal range 25+/-9), the LVESV is 217 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 118 g (normal range 164+/-36). There left ventricular systolic dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No left ventricular thrombus is seen. No evidence of myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 211 ml (normal range 142+/-31), the RV end systolic volume index is 80 ml/m2 (normal range 31+/-9), and the RVESV is 149 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild to moderate atherosclerosis of the aortic arch.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are bilateral pleural effusions, left greater than right. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF18%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. No evidence of prior myocardial infarction. Most of the LV is likely to be viable.2. Normal RV size with severely reduced systolic function (RVEF 29%).3. Severe left atrial dilation.4. Moderate right atrial dilation.5. Mild to moderate atherosclerosis of the aortic arch.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for soft tissue infection. Check deep spaces given contusion of left thigh, subsequent encounter Overall the heterogeneous and ill-defined soft tissue mass in the areas previously described by both CT and MR appears similar to mildly enlarged, specifically the morning or chronic components have minimally increased since 9/25/2015 and mild areas of involvement since the prior MR only evaluating the lower pelvis and upper most thigh. The mass margins remain poorly defined and difficult to measure axially consistently, yet when compared to the prior CT at the level of the upper thigh and area of scattered calcifications, again the mass roughly measures 10 x 9 cm with increased extension and involvement into the left subcutaneous tissues and fat underlying the midline crease (image 21 series 19). Interval increased necrotic and cystic components are again observed inferior to the ischial tuberosity and for reference the 9 x 3 cm collection currently measures 13 x 4 cm (image 19 series 20).Similar mild enlargement of the lobulated cystic and necrotic component centered in the abductor magnus musculature, remains mildly more discrete in margin and currently measures 5.3 x 4.7 cm (image 6 series 40) with mild peripheral enhancement, previously 4.5 x 3.4 cm. The overall pattern of enhancement and signal abnormality begins supports tumor invasion as apposed to specific signs of infection such as gas. Again diffuse subcutaneous reticulation and skin thickening is observed throughout the left thigh, of uncertain significance and although tumor invasion cannot entirely be excluded, this may be possibly related to radiation therapy; please correlate. This larger fluid collection in the abductor magnus however would be readily accessible if sampling was needed clinically.

Output: Persistent redemonstration of heterogeneous ill-defined soft tissue mass throughout the left groin demonstrating mild interval minimal enlargement but largely enlarging central to chronic cystic components. See measurements provided. Overall appearance again remains compatible with known sarcoma and possible interval posttreatment changes. Specifically no discrete new findings to support concern for focal infection, however given tumor characteristics and appearance, specificity and exclusion is difficult to confirm.


Instruction: Generate impression based on findings.

Input: 16-year-old male. Elbow pain medially for a year. Evaluate for UCL tear. LIGAMENTS: We see no full-thickness rupture of the UCL; however, there is thin linear intermediate signal intensity between the distal fibers of the anterior bundle of the UCL and the underlying sublime tubercle of the coronoid process of the ulna, suggestive of mild partial thickness undersurface stripping of the ligament. The lateral collateral ligament appears intact.TENDONS: The common flexor and extensor tendons are intact. The biceps and brachialis tendons are intact. The triceps tendon is intact.ARTICULAR SURFACES AND BONE: We see no osteochondral defects and the bone marrow signal intensity is within normal limits.SURROUNDING STRUCTURES: Contrast extends down the lateral musculature of the forearm related to the arthrogram injection.ADDITIONAL

Output: Mild stripping of the undersurface fibers of the anterior bundle of the UCL from the coronoid process that suggests a partial-thickness undersurface tear.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified site of right female breast Malignant neoplasm of unspecified site of right female breastClinical question: history of breast cancer with new right arm pain and neuropathySigns and Symptoms: right arm pain and numbness and tingling The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.There is a T1 hyperintense focus present within the 12 vertebral body. A similar lesion is present at L1 but a bit smaller. It suppresses on the inversion recovery images. Most likely these represent vertebral body hemangiomasThere is a right paramedian disc extrusion present at C6-7 which is not entirely included on this exam. There is a partially visualized left-sided pleural effusion present.

Output: 1.There is no evidence for spinal metastases to the thoracic spine.2.Findings suggest a right C6-7 disc extrusion which is not entirely included on this exam and likely encroaches the right-sided exiting nerve roots at this level. Please refer to MRI of the cervical spine for further comments.3.There is a left-sided pleural effusion present which is not entirely imaged on this exam.


Instruction: Generate impression based on findings.

Input: Compression of brain. Cord edema. MRI thoracic spine:There is accumulation of a collection behind and around the cord which is high signal on T1 and T2 STIR throughout the thoracic spine but predominantly along the upper thoracic spine. This is associated with the diffuse enhancement. There is effacement of spinal fluid ventral and posterior to the spinal cord especially at the T3 vertebral body level. There is abnormal signal within the spinal cord centrally from the cervical cord down to T8 level.The thoracic vertebral bodies are appropriate in the overall alignment and height. There are bilateral pulmonary opacities with pleural effusions. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.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.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 ureters and renal pelves are dilated.

Output: 1.Suspect combination of epidural lipomatosis, epidural venous engorgement and possibly epidural fluid in the thoracic spine (predominantly upper thoracic) associated with compression of the thecal sac.2.Extensive central cord signal abnormality (C3-T8). Differential considerations include pre-syrinx and venous congestion. The distribution of the cord signal abnormality does not match the vascular distribution of a specific spinal artery. Thus cord infarct is less likely here.3.Bilateral pulmonary opacities with pleural effusions. Please correlate with chest x-ray findings.4.The ureters and renal pelves are dilated. Please correlate with renal findings for possible hydronephrosis.


Instruction: Generate impression based on findings.

Input: Multiple myeloma, right lower extremity and back pain There are multiple foci of abnormal marrow signal scattered throughout the pelvis and proximal femora consistent with history of multiple myeloma. When compared to a prior MRI of 5/24/2016, these lesions have progressed in size and number. There is now a confluent lesion involving the majority of the right sacrum measuring at least 6.2 x 4.6 x 8.1 cm in the greatest transaxial and craniocaudal dimensions. This particular lesion obliterates a portion of the S1 nerve root as well as the majority of S2.The visualized soft tissues are normal in signal intensity.

Output: Diffuse myelomatous involvement of the pelvis which is progressed from the prior exam. There is a confluent expansile lesion involving the right sacrum which obliterates portions of the S1 and S2 nerve roots.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for etiology of breakthrough seizures, history of temporal lobe epilepsy. Signs and symptoms: Breakthrough seizures. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.On coronal flair/T2 series examination demonstrate increased signal intensity on the left hippocampus with suggestion of subtle underlying parenchymal volume loss and resultant enlargement of adjacent sulci and the tip of left temporal horn consistent with mesial temporal sclerosis. There are no prior MRI exams for comparison.Examination also demonstrates subtle uniform prominence of cerebral cortical sulci for patient's stated age of 30. The ventricular system are also mildly prominent in particular on the left side for stated age. Extensive signal abnormality in bilateral frontal horns (left greater than right) is consistent with ulceration artifact and not a true pathology.Myelination of the brain remains within normal.Images through posterior fossa are unremarkable.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and mid normal pattern of enhancement. Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: 1.No acute intracranial process.2.Findings of mesial temporal sclerosis on the left as detailed.3.Mild uniform prominence of cerebral cortical sulci for patient's stated is noted. 4.Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: concern for SC abscess History: concern for SC abscess Brain MRI:Multifocal restricted diffusion lesions on bilateral frontal lobes, left frontal, parietal and temporal lobes. In addition, there are restricted diffusion lesions on bilateral mesial thalami, left basal ganglia, bilateral mesial hippocampi, bilateral midbrain, posterior aspect of pons and medulla, cerebellar vermis and bilateral mid-cerebellar peduncle. The right hemispheric subacute to early chronic ischemic infarction lesions show usual evolution including encephalomalacia with minimal mass effects toward right lateral ventricle. There are multifocal petechial signal voids within the right MCA ischemic lesion indicating hemorrhagic conversion.Mucosal thickenings on bilateral maxillary sinuses.Partial opacifications on bilateral mastoid air cells.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.C-Spine MRIThere are T2 and STIR high signal intensity spinal cord gray matter from skull base to the level of upper thoracic spinal cord. Diagnostic possibilities include acute anterior spinal artery occlusion related spinal cord infarction, extension of brain edema, or less likely demyelinating disease. Spinal cord diffusion weighted image can be attempted to clarify the possibility of spinal cord infarction.Cervical vertebral column shows kyphotic angulation at C56 with focal central protrusion of disc at the level of C45 and broad based disc bulging at the level of C56 abut thecal sac. However, there is no evidence of spinal canal stenosis or neuroforaminal stenosis.Diffuse enhancement of nasopharynx and oropharynx on Gad injection is likely related to endotracheal intubation and nasogastric tube insertion.

Output: 1. Multifocal supra and infra tentorial, hemispheric and brain stem acute ischemic infarctions as described above. 2. Cervical spinal cord gray matter lesions, differential diagnosis include acute spinal cord ischemia or extension of brain stem ischemia related edema. Cervical spinal diffusion weighted imaging can be considered for further evaluation.3. Right MCA territorial subacute or early chronic ischemic infarction with petechial hemorrhages.4. No evidence of intracranial arterial stenosis or intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: Reason: Patient with altered mental status, confusion, UE weakness, please evaluate for stroke/ ischemic changes The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Images are mildly degraded by patient motion which may obscure more subtle abnormalities.

Output: 1.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction identified.3.Images are mildly degraded by patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient has memory impairment, evaluate for brain atrophy. Signs and symptoms: Memory impairment. Nonenhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a few punctate nonspecific subcortical and periventricular low-attenuation white matter which are nonspecific. Considering patient's stated age possibility of minute chronic nonhemorrhagic small vessel ischemic strokes considered.There is mild prominence of parietal cortical sulci and unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise for patient's stated age of 77.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Findings suggestive of very minimal chronic nonhemorrhagic small vessel ischemic strokes.3.Mild prominence of parietal cortical sulci which may be at the upper limits of normal and unremarkable brain MRI otherwise for patient's stated age


Instruction: Generate impression based on findings.

Input: Left knee pain The knee appears normal without specific findings to account for the patient's pain.

Output: Normal-appearing knee without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: Pt is a 66 y/o female with h/o high risk RCC, s/p nephrectomy, evaluate for progression/recurrence History: RCC ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver cysts are unchanged. Previously described liver dome lesion is no longer visualized.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrent or residual disease in the nephrectomy bed. Multiple subcentimeter renal cysts are again seen in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of recurrent or residual disease. No measurable metastatic disease, no significant interval change. Please refer to concomitant CT chest exam from same day for additional findings.


Instruction: Generate impression based on findings.

Input: 18-year-old male with pain. History of previous ACL reconstruction. Evaluate for chondral injury. MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the medial tibiofemoral compartment appears intact. There is a focal partial thickness articular cartilage cleft/fissure within the posterior aspect of the lateral tibial plateau, beneath the posterior horn of the meniscus. The articular cartilage of the lateral tibiofemoral compartment otherwise appears intact. No full-thickness or near full-thickness articular cartilage defects are identified. There is increased bone marrow signal abnormality within the patella which may reflect postsurgical change. There is increased signal abnormality within the posterior aspect of the lateral tibial plateau which may reflect bone contusion from prior injury.LIGAMENTS: The cruciate and collateral ligaments appear intact. Note is made of postsurgical changes of prior ACL graft reconstruction. The graft appears intact. There is decreased signal abnormality along the anterior aspect of the ACL graft which appears most consistent with anterior arthrofibrosis versus synovitis.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings consistent with prior ACL graft reconstruction. The graft appears intact. Signal abnormality along the anterior aspect of the ACL graft likely represents anterior arthrofibrosis versus a synovitis.2. Focal partial thickness articular cartilage cleft/fissure along the lateral tibiofemoral compartment as described above.3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: 68 year old male with history of IPF and known coronary disease (CTO RCA, intermediate LAD disease), hypertension, AAA s/p repair and dyslipidemia presenting for evaluation of coronary disease prior to PCIMEDICATIONS: atorvastatin, amlodipine, warfarin. First Pass PerfusionDuring hyperemia, there is a perfusion defect involving the (1) basal anteroseptum, inferoseptum, inferior, and inferolateral wall and the (2) mid inferior wall. Viability/ Myocardial ScarThere is a large myocardial infarction in the RCA territory. It is nontransmural at the basal inferoseptum, inferior, and inferolateral walls. These segments have an intermediate probability of viability. The infarction is transmural in the mid inferior wall. This segment is not viable. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with normal ventricular function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19), the LV mass index is 38 g/m2, and the LV mass is 81 g. The mid to basal inferior wall is hypokinetic. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 143 ml/m2 (normal range 82+/-16), the RVEDV is 304 ml (normal range 142+/-31), the RV end systolic volume index is 107 ml/m2 (normal range 31+/-9), and the RVESV is 227 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (34 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is bilateral lung markings consistent with chronic lung disease (refer to dedicated lung imaging). Mediastinal lymph nodes 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. There is a large myocardial infarction in the territory of the right coronary artery associated with mild, peri-infarct ischemia. 2. Most of the segments affected by the infarction have an intermediate probability of viability.3. Normal LV size and systolic function (LVEF 57%) with hypokinesis of the basal to mid inferior wall.4. Moderately dilated right ventricle with severely reduced systolic function (RVEF 25%).5. Moderately dilated pulmonary artery. 6. Severe right atrial dilation.


Instruction: Generate impression based on findings.

Input: Medically refractory epilepsy treated with cortical resective surgery 2008 and status post vagal nerve stimulator surgery 2010. There are postoperative findings related to left temporal topectomy. There is confluent T2 hyperintensity along the surgical margins. There is mild compensatory midline shift to the left and mild ex vacuo dilatation of the left temporal horn. The hippocampi appear to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Postoperative findings related to left temporal topectomy with confluent T2 hyperintensity along the surgical margins, which may represent gliosis and/or encephalomalacia.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of spinal cord [192.2], Reason for Study: ^Reason: hx cervical fibrous tumor w/ Atypical features. F/u 6 months for growth History: surveillance imaging for growth Plaque like enhancing mass on the posterior aspect of the T1 vertebral body is now measured about 29mm x 11.7mm x 9.4mm which was about 22.4mm x 9.7mm x 6.9mm showing interval increase in size.Accordingly external compression toward left side of spinal cord and thecal sac has been aggravated since prior scan.At the level of T1-T2 left side neural foramen, there is low signal intensity lesion on the left ventral aspect of the spinal cord extending toward the left side neural foramen. This lesion does not show any evidence of enhancement (series 1201, image 8/48) and shows low signal intensity on both T1 and T2 weighted images indicating fibrous tissue or non enhancing portion of the tumor mass. Comparing to prior scan, this lesion does not show any significant interval change.Prior laminectomy at the level of cervicothoracic junction, vertebral body signal changes due to prior radiation and various degreed enhancement of vertebral bodies and posterior compartments on C3 and skull base show no significant interval change. Spinal cord signal intensity appears to be normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. Intervertebral discs show dessication of discs at the level of C34, C45 and C56 without showing evidence of disc herniation.

Output: 1. Interval increase in size of T1 level extradural enhancing mass with increased mass effect toward spinal cord as described above.2. No abnormal spinal cord signal intensity.


Instruction: Generate impression based on findings.

Input: MRI CARD WWO CNTRST, VIABLTY/SCAR IMAG.MORPH/FUNCT, 10/27/2016 2:48 PM Left VentricleThe left ventricle is normal in size with normal systolic function. There is no hypertrophy (lateral wall and septum 7-9mm in thickness). There is abnormal septal motion consistent with a bundle branch block. The overall LV ejection fraction is 57%. The LVEDV is 195 ml (normal range 142+/-34), the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVESV is 85 ml (normal range 47+/-19) and the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time in the lateral wall is 1124 ms and in the IV septum it is 1114 ms. These values are mildly elevated and are suggestive of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%. The RVEDV is 212 ml (normal range 142+/-31), RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVESV is 107 ml (normal range 54+/-17), and the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The native T1 myocardial relaxation time in the lateral wall is 1124 ms and in the IV septum it is 1114 ms. These values are mildly elevated and are suggestive of underlying diffuse fibrosis or infiltration. However in the absence of delayed enhancement, this is a non-specific finding.2.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%.3.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 79-year-old female with left upper quadrant and left lower quadrant pain ABDOMEN:LUNG BASES: Mild bronchiectasis and nonspecific, careful increased densities at the lung bases, not significantly changed from previous study.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Interval increase in the size of the previously described hypodense lesion in the neck of the pancreas. This lesion now measures 2.5 x 1.7 cm on image number 38, series number 3. Left of IV contrast limits optimal evaluation of this lesion. MRI is recommended for further evaluation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole punctate nonobstructing stone.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, ADNEXA: Right adnexal cystic lesion is unchanged measuring 4.2 x 4.2 cm on image number 112, series number 3. Left adnexal solid-appearing lesion measures 6.4 by 5 cm on image number 109, series number 3, slightly increased in size compared to previous CT.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Limited study lack of IV contrast. Right renal nonobstructing stone.Slight interval increase in the size of the cystic lesion in the head of the pancreas. MRI of the pancreas is recommended for further evaluation.Interval minimal increase in the size of the left adnexal solid lesion. Ultrasound may be helpful for further evaluation.


Instruction: Generate impression based on findings.

Input: 19-year-old female with left knee pain Evaluation of the proximal tibia is limited by metallic susceptibility artifact resulting from an intramedullary rod.MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Mild increased signal intensity of the articular cartilage of the lateral facet of the patella inferiorly is suspected to be of no clinical significance although could conceivably represent mild intrasubstance degeneration. No fluid-filled cartilage defects. No bone marrow lesions.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: Diffuse thickening of the patellar tendon compatible with tendinosis with mild signal intensity within the proximal fibers at the patellar attachment. No fluid signal intensity to indicate a tear is seen. Quadriceps tendon appears intact.ADDITIONAL

Output: Postoperative changes and thickening of the patellar tendon compatible with tendinosis. Otherwise, no findings to account for the patient's knee pain.


Instruction: Generate impression based on findings.

Input: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Left facet hypertrophy causes minimal left neural foraminal stenosis.C3/4: Mild posterior osteophyte disc complex and left uncinate hypertrophy causing minimal left neural foraminal stenosis.C4/5: Posterior osteophyte disc complex causes slight anterior and anterior cord without intrinsic cord signal abnormality. There is also ligamentum flavum thickening and bilateral uncinate hypertrophy. There is mild central, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and left uncinate hypertrophy. There is mild to moderate left neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis.C7/T1: Trace anterolisthesis C7 on T1, minimal disc bulge, and bilateral facet hypertrophy. There is mild to moderate bilateral neural foraminal stenosis.Facet hypertrophy is noted of the visualized upper thoracic spine which encroach the leftward neural foramina at T1/2 and T2/3.

Output: 1.C2/3: Minimal left neural foraminal stenosis.2.C3/4: Minimal left neural foraminal stenosis.3.C4/5: Mild central, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis.4.C5/6: Mild to moderate left neural foraminal stenosis.5.C6/7: Mild bilateral neural foraminal stenosis.6.C7/T1: Mild to moderate bilateral neural foraminal stenosis.7.Facet hypertrophy is noted of the visualized upper thoracic spine which encroach the leftward neural foramina at T1/2 and T2/3. If the patient has symptoms referable to the thoracic spine, dedicated thoracic MRI would be recommended if deemed clinically beneficial.