Instruction: Generate impression based on findings.

Input: 28 year old man with history of recently diagnosed biventricular dysfunction who was admitted with cardiogenic shock, referred now for cardiac MRI to evaluate for possible etiologies of his non-ischemic cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 212 ml/m2 (normal range: 74+/-15), the LVEDV is 427 ml (normal range 142+/-34), the LV end systolic volume index is 182 ml/m2 (normal range 25+/-9), the LVESV is 368 ml (normal range 47+/-19), the LV mass index is 95 g/m2 (normal range 85+/-15), and the LV mass is 191 g (normal range 164+/-36). Wall motion is globally hypokinetic. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Artefact makes detailed evaluation of LV myocardium difficult on T2* imaging; there were no gross abnormalities appreciated in T2* sequences. There is an LV thrombus at the apex. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severe systolic dysfunction. The overall RV ejection fraction is 18%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 219 ml (normal range 142+/-31), the RV end systolic volume index is 89 ml/m2 (normal range 31+/-9), and the RVESV is 180 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 moderate-severe mitral regurgitation. This appears most evident on the short-axis views, and was not corroborated well on the 4-chamber cine.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 (31mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Globular heart with severe LV dilatation.2. Severely reduced biventricular function (LVEF = 14%; RVEF = 18%)3. LV thrombus is noted at the apex4. Moderate-severe mitral regurgitation5. Small pericardial effusion 6. No late gadolinium enhancement to suggest the presence of infiltrative, inflammatory or fibrosis disease of the myocardium.


Instruction: Generate impression based on findings.

Input: Male, 24 years old, with scotoma and tingling. Assess for multiple sclerosis. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is detected.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Dedicated imaging of the orbits is somewhat motion degraded. Within this limitation, no definite abnormalities of the optic nerves are detected. The extraocular muscles demonstrate normal morphology and pattern of enhancement. The globes are round and symmetric. No masses are identified.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable examination of the brain and orbits allowing for motion degradation on many of the orbital sequences. In particular, no specific findings are seen to account for the patient's visual symptoms, and no evidence of any active demyelinating disease is detected.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: Concern for neurovegetative disease History: numbness, weakness There is no evidence of abnormal enhancement on this scan.Subtle T1 low signal intensity lesions on bilateral white matter which are corresponding to T2/FLAIR high signal intensity lesions are seen without showing any evidence of contrast enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels.

Output: No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 32 year old male with history of Ewing sarcoma off therapy. Assess for recurrence. Again seen is a well circumscribed mass within the retrovesicular space, not significantly changed in size, measuring 6.2 x 5.5 cm previously 6.1 x 5.6 cm. This mass again demonstrates heterogeneous high T1 and T2 signal with a hypointense rim likely reflecting blood products of varying ages. Following gadolinium administration, there is no enhancement. Mass effect on the adjacent rectosigmoid is also similar to prior.Amorphous curvilinear signal abnormality involving the left sacral wing and along the SI joint are similar to prior and may represent insufficiency fracture, post therapy changes or metastasis. Round focus of low signal with no enhancement in the posterior aspect of the left iliac wing may represent a treated metastasis and also appears similar to prior.No new foci of abnormal signal or enhancement.Wall thickening of the bladder and rectosigmoid may be related to radiation.

Output: 1.Unchanged pelvic mass.2.Foci of signal abnormality within the pelvic bones appear similar to prior and may represent a combination of treated metastases and post radiation changes. 3.No new foci of abnormal signal.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, with radicular pain and paresthesias. Brain:Several scattered small foci of T2 hyperintensity are seen within the bilateral frontal white matter. The largest of these is on the right and measures up to 2 mm.There is no evidence of restricted diffusion or any parenchymal edema. No pathologic parenchymal or extra-axial enhancement is detected. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection are observed. The ventricles are normal in size and morphology. The cerebellar tonsils terminate 2 to 3 mm below the plane of the foramen magnum.Bilateral maxillary sinus and ethmoid air cell mucosal thickening is seen.C-spine:Mild reversal of the normal cervical lordosis may be positional. Spinal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality or pathologic marrow enhancement is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No focal lesions or any pathologic parenchymal or leptomeningeal enhancement is seen.The intervertebral discs are within normal limits. No significant spinal canal or foraminal stenosis is seen.

Output: 1.Several very small foci of white matter signal abnormality are seen in the frontal lobes. These are associated with no evidence of edema and no pathologic enhancement. Findings are nonspecific, and in particular, they are not typical for demyelinating disease.2.Cerebellar tonsillar ectopia is seen. This finding is of uncertain significance relative to the patient's presentation.3.Unremarkable evaluation of the cervical spine with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: There is stepwise trace grade 1 retrolisthesis of C4 on C5-6 and C7. There is also minimal grade 1 anterolisthesis of C7 on T1. The cervical spine is otherwise in normal alignment, with mild reversal of the normal cervical lordosis centered at C3-C4. The vertebral body heights are well-maintained. There is multilevel disc narrowing, moderate in degree at C3-C4 through C6-C7. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. At C2-C3, there is minimal left facet arthropathy and uncovertebral hypertrophy and mild left foraminal narrowing.At C3-C4, there is uncovering of the disc with a mild posterior osteophyte disk complex. There is right-sided uncovertebral hypertrophy with overall moderate-severe right and moderate left foraminal narrowing.At C4-C5, there is uncovering of the disc with a rightward predominant posterior osteophyte disk complex. Right-sided uncovertebral hypertrophy. There is resultant mild-moderate central spinal canal stenosis and severe right as well as mild-moderate left foraminal narrowing.At C5-C6, there is uncovering the disc with a diffuse posterior osteophyte disk complex and bilateral uncovertebral hypertrophy resulting in moderate-severe bilateral foraminal narrowing and mild central spinal canal stenosis. There is also ligamentum flavum thickening.At C6-C7, there is uncovering the disc with a superimposed posterior osteophyte disk complex with bilateral uncovertebral hypertrophy. There is moderate-severe bilateral foraminal narrowing.At C7-T1, there is uncovering of the disc with mild ligamentum flavum thickening and facet arthropathy.There is trace fluid in underpneumatized right mastoid air cells. There is a probable mucus retention cyst in the posterior nasopharynx.LUMBAR SPINE

Output: 1. Moderate multilevel cervical spondylotic changes including minimal degenerative subluxations with high-grade foraminal narrowing on the right at C3-C4 and C4-C5, bilaterally at C5-C6, and on the left at C6-C7.2. Prominent dextroscoliosis of the lumbar spine. No significant interval change in previously described multilevel lumbar spondylotic changes including multilevel degenerative subluxations, except for decreased prominence of disc pathology at L1-L2. No high-grade central spinal canal stenosis at any level, although there are multiple levels of persistent high-grade foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: 78-year-old woman with history of cancer of unknown primary and multiple hepatic and splenic lesions. ABDOMEN:LIVER, BILIARY TRACT: A well-defined area of T2 hyperintensity is seen in the left lobe of the liver (series 4, image 20) represents a cyst. A hypoattenuating focus seen in segment 7 of the liver on the prior CT is not well seen on the current examination. A peripheral focus of arterial enhancement in the right lobe of the liver (series 14, image 22) is likely perfusional.The gallbladder is unremarkable.SPLEEN: Innumerable T2 hyperintense lesions are seen in the spleen, the largest of which near the splenic hilum (series 4, image 15) demonstrates progressive nodular enhancement with centripetal filling is and is most likely a hemangioma. The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A septated cystic lesion in the right mid/upper pole is seen without definite enhancement and measures 27 x 22 mm (series 4, image 22). Multiple, additional subcentimeter cysts are seen in the right kidney. The left kidney appears normal.RETROPERITONEUM, LYMPH NODES: The enhancing paracaval focus seen on the prior CT is unchanged in size and measures 10 x 7 mm (series 4, image 29).BOWEL, MESENTERY: The visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Innumerable splenic lesions, not compatible with sarcoidosis by imaging, largest focus demonstrates characteristics consistent with that of a hemangioma, smaller additional lesions more difficult to characterize due to size but may be followed up with imaging as clinically warranted.2.Bosniak 2F equivalent right renal cyst which may be followed up as clinically warranted.


Instruction: Generate impression based on findings.

Input: Diabetes, alcohol abuse, 40lbs weight loss, CT showed soft tissue infiltration around head of pancreas, evaluate for underlying neoplasm ABDOMEN:LIVER, BILIARY TRACT: No significant biliary duct dilatation. SPLEEN: No significant abnormality noted.PANCREAS: Dilatation of main pancreatic duct, measuring up to 7 mm, seen to level of ampulla, no evidence of obstructing mass. Intraductal stones/debris seen. No definite obstructing lesion seen. Marked pancreatic parenchymal atrophy with relative sparing of head. Curvilinear T2 hyperintensity at level of pancreatic head likely the cystic duct, image 14 series 501.ADRENAL GLANDS: 1 cm right adrenal nodule demonstrating signal loss on opposed phase imaging, consistent with adrenal adenoma, image 47 series 901.KIDNEYS, URETERS: Mild perinephric stranding. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Findings compatible with chronic pancreatitis with ductal dilatation, secondary to stones. No definite obstructing lesion seen.2. Right adrenal adenoma.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. There is again abnormal caudal extension of the cerebellar tonsils below the level of foramen magnum, extending 11 mm. Overall, the cerebral tonsils remain rounded in configuration without significant pointing. There is moderate associated crowding at this level. Biphasic CSF flow is again diminished dorsally at the level of the foramen magnum.The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. There is minimal disc narrowing at C4-C5 and C5-C6. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. There is trace fluid within mastoid air cells bilaterally.

Output: Abnormal caudal extension of the cerebellar tonsils 11 mm below the level of the foramen magnum, although they remain rounded in morphology, with moderate crowding of structures. Diminished CSF flow dorsally at this level. Please correlate clinically for possible Chiari I malformation.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with head and fatigue. There are several cerebral white matter lesions. A lesion in the left frontal centrum semiovale has slightly increased in size, although the associated enhancement has essential resolved. On the other hand, an anterior right frontal lobe lesion has decreased in size. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Multiple demyelinating lesions related to multiple sclerosis, including decrease in size of a right anterior frontal lobe and slight increase in size of a left frontal centrum semiovale lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Preoperative Stealth brain MRI. Signs and symptoms: Craniotomy CCM resection. Pre-and post enhanced Stealth brain MRI:Examination demonstrates a tiny focus of enhancement in the lower posterior pons consistent with a tiny cavernoma. This finding demonstrated susceptibility signal changes on prior MRI and enhancement without interval change. It measures approximately 1.9 mm in size.Examination also redemonstrated a right frontal cavernoma in the cingulate gyrus measuring approximately at 11 times 12-mm in transaxial dimensions. This lesion demonstrates no surrounding encephalomalacia or edema however hemosiderin staining is present similar to prior exam. Ventricular system are within normal size and the maintained midline. Diffuse punctate foci of T2 hyperintensity in the subcortical and periventricular white matter remains stable since prior exam.Note should be made that this exam he is performed as a surgical guidance and is not a true diagnostic study.

Output: 1.Right anterior frontal cingulate gyrus cavernoma without change since prior exam.2.Inferior posterior pontine enhancing cavernoma measuring1.9 mm without change since prior exam.3.Stable scattered subcortical and periventricular foci of flair hyperintensity since prior exam.


Instruction: Generate impression based on findings.

Input: 33-year-old female, status post transsphenoidal surgery on 4/21/16 for lymphoplasmacytic inflammatory infiltrates suggestive of lymphocytic panhypophysitis in a young, pregnant/postpartum woman, surveillance. There has been continued interval evolution of findings related to transphenoidal surgery, with persistent mild heterogeneity of the pituitary gland. The pituitary gland proper has decreased in maximal depth, now measuring 6 mm (previously 8 mm). There is no encroachment of the optic apparatus. The pituitary infundibulum is intact. The posterior pituitary bright spot is still not apparent on this scan. Left sphenoid sinus secretions have resolved. The imaged portions of the brain are unremarkable.

Output: There has been continued interval evolution of findings related to transphenoidal surgery, with persistent mild heterogeneity of the pituitary gland. The pituitary gland proper has decreased in maximal depth, now measuring 6 mm (previously 8 mm).


Instruction: Generate impression based on findings.

Input: BRAIN: There is no acute infarct, mass effect, or cerebral edema. There are few nonspecific punctate white matter T2 hyperintense foci in the bilateral frontal white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is retroflexion of the dens tip effacing the ventral CSF. The lower brain stem/upper cervical cord is somewhat draped along the dens, and there is resultant mild mass effect on the inferior cerebellar tonsils and vermis. There is mild resulting crowding of soft tissue of the foramen magnum without Chiari I malformation.PITUITARY: The pituitary gland is not enlarged. There is homogeneous enhancement of the pituitary gland without focal lesion. The posterior pituitary T1 hyperintense focus is present. The cavernous sinuses symmetrically enhance. The pituitary stalk is not deviated. There is no mass effect on the optic chiasm.

Output: 1.No evidence of pituitary lesion.2.Retroflexion of the dens tip with draping and displacement of the lower brain stem/upper cervical cord posteriorly with secondary mild mass effect on the inferior cerebellar tonsils and vermis. There is also mild crowding of structures at the foramen magnum without Chiari I malformation. It should be noted that this exam is a static exam. Therefore, this appearance may change with changes in positioning of the head. Please correlate clinically.3.Few punctate nonspecific white matter signal abnormalities in the frontal lobes.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy, claudication. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal anterolisthesis of L3 on L4 and minimal retrolisthesis of L4 and L5 which appear new since prior. Alignment is otherwise maintained. Multilevel degenerative changes are present with multilevel disc desiccation, progressed particularly at the L4-L5 level with also new endplate edematous marrow signal changes at the L4-L5 level. Bone marrow signal is benign. The conus medullaris is normal in position at the L1-L2 level.Multilevel degenerative changes are seen, as described below:T12-L1: Severe disc height loss with disc osteophyte complex. There is effacement of the ventral thecal sac, right greater than left. There is also bilateral facet arthropathy. There is overall mild to moderate spinal canal stenosis. There is mild to moderate right and mild left neural foraminal narrowing. These findings have progressed.L1-L2: Minimal disc bulge and advanced bilateral facet arthropathy with moderate spinal canal stenosis which has progressed in the interval. There is mild narrowing of the bilateral neural foramina.L2-L3: Mild disc bulge, advanced facet arthropathy, and ligamentum flavum thickening are again seen with moderate to severe spinal canal stenosis similar to prior. There is mild narrowing of the neural foramina.L3-L4: There is severe bilateral facet arthropathy and ligamentum flavum thickening as well as minimal disc bulge. There is moderate to severe spinal canal stenosis which is slightly progressed in the interval. Minimal narrowing of the neural foramina.L4-L5: Disc bulge and bilateral facet arthropathy. There is partial effacement of the lateral recesses. No significant central spinal canal stenosis. There is mild right and minimal left neural foraminal narrowing.L5-S1: Thecal sac terminates at this level with epidural fat again evident, likely developmental. There is bilateral facet arthropathy, more advanced on the right and progressed in the interval. There is mild to moderate right and mild left neural foraminal stenosis.

Output: Multilevel degenerative changes throughout the lumbar spine which have progressed since prior MRI since 2/9/2011. There is moderate to severe spinal canal stenosis at L2-L3 and L3-L4 and to a lesser degree at the L1-L2 and T12-L1 levels. Multilevel neural foraminal stenoses and additional details as above.


Instruction: Generate impression based on findings.

Input: Cellulitis and abscess There is a large soft tissue defect along the posteromedial aspect of the lower leg which appears continuous with a nonenhancing collection in the underlying subcutaneous fat which tracks laterally along the posterior margin of the soleus. At this level, the collection measures 5.5 x 2 cm, demonstrates rim enhancement, and tracks superiorly between the soleus and medial head of the gastrocnemius into the proximal calf where there is edema of the adjacent posterior calf musculature. The collection also extends distally, disrupting the fibers of the Achilles tendon, where it communicates with a second skin defect approximately 4 to 5 cm above the calcaneus. The total craniocaudal extent of this collection measures approximately 25 cm.Intermediate signal intensity material overlying the above-mentioned skin wounds likely reflects packing material. There is a small collection of nonenhancing fluid deep to the soleus which we suspect is reactive in nature. There is deformity of the tibial and fibular diaphyses indicating prior trauma and orthopedic intervention. There is no bone marrow edema or enhancement to suggest osteomyelitis. Small foci of signal abnormality within the tibia likely reflect areas of osteonecrosis. There is mild fatty atrophy of the peroneal muscles and there is circumferential subcutaneous edema that becomes confluent lateral to the proximal tibia/fibula.

Output: Large soft tissue defect appearing continuous with a large nonenhancing fluid collection that extends beneath the medial head of the gastrocnemius into the proximal calf and distally through the Achilles tendon. There is no evidence of osteomyelitis. Additional findings are described above.These findings were discussed with Dr. S. Catlett of the primary service at 9:35 AM.


Instruction: Generate impression based on findings.

Input: 58 year old man with ischemic cardiomyopathy, referred for follow up evaluation of LV function after medical therapy. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 150 ml/m2 (normal range: 74+/-15), the LVEDV is 291 ml (normal range 142+/-34), the LV end systolic volume index is 90 ml/m2 (normal range 25+/-9), the LVESV is 175 ml (normal range 47+/-19). There is hypokinesis of the mid anterior/anteroseptal walls. There is akinesis of the apical anterior wall. There is dyskinesis in the apex. There is extensive transmural late gadolinium enhancement in the mid to apical anterior, septal and entire apex. This pattern is typical for myocardial infarction. This is not significantly changed from prior study.Left AtriumThe left atrium is moderate to severely enlarged. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 129 ml/m2 (normal range 82+/-16), the RVEDV is 251 ml (normal range 142+/-31), the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9), and the RVESV is 126 ml (normal range 54+/-17).Right AtriumThe right atrium is moderate to severely dilated.Aortic ValveThe aortic valve opens widely and there is mild 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 at least mild 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 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 severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 40%.2. There is hypokinesis of the mid anterior/anteroseptal walls. There is akinesis of the apical anterior wall. There is dyskinesis in the apex. There is extensive transmural late gadolinium enhancement in the apex, mid to apical anterior, septal and distal inferior walls. This pattern is typical for myocardial infarction. This is unchanged from the prior study on 9/17/15.3. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%.4. Overall, there is no significant change from prior study on 9/17/15.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 25 year-old female with right hip pain, no improvement with physical therapy or medications. ACETABULAR LABRUM: Gadolinium traverses the anterior/superior labrum, at approximately the two o'clock position, indicating a full thickness tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact. We see no CAM deformity. Suspected edema-type signal within the superior pubic rami on the previous study is not present on today's study. The bone marrow signal intensity is within normal limits.SOFT TISSUES: The musculature appears normal. The remaining soft tissues are unremarkable.

Output: Anterior/superior labral tear, as above.


Instruction: Generate impression based on findings.

Input: Male, 81 years old, with altered mental status. No restricted diffusion is seen. Numerous scattered foci of periventricular and cortical T2 hyperintensity are seen, becoming somewhat confluent in the periatrial regions. The quantity and distribution of these lesions appear similar to the prior MRI exam. No evidence of mass effect or edema is seen. No intracranial hemorrhage or abnormal extra-axial fluid collection is detected. No pathologic parenchymal or extra-axial enhancement is seen. The ventricles and sulci are prominent compatible with underlying volume loss, similar to prior.

Output: 1.No acute intracranial abnormality.2.Findings compatible with chronic microvascular ischemic disease without significant interval change.


Instruction: Generate impression based on findings.

Input: Ms. Magar is a 33-year-old female with a family history of breast cancer in her maternal aunt, great aunt, grandmother, and two cousins. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.In the left upper inner breast, there is a faint focus of enhancement identified. However, this area of enhancement corresponds to a small cluster of cysts as confirmed on the T2-weighted imaging. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: There are partially-imaged postoperative findings related to T1 corpectomy and C7-T1 fusion with prior C6-T1 laminoplasty. There is no evidence of abnormal enhancement in the extradural space to suggest tumor. However, there is a partially-imaged lobulated mass in the left paraspinal region at the C7-T1 level. The vertebral column alignment is unchanged. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: 1. Partially-imaged postoperative funding at C6-T1 without evidence of recurrent tumor within the spinal canal.2. Partially-imaged lobulated mass in the left paraspinal region at the C7-T1 level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 33-year-old female with history of chronic abdominal pain, nausea, vomiting, diarrhea, weight loss. Rule out inflammatory bowel disease or other small bowel pathology. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume of stool is noted throughout the colon. Appropriate distention of the small bowel loops for this MR enterography exam. No abnormal wall thickening or abnormal wall enhancement. Normal appearance of the terminal ileum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Normal uterus. Normal appearing right ovary containing an involuting corpus luteal cyst (series 17 image 65).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid in the dependent pelvis likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence for inflammatory bowel disease or acute small bowel pathology.2.Large volume stool throughout the colon compatible with constipation, may be correlated clinically.


Instruction: Generate impression based on findings.

Input: 64 year old male with right elbow pain. TENDONS: There is thickening and heterogeneity of the common extensor tendon indicating moderate to severe tendinopathy. There are foci of near fat signal intensity within the tendon corresponding to ossicles seen on outside hospital radiographs. There is a band of high signal intensity which separates the tendon and ossicles from the underlying lateral humeral condyle compatible with partial thickness tearing. There are tiny enthesophytes at the origin of the common flexor tendon, better seen on recent radiographs, but the tendon itself is unremarkable. The biceps, brachialis, and triceps tendons appear intact.LIGAMENTS: The ulnar collateral ligament appears intact. The radial collateral ligament proper is difficult to separate from the thickened common extensor tendon. What we believe to be the ligament appears separated from the humerus by high signal intensity, suggestive of a tear at its humeral attachment. The lateral ulnar collateral ligament appears intact.ARTICULAR SURFACES AND BONE: There are small foci of signal abnormality within the lateral epicondyle and the more proximal of the 2 intratendinous ossicles which are likely degenerative in etiology. There is subjective thinning of the articular cartilage of the radiocapitellar articulation, representing mild to moderate degeneration. The articular cartilage of the ulnohumeral articulation appears relatively intact.ADDITIONAL

Output: Tendinosis and partial-thickness tearing of the common extensor tendon and possible tear of the radial collateral ligament proper of the right elbow.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with left-sided paresthesias. Patchy periventricular and subcortical T2 hyperintensity is seen, a nonspecific finding. No definite evidence of restricted diffusion is noted. There is a small focus of bright diffusion signal in the right doral pons but with no clear ADC correlate. No parenchymal edema or mass effect is detected. There are a few punctate foci of susceptibility scattered throughout the brain compatible with chronic micro-hemorrhage. No acute intercranial hemorrhage or any abnormal extra-axial fluid collections are seen. Diffuse prominence of the sulci likely reflects a mild degree of parenchymal atrophy. The ventricular system is within normal limits for size and morphology.

Output: 1. Patchy white matter signal abnormality is nonspecific but most commonly reflects chronic microvascular ischemic disease.2. No definite evidence of acute ischemia is seen. A small focus of bright diffusion signal within the right dorsal pons does not show a clear ADC correlate and therefore does not clearly represent restricted diffusion. This may indicate an imaging artifact, or T2 shine through of a chronic lesion, or perhaps a late subacute resolving ischemic lesion. The ascending spinothalamic tract does traverse through this area of the pons which would coincide with the reported symptomatology. Correlation with timing and nature of symptomatology is suggested.


Instruction: Generate impression based on findings.

Input: Ms. Gagnon is a 59-year-old female with biopsy-proven IDC/DCIS of the right breast, spanning approximately 7.3 cm on prior MRI. She is currently undergoing neoadjuvant chemotherapy. She presents today for repeat MRI to assess for imaging evaluation to treatment response. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST: There has been an interval decrease in size of biopsy-proven heterogeneously enhancing mass in the right upper outer breast, posterior depth, now measuring 2.1 x 1.5 x 1.8 cm, previously measuring 2.8 x 2.3 x 2.4 mm (AP x LR x CC). There continues to be a thin fat plane between thismass and pectoralis muscle on T2 weighted images, and there is no pectoral enhancement, suggesting no invasion into the muscle. There continues to be segmental nonmass enhancement extending anteriorly from the mass in the right upper outer breast, measuring approximately 5.0 x 1.6 cm, previously measuring 5.1 x 1.7 cm. However, this non-mass enhancement has decreased in overall enhancement intensity and pattern. Overall measurement including mass and non mass enhancement is 6.6 x 2.3 cm, compared to 7.3 x 2.8 cm.LEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.A vascular port overlies the left upper chest wall.

Output: (1) Decreasing size of index malignancy in the right upper outer breast with residual total enhancement measuring 6.6 cm in the AP dimension (compared to 7.3 cm).(2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Right knee pain, proximal tibia, fever, leukocytosis, elevated ESR/CRP, assess for osteomyelitis Extensive osseous T1 hypointensity predominantly involving the proximal tibial metaphysis, and to a lesser degree, the proximal tibial epiphysis, proximal and middle thirds of the tibial diaphysis, as well as the proximal fibular epiphysis, metaphysis, and diaphysis. There is associated T2 hyperintensity in these regions. The cortex of the proximal tibial is thin and indistinct, particularly posterolaterally. These findings are compatible with acute osteomyelitis. There is associated enhancement in these regions on the post contrast images but no evidence of enhancing fluid collection to suggest abscess. There is a small knee joint effusion. Subcutaneous and intramuscular soft tissue edema is present in the upper leg.

Output: Acute osteomyelitis of the proximal tibia and fibula as above without evidence of abscess. Findings discussed with Orthopaedics x4081 at 1045 am on 2/11/2016.


Instruction: Generate impression based on findings.

Input: Examination is limited due to patient motion artifact and inability to complete all sequences. There is an area of diffusion restriction centered in the left basal ganglia and left caudate nucleus that also involves a portion of the corona radiata, corresponding to area of hypoattenuation seen on prior CT. This area is also associated with T2 hyperintensity. There are other scattered punctate foci of T2 hyperintensity in the periventricular and deep white matter and left thalamus. Again seen is an area of volume loss in the right occipital lobe, in the area of hypoattenuation on CT.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or significant mass effect. No extra-axial fluid collection is identified.Normal flow-voids are grossly demonstrated in the visualized major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Limited examination demonstrating an acute to subacute infarct centered in the left basal ganglia.2.Foci of T2 hyperintensity in the periventricular, deep white matter, and left thalamus likely represent mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of sacral decubitus ulcer and fever, evaluate for osteomyelitis. BONE MARROW: Scattered foci of decreased T1 marrow signal are present in a distribution suggestive of red marrow reconversion. Abnormally decreased T1 signal and increased T2 signal with associated contrast enhancement is present within the lesser trochanter of the right femur (series 401, image 21) compatible with osteomyelitis. There is abnormally decreased T1 signal with associated abnormally increased T2 signal with associated increased heterogenous enhancement involving the right ischial tuberosity (series 401, image 24) which is also suspicious for osteomyelitis. There is abnormally decreased T1 signal with associated increased T2 signal and enhancement involving the left ischial tuberosity (series 401, image 24) which is compatible with osteomyelitis. Abnormal signal extends from the bilateral ischial tuberosities into the adjacent inferior pubic rami. The bone marrow of the sacrum appears within normal limits.SOFT TISSUES: Extensive soft tissue ulceration is present superficial to the bilateral ischial tuberosities and right lesser trochanter with foci of air extending to the aforementioned bones. There is associated increased soft tissue enhancement compatible with infection. No discrete drainable fluid collections are identified.JOINTS: Small joint effusions present bilaterally.ADDITIONAL

Output: 1.Decubitus ulcers with associated osteomyelitis of the right lesser trochanter of the femur as well as bilateral ischial tuberosities.2.Small bilateral hip joint effusions. Given presence of adjacent osteomyelitis, infection of the joint spaces cannot be excluded.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS, follow up progression History: paresthesias There are wedge shaped ill defined FLAIR high signal intensity lesions on bilateral corpus callosum body portion, best seen on sagittal scan.Another small focal lesion is seen on the left frontal lobe superior frontal gyrus.A small right anterior thalamic FLAIR high signal lesion is non specific.Subtle FLAIR high signal intensity lesions are seen on bilateral periventricular white matter especially trigone area. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal bihemispheric FLAIR high signal intensity lesions on bilateral corpus callosum and periventricular white matter. Considering the patient's clinical history of MS, these lesions are consistent with demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with new diagnosis of stage IV lung cancer. Numerous scattered small T2 hyperintense lesions are seen within the periventricular and subcortical white matter of the bilateral cerebral hemispheres. No evidence of mass effect or edema is seen. No pathologic parenchymal or extra-axial enhancement is detected.There is no evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.Marrow signal characteristics are unremarkable. Degenerative spondylosis is partially visualized in the upper cervical spine.

Output: 1.No evidence of intracranial metastatic disease.2.Scattered nonspecific white matter lesions which likely represent chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: History of newly diagnosed MS, restarting Tysabri after pregnancy. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Examination demonstrates extensive periventricular and to a lesser degree subcortical and corpus callosum foci of flair hyperintensity consistent with patient's known demyelinating disease. There is no convincing evidence of interval change in the extent of the findings. There is no detectable abnormal enhancement to suggest an active plaque.Also stable since prior exam are mild findings of chronic demyelinating disease involving the mid brain, pons and the right cerebellum.The cerebral cortex, cortical sulci and ventricular system remain normal for patient's stated age of 31. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Stable findings of multiple sclerosis and without evidence of new or enhancing lesions since prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: altered mental status. Signs and symptoms: Nonenhanced head CT:Technique.Axial 5 mm CT images of the head without administration of contrast is obtained. Sagittal and coronal 2-D reformatted images rendered.There is paucity of cortical sulci, small supratentorial ventricular system and in the CSF cisterns. Although this finding may be well within normal for patient stated age of 19 possibility of subtle increase intracranial pressure/edema cannot be entirely ruled out. The gray -- white matter differentiation remains well within normal. Images through posterior fossa demonstrate crowding of the cerebellar tonsils which is suspected for Chiari malformation. This finding is best appreciated on sagittal reformatted images in particular on number 26. Recommend follow-up with an MRI examination.There is no evidence of hemorrhage or midline shift.

Output: 1.Ectopia of cerebellar tonsils evident by crowding of the foramen magnum. Recommend follow-up with an MRI exam.2.No definitive evidence of density abnormality of brain parenchymal or morphologic abnormality. Paucity of cortical sulci and the small size of ventricular system and CSF cisterns are noted which could still be within normal range for patient stated age of 18. Subtle intimal may present with this appearance.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The midline structures and craniocervical junction are within normal limits. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mucosal thickening within the right maxillary sinus.

Output: No evidence of intracranial anomalies.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 posterior fossa tumor resection. There are postsurgical changes of a left retrosigmoid suboccipital craniectomy for posterior fossa tumor resection, with a small amount of extra-axial fluid deep to the craniotomy flap. There is an enhancing nodular lesion with measuring approximately 15 mm in diameter in the posterior left cerebellomedullary angle cistern region, along the lateral aspect of the fourth ventricle. There is also a 12 mm diameter nodular enhancing lesion more anteriorly in the left cerebellomedullary angle cistern region. There is extensive encephalomalacia in the left cerebellar hemisphere and middle cerebellar peduncle and what may represent a small amount of acute ischemia in the left cerebellar hemisphere. There is no midline shift or herniation. The third and lateral ventricles are not enlarged. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are skin fiducial markers.

Output: Recent postoperative findings with residual tumor in the left cerebellomedullary angle cistern region.


Instruction: Generate impression based on findings.

Input: History of cirrhosis and portal vein thrombosis. Evaluate portal vein. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology.Cholelithiasis within a normally distended gallbladder without specific evidence of gallbladder inflammation.No suspicious arterially enhancing and washing out lesion.The portal vein is nonopacified and is markedly attenuated. There is reconstitution of attenuated left portal vein at the hepatic hilum, as well as proximalmost right portal vein.SPLEEN: Splenomegaly measuring 15.4 cm in craniocaudal dimension. Trace perisplenic ascites. Perisplenic collateral vessel formation.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume of abdominopelvic ascites. Extensive right-sided retroperitoneal and mesenteric collateral vessels.BONES, SOFT TISSUES: Mild dependent body wall edema. Gynecomastia.OTHER: Moderate right-sided pleural effusion with adjacent consolidation/atelectasis, slightly improved from prior.

Output: 1.Cirrhotic liver with no suspicious lesion. 2.Chronically thrombosed main portal vein. Reconstitution of an attenuated left portal vein as well as proximalmost right portal vein at the hilum.3.Moderate size right-sided pleural effusion with adjacent consolidation/atelectasis, slightly improved. 4.Stigmata of portal hypertension including extensive portosystemic collateral vessel formation and splenomegaly.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, status post Chiari decompression with syrinx, one year follow-up from surgery. Postoperative findings are seen compatible with Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. The cerebellar tonsils terminate above the level of the neo-foramen magnum, and demonstrate a relatively normal round morphology. The degree of CSF expansion along the posterior aspect of the foramen magnum appears similar to prior. Robust biphasic CSF flow is seen along the ventral neo-foramen magnum. Only a mild blush of flow related signal is seen dorsally through the neo-foramen magnum.A previously seen syrinx in the cervical region has decreased both in craniocaudal extent and in maximal diameter. The syrinx previously began at C4 and extended to the upper thoracic level. It is now only reliably detected at the C6 and C7 levels. The maximum dimension measures 1 mm, previously 2 mm.A larger syrinx cavity seen previously within the thoracic region has also decreased in craniocaudal extent, though the maximum caliber remains similar to prior. The syrinx previously extended from T4-5 down to T9, and currently extends from T5 to T8. The maximum caliber measures 7 x 7 mm, unchanged from prior.The conus tip terminates at L1 which is normal. No intraspinal masses are seen.Spinal alignment and vertebral body morphology are within normal limits. No concerning marrow signal abnormality is detected. The intervertebral discs are normal. No significant spinal canal or neuroforaminal stenosis is detected.

Output: 1.Demonstration of findings compatible with Chiari decompression. The cerebellar tonsils remain above the level of the neo-foramen magnum and show a round morphology.2.Robust CSF flow is seen along the ventral aspect of the neo-foramen magnum, with only a small amount of detectable flow dorsally.3.Interval decrease in caliber and longitudinal extent of a small cervical cord syrinx.4.Interval decrease in longitudinal extent of a large thoracic cord syrinx.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 59M w/ no significant PMHx presenting with SOB and evaluation for CABG and aortic valve replacement. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%. The LVEDV is 475 ml (normal range 142+/-34), the LV end diastolic volume index is 215 ml/m2 (normal range: 74+/-15), the LVESV is 313 ml (normal range 47+/-19) and the LV end systolic volume index is 142 ml/m2 (normal range 25+/-9). The LV mass is 159 g (normal range 164+/-36) and the LV mass index is 72 g/m2 (normal range 85+/-15). There is akinesis of the inferior and severe hypokinesis of the inferoseptum from base to LV apex. There is transmural late gadolinium enhancement in the inferior and inferospetal walls. These areas are likely not viable. There is also subendocardial late gadolinium enhancement in the basal posterior wall. This area is of intermediate viability. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%. The RVEDV is 244 ml (normal range 142+/-31), RV end diastolic volume index is 110 ml/m2 (normal range 82+/-16), the RVESV is 143 ml (normal range 54+/-17), and the RV end systolic volume index is 65 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThere is calcification of the aortic valve leaflets. The aortic valve is functionally bicuspid with likely fusion of the right and non coronary cusps. Qflow measurement was limited by patient's frequent PVCs. Regurgitant volume (Qflow method = 53%). Using ventricular stroke volume, regurgitant fraction was 38%. Taking these finding into account, there is at least moderate aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. The mitral valve leaflets appear thickened.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.Ao sinus of valsalva = 41 x 41 x 41 mmAo sinotubular junction = 35 x 34 mmAscending aorta pre-branching = 37 x 38 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The LV is severely dilated with moderately reduced systolic function (LVEF 34%)2.There is akinesis of the inferior and severe hypokinesis of the inferoseptum from base to LV apex. There is transmural late gadolinium enhancement in the inferior and inferoseptal walls. These areas are likely not viable. There is also subendocardial late gadolinium enhancement in the basal posterior wall. This area is of intermediate viability. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction.3.The RV is normal in size with mildly reduced systolic function (RVEF 41%)4.Functionally bicuspid aortic valve. There is at least moderate aortic regurgitation, quantification limited by frequent PVCs.5.Aortic measurements as 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: 84 year old male with bilateral leg weakness, stool incontinence, history of metastatic prostate cancer. Evaluate for cord compression. No large marrow infiltrating lesions are appreciated within the cervical, thoracic, or lumbar spine. No obvious epidural tumor. The vertebral bodies heights are grossly maintained. There is mild reversal of cervical lordosis. Alignment of the spine is otherwise grossly maintained. There are no findings to suggest acute cord compression.Degenerative changes are seen throughout the cervical spine with at least moderate degree of spinal canal stenosis at C3-C4 and C5-C6 and to a lesser degree C4-C5 levels related to disc bulge and ligamentum flavum thickening. Additional multilevel degenerative changes are also seen involving the lumbar spine, most prominently involving the L3-4 level where there is moderate to severe spinal canal stenosis which is better appreciated on the dedicated lumbar spine performed subsequently.Prominent endplate degenerative changes are present at L3-L4 and to a lesser degree at the L4-L5 levels. There is a prominent Schmorl's node involving the superior endplate of L4. There is also edema involving the superior L4 endplate which is favored to be on an advanced degenerative basis.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No acute cord compression is identified. Degenerative changes at multiple levels in the cervical and lumbar spine with at least moderate spinal canal stenosis at C3-C4 and C5-C6 and moderate to severe spinal canal stenosis at L3-L4. Please refer to separate dedicated lumbar spine MRI report.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 69 years old Reason: myeloma with worsening sciatic pain left buttock Multiple sequences are limited by motion. BONE MARROW: Diffusely heterogeneous bone marrow signal on T1 and T2 imaging consistent with patient's known history of myeloma. Again seen is a focal T1 hypointense lesion replacing much of the L5 vertebral body, probably on the right. There is a soft tissue component to this lesion, similar to the recent lumbar MRI, which extends into the right retroperitoneum has mass effect on the vessels.SOFT TISSUES: Again seen is a T1 and T2 hypointense lesion in the far lateral left L5-S1 foramen which has mass effect on and appears to impinge the exiting L5 nerve root (series 5, image 8). Remaining sacral nerves are well-visualized and appear to be surrounded by fat. Large fluid collection adjacent to the left greater trochanter most likely represents bursitis. The left gluteal muscles are atrophied compared to the contralateral side.JOINTS: There is a large subchondral cyst at the lateral femoral head neck junction. ADDITIONAL

Output: 1.Diffuse abnormal bone marrow signal consistent with known myeloma.2.Large fluid collection adjacent to the left greater trochanter likely represents bursitis. Atrophy of the left gluteal muscles compared to the contralateral side.3.Lesion causing destruction of the L5 vertebral body is not significantly changed compared to most recent lumbar spine MRI.4.Impingement of the exiting L5 nerve root caused by a soft tissue abnormality in the lateral left foramen.


Instruction: Generate impression based on findings.

Input: 62 year old man with OHT, referred for evaluation of underlying rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 93 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time is moderately elevated and the ECV fraction is mildly elevated, both in a diffuse non-focal pattern.T2 ratio = 1.6 (<2 normal)Global relative enhancement ratio = 3.2 (<4 normal)Native myocardial T1 = 1167ms (<1050ms normal)Native LV cavity T1 = 1668msECV Fraction = 32% (20-30% normal)Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 FindingsModerate sized right pleural effusion. 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. Normal left ventricular size and systolic function (LVEF 61%) without evidence of underlying myocardial replacement fibrosis. However, native myocardial T1 times are moderately elevated and the ECV fraction is mildly elevated (see values above). A recent publication (Miller et al. JCMR 2014;16:52) suggests that the native T1 time by 3 months is expected to be 1089 +/-62ms and the ECV is 30.1+/- 0.5%. 2. Normal right ventricular size and systolic function (RVEF 54%).3. Moderate sized right pleural effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old female with posterior fossa meningioma. Evaluate for mass change. Heterogeneous mass within the left posterior fossa extending into the upper cervical spine is seen. There is mass effect on the left cerebellar hemisphere and fourth ventricle with surrounding vasogenic edema corresponding to recent MRI. There is no significant hydrocephalus. The basal cisterns are normal in size and configuration. There is no evidence of intracranial hemorrhage. Extensive of subcortical lucencies consistent with small vessel ischemic disease is unchanged.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute change in left posterior fossa meningioma with no evidence of hydrocephalus2. Extensive small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, unspecified sideClinical question: low back painSigns and Symptoms: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a mild degree of anterior subluxation of L1 on L2. The patient is status post lower lumbar spine surgery.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is left-sided facet hypertrophy present at this level which was also present on the prior exam and associated with mild encroachment of the nerve roots of the left lateral recess. There is ligamentum flavum hypertrophy present bilaterally at this level. Overall compared to the prior exam there appears to be some mild progression of the facet hypertrophy.At L4-5 there is a diffuse disc bulge present associated loss of disc space height and disc desiccation as well as a moderate degree of bilateral facet and ligamentum flavum hypertrophy. There is progression of loss of disc space height at this level. There is disc desiccation present at this level. There is obliteration of CSF within the thecal sac at this level. Disc material extrudes behind the adjacent endplates at this level. Overall the spinal stenosis has progressed since the previous exam as has the disc extrusion in the facet hypertrophy. There is narrowing of the neural foramina bilaterally at this level with the encroachment of the left-sided exiting nerve roots within the neural foramen due to combination of disc disease and facet disease. There is a superimposed left far lateral disc protrusion at this level which is new compared to the prior exam. The neural foraminal encroachment of the left exiting nerve root is new since the prior exam. There is also some progression of encroachment of the right exiting nerve root without obliteration of the fat surrounding the right exiting nerve roots. Overall there is moderate to severe spinal stenosis at this level.At L3-4 there is progression of loss of disc space height and a diffuse disc bulge as well as ligamentum flavum hypertrophy. The endplate reactive changes are predominantly bright signal on T1 and suppresses on the inversion recovery T2 images. There is effacement of the fat at the lateral recesses bilaterally at this level which was also present on the prior exam. There is effacement of the CSF surrounding the nerve roots at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level. There is a left far lateral disc protrusion at this level which encroaches on the left exiting nerve root which was not evident on the prior exam. Overall there is moderate to severe spinal stenosis at this level.At L2-3 there is loss of disc space height and diffuse disc bulge as well as mild ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level. There is some narrowing of the neural foramina at this level, however, the exiting nerve roots are surrounded by fat within the neural foramina. Compared to the prior exam loss of disc space height has progressed. There are more endplate reactive changes on the current exam versus the prior exam. These endplate reactive changes are predominantly bright signal on T1 and suppresses on the inversion recovery T2 images. Overall there is a moderate degree of spinal stenosis at this level.At L1-2 there is loss of disc space height, disc desiccation and diffuse disc bulge which has progressed since the prior exam. There is ligamentum flavum hypertrophy present this level as well as a small left-sided ligamentum flavum cyst. Overall there is a mild degree of spinal stenosis at this level.

Output: 1.There are multilevel degenerative changes present in the lumbar spine which have progressed since 2006. There is a moderate to severe spinal stenosis at L4-5 and L3-4 and moderate spinal stenosis at L2-3 as detailed above. There is encroachment of exiting nerve roots on the left-sided L4-5 and L3-4 as detailed above. Please note that a contrast enhanced exam may help differentiate scar formation from degenerative change.


Instruction: Generate impression based on findings.

Input: 60 years Male (DOB:10/19/1955)Reason: MRI with (wo already done) History: Eval source of L occipital bleedPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER There is a hematoma measuring approximately 3 cm located in the left cuneus and precuneus. It is not associated with any significant degree of contrast enhancement.There is a moderate degree of periventricular and subcortical punctate hypointense white matter lesions present identified on the T1 weighted images. These correspond to T2 hyperintense foci in the prior MR.There is a hypointense focus present in the right thalamus corresponding to T2 hyperintense focus in the prior MR.Incidental note is made of a developmental venous anomaly located in the right cerebellar hemisphere.There is a mucous retention cyst in the left maxillary sinus.

Output: 1.There is no associated enhancing lesion related the patient's left occipital and parietal lobe hematoma. There is no evidence for brain metastases.2.Exam is limited to pre and postcontrast T1-weighted imaging. There is a prior MRI from 1/31/2016. Please refer to that for further comments.3.Old lacunar infarct is redemonstrated in the right thalamus4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: ORBITS: The globes, lenses, extraocular muscles, optic nerves, optic chiasm, and intraconal space are symmetric and normal. The orbital soft tissues are normal. There is no abnormal enhancement.The imaged intracranial contents are unremarkable, without evidence of mass, mass effect, hemorrhage, or acute infarct. There is minimal mucosal thickening of the bilateral maxillary sinuses and nasal cavity. There is mild leftward nasal septum deviation. NECK: The minimal diffuse mucosal thickening in the nasopharynx, oropharynx, and hypopharynx is unchanged. The effacement of the mucosal contours of the posterior nasopharynx are similar to prior. Asymmetry in the left oropharynx is noted and appears similar to prior. There is no enhancing mass identified. The salivary and thyroid glands appear within normal limits. There are small scattered lymph nodes, which are not enlarged by size criteria. Again noted is a left paracentral disc protrusion at C4-5, which effaces the left ventral spinal cord and contributes to mild to moderate spinal canal narrowing. There is T1 shortening of the skull base and upper cervical vertebrae, compatible with prior radiation therapy.

Output: 1. No MR evidence for local tumor recurrence or cervical lymphadenopathy.2. Unremarkable MRI of the orbits.


Instruction: Generate impression based on findings.

Input: Metastatic esophageal cancer to brain, SRS treatment planning. There is a subcentimeter left cerebral hemisphere lesion. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Pre-treatment planning MRI for a left cerebral hemisphere probable metastasis.


Instruction: Generate impression based on findings.

Input: psychosis, neuropsychiatric lupus. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.Developmental venous anomaly (normal variation of venous drainage) is seen on the right temporal lobe superior temporal gyrus crossing underneath of the right Heschel's gyrus toward right lateral ventricle posterior horn ependymal vein.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate decreased luminal diameter of bilateral distal intracranial ICAs (left worse than right). In addition, bilateral proximal MCA M1 and bilateral ACA A1 segments also show decreased luminal diameter. However, distal MCAs and distal ACAs appear to be normal. Angiographically, these findings constitute Moyamoya syndrome.Vertebrobasilar system appears to be normal.Right Pcom artery appears to be patent and normal size.The left PCA is fetal origin.There is no intracranial arterial aneurysm.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. DVA on the right superior temporal gyrus.4. Normal brain MRV.4. Bilateral distal intracranial ICA and proximal MCAs and ACAs luminal narrowing on MRA. This may represent Moyamoya syndrome. Clinical correlation is recommended.Discussed with Dr. Di-Ranieri at the time of this dictation.


Instruction: Generate impression based on findings.

Input: 43 year old woman with DLBCL, referred for evaluation of constrictive pericarditis. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 181 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 92 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 97 g (normal range 114+/-24). LV dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying replacement fibrosing, infiltrative, or inflammatory process. There is a moderate increase (in native myocardial T1 diffusely throughout the left ventricle suggesting the presence of interstitial myocardial fibrosis. The native myocardial T1 time is 1187ms, the LV T1 time is 1702ms. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 159 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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. PericardiumThe pericardium is thickened (about 6mm) circumferentially around the entire heart. Based on myocardial tagging, there is pericardial to myocardial tethering most pronounced along the basal left ventricle. A "septal bounce" (which is most pronounced with inspiration) is present and indicative of ventricular interdependence and the diagnosis of pericardial constriction. The majority of the pericardium has late gadolinium enhancement present but without increased T2-signal, indicative of pericardial fibrosis. No significant pericardial effusion is noted. Extracardiac FindingsThere are moderate to large 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. There is evidence of significant pericardial thickening with evidence of chronic pericardial constriction as described above.2. The left ventricle is normal in size with mildly reduced systolic function (LVEF 49%) without evidence of late gadolinium enhancement to suggest the presence of underlying myocardial replacement fibrosis, inflammation, or infiltration. However, the native myocardial T1 time is moderately elevated diffusely, suggesting the presence of interstitial fibrosis. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%. 4. Moderate to large bilateral pleural effusions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is a suggestion of increased soft tissue density anterior to the interpeduncular cistern and extending leftward. Previous MRI from September demonstrated a suggestion of leptomeningeal enhancement at the level of the interpeduncular cistern, thus this may represent progression of cisternal leptomeningeal disease at this level, perhaps involving the left third cranial nerve.Redemonstrated is a right transfrontal ventriculostomy cathter that terminates in the expected region of the right foramen of Monro, unchanged in position. The ventricular system configuration remains unchanged. There is unchanged moderate cerebral white matter hypoattenuation, which may be treatment related. The gray-white matter differentiation is preserved. There is no mass effect, midline shift, or acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Previously described mild bulging of the anterior optic nerves bilaterally is not well demonstrated on this study.

Output: 1.There is a suggestion of increased soft tissue density anterior to the interpeduncular cistern and extending leftward. Previous MRI from September demonstrated a suggestion of leptomeningeal enhancement at the level of the interpeduncular cistern, thus this may represent progression of cisternal leptomeningeal disease, perhaps involving the left third cranial nerve. This could be better characterized, and/or confirmed, by gadolinium enhanced brain MRI.2.The remainder the study is unchanged.


Instruction: Generate impression based on findings.

Input: 50 year old woman with history of HFpEF who presents for cardiac MRI to evaluate for restrictive cardiomyopathy Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 90 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 32 ml (normal range 31+/-10), the LV mass index is 79 g/m2 (normal range 67+/-11), and the LV mass is 111 g (normal range 114+/-24). There is mild systolic flattening of the interventricular septum suggesting increased RV systolic pressure.Aside form the mild late gadolinium enhancement of the anterior and inferior RV insertion points, which is well described and common in patients with pulmonary hypertension, there is no other late gadolinium enhancement of the myocardium or pericardium to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. It is moderately hypertrophied. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation. There is aliasing of the tricuspid regurgitation jet suggesting increased TR velocity.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 mild to moderately dilated (34 mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is moderate sized pericardial effusion. There is no enhancement of the pericardium on late gadolinium imaging.Extracardiac FindingsThere is moderate sized right pleural effusion with evidence of septation and some complex features raising the possibility that it may be exudative in nature. This effusion was not present on the prior study. There is a trace left pleural effusion. 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. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 50%) with significant hypertrophy and evidence of mild systolic flattening of the interventricular septum and late gadolinium enhancement of the anterior and inferior RV insertion points. All of these findings are consistent with the patients known history of pulmonary hypertension. 4. Severe biatrial dilation5. Moderate tricuspid regurgitation6. Mild aortic regurgitation7. Moderate sized pericardial effusion (slightly larger than on the prior study)8. Mild to moderately dilated main pulmonary artery (34 mm)9. In comparison to the cardiac mri done on 7/8/10, there is now a complex appearing right pleural effusion. The cardiac structures are essentially unchanged with the exception of mild late gadolinium enhancement involving the RV insertion points.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with spinal stenosis. Straightening of the lumbar lordosis is unchanged. At most there may be a trace retrolisthesis of L4 relative to L5. Alignment is otherwise unremarkable. Marrow signal characteristics are heterogeneous but overall benign in nature. Edematous endplate signal at L3-4 has slightly progressed.The distal spinal cord, conus and cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Mild facet arthropathy. Mild bulging disc. Narrowing of the lateral recesses but no significant spinal canal stenosis. Minimal if any foraminal narrowing. No interval changes. L3-4: Moderate facet arthropathy. Slight loss of disc height and minimal disc bulging. New left far lateral annular fissuring and protrusion. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, slightly progressed. L4-5: Moderate facet arthropathy. Loss of disc height with mild disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes. L5-S1: Moderate facet arthropathy with effusions. Progressive ligamentum flavum thickening. Effacement of the posterior aspect of the thecal sac with mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. Findings have progressed.

Output: 1.Progressive degenerative findings at L5-S1, particularly affecting the ligamentum flavum. As a result, there is progressive moderate bilateral foraminal narrowing.2.Degenerative findings at additional levels are stable or only mildly increased. No areas of high-grade spinal canal stenosis are seen.


Instruction: Generate impression based on findings.

Input: Male, 42 years old, with numbness and tingling of the hands. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: Mild left facet hypertrophy. Mild left uncovertebral hypertrophy. No spinal canal stenosis. Mild left foraminal narrowing. No interval changes. C3-4: Mild bilateral facet hypertrophy. Mild left uncovertebral hypertrophy. No spinal canal stenosis. Mild left foraminal narrowing. No interval changes. C4-5: Mild facet hypertrophy, slightly progressed. No significant spinal canal stenosis. No significant foraminal narrowing. C5-6: Bilateral facet hypertrophy, slightly progressed. Posterior disc-osteophyte complex formation asymmetric to the left foraminal zone, slightly progressed. No spinal canal stenosis. Severe left foraminal narrowing slightly progressed. C6-7: Left facet hypertrophy, slightly progressed. Minimal posterior disc-osteophyte complex formation, slightly progressed. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, slightly progressed. C7-T1: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. No interval changes.

Output: Slight interval progression of relatively mild multilevel degenerative disease of the discs and posterior elements. There is no significant spinal canal stenosis and at most levels only mild foraminal narrowing. However, on the left at C5-6, foraminal narrowing is severe.


Instruction: Generate impression based on findings.

Input: Biliary dilation and chronic pancreatitis. Portal vein thrombus. Hepatitis C and alcoholic liver disease. Per medical record, patient has history of chronic pancreatitis and dilated pancreatic and CBD ducts in 2004, s/p pancreaticojejunostomy, choledochoduodenostomy, cholecystectomy, splenectomy at Rush for obstructive jaundice. Since then, he has been found to have biliary dilatation on his MRI MRCP in July 2014. ABDOMEN:LIVER, BILIARY TRACT: Cavernous transformation of the portal vein, similar to that seen on the CT on 11/3/2014, reflecting chronic thrombosis. The recanalized right portal vein is seen, though narrow. The left portal vein is not well seen. There is diffuse nodular enhancement of the liver on arterial phase, which becomes homogeneous on venous phase, without washout to raise suspicious for focal lesions. No specific stigmata of cirrhosis. There is moderate diffuse biliary dilation. The hepatic duct measures up to 8 mm wide, with smooth narrowing of the common bile duct at the choledochoduodenostomy, which remains patent and similar to the CT on 11/3/14. No associated mass is seen.SPLEEN: Surgically absent.PANCREAS: Post surgical changes at the pancreatic head and pancreaticojejunostomy, without complication evident. The remaining pancreas is atrophic with heterogenous parenchymal T1 signal and beading irregularity of the pancreatic duct, compatible with the known history of chronic pancreatitis. No focal mass is seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts. Otherwise, no significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evidence of pancreaticojejunostomy and choledochoduodenostomy, without acute abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Stable post-surgical biliary changes and moderate biliary dilation. No specific evidence of complication. 2. Chronic portal vein thrombosis with cavernous transformation, similar to 2014. No specific evidence of cirrhosis.


Instruction: Generate impression based on findings.

Input: 56M with h/o cervical arthritis, x-ray with degenerative changes, patient has decreased ROM and radicular pain (R > L arm) described as shooting, ?lesion amenable to surgery for pain relief? Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from loss of cervical lordosis. Bone marrow signal is benignThe cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine with multilevel disc desiccation and disc height loss which is worst at the C4-C5 level. Individual levels as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Partial effacement of the ventral thecal sac without significant spinal canal stenosis overall. No significant neural foraminal stenosis.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy on the right resulting in mild to moderate right-sided neural foraminal stenosis. No significant spinal canal compromise or left neural foraminal narrowing.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: Small disc osteophyte complex and uncovertebral hypertrophy on the left. There is no significant spinal canal stenosis. There is mild to moderate left neural foraminal narrowing. No significant right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Right vertebral artery is diminutive which may be related high-grade stenosis. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate right C4-C5 and left C6-C7 neural foraminal stenoses. There is no significant spinal canal stenosis at any level.2. Right vertebral artery flow-void is diminutive which may be related to high-grade stenosis. Dedicated CTA or MRA neck may be considered for better assessment.


Instruction: Generate impression based on findings.

Input: Follow-up hemangioma. History of P53 syndrome. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Segment 7 lobular T2 hyperintense lesion measuring 4.8 x 4.4 cm demonstrates peripheral nodular discontinuous enhancement which progressively fills in, compatible with a hemangioma.Numerous small and large gallstones within an elongated gallbladder without evidence of cholecystitis.No intrahepatic biliary duct dilatation, additional suspicious liver lesion or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild bilateral left greater than right adrenal thickening without a discrete nodule.KIDNEYS, URETERS: Right renal superior pole simple appearing cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses. Diastases of the rectus abdominis muscles with broad base fat-containing hernia without evidence of complication.OTHER: No significant abnormality noted.

Output: 1.The right hepatic lobe lesion currently measures 4.8 x 4.4 cm compared to 3.6 x 3.4 cm in 2013 and remains compatible with a hepatic hemangioma.2.Bilateral hyperplastic adrenal glands, unchanged.3.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 61-year-old woman with supratherapeutic INR now with acute mental status change. Parenchymal hemorrhage with layering blood products is present at the left posterior temporoparietal junction. The hemorrhage measures 3.4 x 3.0 cm in the axial plane (series 2 image 12). A rim of edema surrounds the hemorrhage. There is no underlying lesion evident by CT. There is mild mass effect upon the left lateral ventricle but no appreciable midline shift. The basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Extensive soft tissue abnormality is present in the occipital region. This may represent sequela of prior soft tissue hemorrhage as seen on the MRI dated 1/17/2007.

Output: Left temporoparietal junction parenchymal hemorrhage as detailed above. No underlying lesion is evident by CT -- MRI is recommended for further evaluation if clinically appropriate.


Instruction: Generate impression based on findings.

Input: Clinical question:? Central lesion resulting in visual field defect. Signs and symptoms: Possible left hemianopia on visual field testing. Nonenhanced brain MRI:Negative diffusion weighted images.There are numerous small foci of flair hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres, minimally in bilateral basal ganglia and pons with abdomen is soft hemorrhagic changes. Although the findings are nonspecific this appearance is often result of microvascular chronic ischemic strokes. Less likely possibility of demyelinating disease cannot be entirely excluded. Correlate with history and risk factors for both disease processes. There is no detectable cortical, cerebellar or vermian abnormalities.Ventricular system as well as the CSF spaces and cortical sulci remain within normal for stated age. There is no detectable mass in the midline and basal cistern is unremarkable.Signal void the major intracranial arterial branches are identified.Unremarkable calvarium, scalp, orbits and paranasal sinuses.

Output: 1.No acute intracranial process.2.No evidence of mass as these clinically questioned.3.Periventricular, subcortical, basal ganglia and pontine foci of flair hyperintensity although nonspecific the appearance is often result of microvascular ischemic disease. Less likely possibility of demyelinating disease cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: new met, fracture, dislocation History: left elbow pain There is soft tissue swelling predominantly along the dorsal aspect of the forearm. There is also elevation of the fat pads indicating a joint effusion. We see no fracture line. There is a mottled appearance of the coronoid process of the ulna with poor definition of the cortex best seen on the internal oblique view. This corresponds to a focus of increased radiotracer activity on a bone scan in 2015, suggesting metastatic disease. If further evaluation is clinically warranted, MRI may be obtained.

Output: 1.Soft tissue swelling and joint effusion without fracture.2.Findings suggestive of metastatic disease to the proximal ulna. MRI may be helpful for further evaluation, if clinically warranted.


Instruction: Generate impression based on findings.

Input: 66-year-old female patient with Crohn's disease and fistula in 6/2015. Evaluate for perianal Crohn's disease. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered small mesenteric lymph nodes.BOWEL, MESENTERY: There is an 8 cm segment of rectum and distal sigmoid colon with mild wall thickening and increased edema signal that extends to the anal verge with enhancement. The ischiorectal fat is indurated and there is an enhancing left anterior transsphincteric perianal fistula that extends from the 2:00 position to the left perineum (series 9 image 76). There is also a blind ending tract extending from the anterior anus, 12:00 position (series 9 image 74).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left anterior transsphincteric perianal fistula extending to the left perineum.2.Blind ending tract from the anterior anus.3.Active inflammatory changes of the rectosigmoid colon compatible with history of Crohn's disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Anesthesia of skinClinical question: please do dr Javed MS protocol and compare to priorSigns and Symptoms: numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of partial empty sella.There is redemonstration of multiple T2 and FLAIR hyperintense punctate lesions in the subcortical and periventricular white matter which were also present on the previous exam. They tend to be hypointense on T1. They appear to have been present on the prior exam and not substantially changed in number or location. However, they're more conspicuous on the current exam. The conspicuity may be explained in part due to differences in MR acquisition technique.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is redemonstration of multiple periventricular and subcortical white matter lesions which are nonspecific but compatible with the patient's clinical history of demyelinating disorder. They appear stable when compared to the prior exam in number and location. Differences in conspicuity may be accounted for on the basis of differences in MR acquisition technique.


Instruction: Generate impression based on findings.

Input: 9 months Female (DOB:6/4/2015)Reason: is there any evidence of tumor or aqueductal stenosis? History: child with NF1 and very large head but soft anterior fontanelle.PROVIDER/ATTENDING NAME: JAMES H. TONSGARD JAMES H. TONSGARD The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for aqueduct stenosis or intracranial mass lesion. No stigmata for neurofibromatosis are appreciated on the current exam.


Instruction: Generate impression based on findings.

Input: 48-year-old female status post left triple wire localization lumpectomy and sentinel lymph node biopsy in September 2015 after neoadjuvant chemotherapy, final pathology showed DCIS grade 3, 0 out of 7 nodes ypTisN0). There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Seroma cavity is seen in the left central breast measures 52 x 32 mm. No abnormal enhancement noted around the seroma cavity. Redemonstrated is a focus of enhancement in the central left breast around 6:00 position.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Postoperative changes in the left breast.No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 59-year-old male with prostate cancer. PSA 7.2. Adenocarcinoma right medial mid gland, Gleason 3 + 3 = 6. PELVIS:Evaluation is moderately degraded by artifact from right hip prosthesis.PROSTATE:Prostate Size: 4.9 x 3.4 cm.Peripheral Zone: No suspicious peripheral zone lesion is identified.Central Gland: Nodules in the central gland demonstrate benign morphology without suspicious characteristics. No suspicious lesion is identified.Seminal Vesicles: No significant abnormality is identified.Extracapsular Extension: No significant abnormality is identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No candidate lesions are identified for patient's known prostatic adenocarcinoma.