Instruction: Generate impression based on findings.

Input: There are multiple scattered T2 hyperintense foci in the cerebral white matter, which appear to be similar in number and extent, accounting for differences in technique. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple scattered nonspecific T2 hyperintense foci in the cerebral white matter appear to be similar in number and extent, accounting for differences in technique.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Low back pain radiating to the left leg. There is disc desiccation and bulge at L4-L5 with superimposed disc extrusion that extends into the left lateral recess with impingement upon the descending left L5 nerve roots. There is no significant neural foramen stenosis. There are trace effusions in the L4-L5 facet joints bilaterally with an associated subcentimeter posterior right synovial cyst. There is mild loss of the usual lumbar lordosis. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Disc desiccation and bulge at L4-L5 with superimposed disc extrusion that extends into the left lateral recess with impingement upon the descending left L5 nerve roots.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: Are there brain metastases? History: Hearing loss. Left sided ear fullness. Vertigo. Dysequilibrium. Metastatic cancer There is single restricted diffusion lesion on the left cerebellar hemisphere without evidence of hemorrhagic conversion (series 4, image 8) indicating acute ischemic infarction.Underlying brain shows non specific small vessel ischemic disease. There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on bilateral ethmoid sinuses, frontal sinus and left maxillary sinus.

Output: 1. Acute ischemic infarction on the left cerebellar hemisphere without evidence of hemorrhagic conversion.2. Non specific small vessel ischemic disease.3. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with metastatic melanoma. Signs and symptoms: Numbness, weakness bilateral lower extremities (left greater than right). Pre-and post-enhanced lumbar MRI:This examination extends from T10 inferiorly through S3 and demonstrates no evidence of osseous or leptomeningeal enhancement.Lower most visualized thoracic spine and thoracic cord is unremarkable with the exception of mild degenerative changes.T12 -- L1 demonstrate moderate disk disease and loss of disk height without spinal stenosis or neural foraminal compromise.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foramina compromise.L2 -- L3 demonstrate mild degenerative changes and unremarkable otherwise.L3 -- L4 demonstrate mild disk disease and loss of disk height and mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis. Mild to moderate left neural foraminal compromise.L4 -- L5 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral facet and ligamentum flavum hypertrophy, mild bilateral widening of the facet spaces and with facet effusion. There is mild central spinal stenosis and moderate bilateral neural foraminal compromise.L5 -- S1 demonstrate moderate to advanced disk disease and loss of disk height, mild to moderate the right and mild left facet and ligamentum flavum hypertrophy. There is a central and left lateral disk protrusion projecting into the ventral epidural space with resultant left lateral recess compromise. No central spinal stenosis. Degenerative changes at this level results in significant (left greater than right) neural foraminal compromise.Unremarkable paraspinal soft tissues.

Output: 1.No evidence of osseous or leptomeningeal metastases.2.Mild-to-moderate degenerative changes of disks and the posterior elements with resultant mild central spinal stenosis only at L4 -- L5 level.3.Multiple levels of neural foramina compromise more significantly at L5 -- S1 bilaterally.4.Disk protrusion at L5 -- S1 with resultant mild left lateral recess compromise.


Instruction: Generate impression based on findings.

Input: Female, 75 years old, with seizures. Evaluate for brain metastases, subclinical status in the bifrontotemporal regions. Image quality is degraded by motion artifact. Within this limitation, no edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is observed. There are a few very small scattered foci of FLAIR hyperintensity which are nonspecific. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricles and sulci are slightly prominent compatible with mild underlying volume loss.

Output: Within the limitations of a motion degraded examination, no evidence of brain metastases or any other specific finding is seen to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: History of breast cancer. Headache status post tumor resection. There are postoperative changes related to bilateral frontal craniotomy for resection of a lesion in the cingulate gyrus in the right posterior frontal lobe. There is resection of much of the solid component medially with residual lobular enhancement at the anterior, lateral and posterior margin of the resection cavity. There is slightly increased surrounding vasogenic edema. The tumor minimally extends across the midline and likely through the falx to the left. There is redemonstration of additional supratentorial and infratentorial enhancing lesions consistent with metastatic lesions. There is a second superficially located left frontal metastatic tumor with enhancement measuring approximately 11 mm, previously 12 mm, with minimal surrounding edema and regional mass effect. A third smaller metastatic lesion abutting the right falx in the left posterior parietal region measures 8 mm, previously 9 mm, with mild surrounding edema and mild mass effect.There is a parenchymal metastatic lesion in the right posterior cerebellum measuring 10 mm, previously 10 mm, without surrounding edema or appreciable mass effect. Ventricular system is within normal limits and without midline shift. The signal void of major intracranial arterial branches are identified. Calvarium is unremarkable without detectable abnormal enhancement. Paranasal sinuses demonstrate a small retention cyst in the dependent portion of right maxillary sinus and unremarkable otherwise.

Output: Postoperative findings related to subtotal resection of a right posterior frontal cingulate gyrus lesion. No significant interval change in the size of the multiple other supratentorial and infratentorial metastatic lesions.   I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, complaining of low back pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen.The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.Incidental note is made of small multicystic kidneys. There are more cysts now when compared to the prior examination.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L3-4: No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes. L4-5: Mild facet arthropathy. No significant spinal canal or neuroforaminal narrowing. No interval changes. L5-S1: Mild facet arthropathy. Minimal foraminal narrowing bilaterally. No significant spinal canal stenosis. No interval changes.

Output: No significant spinal canal stenosis is seen. Only minimal foraminal narrowing is evident at L5-S1, unchanged from prior. Multicystic appearance of the kidneys has progressed from prior.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for mets, staging of tumor History: Breast Ca MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple marrow replacing lesions throughout the calvarium. The largest one is adjacent to the superior sagittal sinus and is associated with some mild displacement of the superior sagittal sinus inferiorly. It measures approximately 36 by 10 mm sagittal dimensions and appears to have an epidural component.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment. The cervical spinal cord has normal signal characteristics and overall morphology. There are multiple marrow replacing lesions present throughout the cervical spine with near complete marrow replacement at C4, C5 and C6. There is mild loss of vertebral body height at C4.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There are endplate osteophytes and uncovertebral osteophytes at this level appear to be old but worse on the right side versus the left where there is narrowing of the right neural foramen.At C3-4 there is loss of disk space height and endplate osteophytes with bilateral narrowing of neural foramina and partial effacement of spinal fluid ventral, but not posterior to the spinal cord. There is a an infiltrating enhancing lesion extending into the left neural foramen and encroaching on the left-sided exiting nerve root at this levelAt C4-5 there is loss of disk space height, endplate osteophytes and bilateral uncovertebral osteophytes resulting in narrowing of neural foramina - right worse than left - with partial effacement of spinal fluid ventral, but not posterior to the spinal cord. There is encroachment of right-sided exiting nerve roots and to a lesser degree left-sided exiting nerve roots at this level. There is a an infiltrating enhancing lesion extending into the left neural foramen and encroaching on the left-sided exiting nerve root at this level and displacing the left vertebral artery.At C5-6 there is loss of disk space height and endplate osteophytes with mild bilateral narrowing of neural foramina. There is no significant compromise to the spinal canal or neural foramina. There is a an infiltrating enhancing lesion extending into the left neural foramen at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. There is a compression fracture present at T12 with mild retropulsion into the spinal canal.There are multiple marrow replacing lesions throughout the thoracic spine worse at T3 through T6. There is epidural extension of tumor extending from the C3-4 to the T5-6 level and resulting in spinal stenosis at the T5 vertebral body level with effacement spinal fluid compression of the spinal cord. There is additional infiltration of the neural foramina bilaterally at the C4-5, C5-6 and C6-7 and T7-T8.There is an infiltrating lesion extending into the right neural foramina at the T11-T12 and T12-L1 levels and affecting the exiting nerve roots appear infiltrating lesions extending to the left neural foramina at T9-10.There are small bilateral pleural effusions present

Output: 1.There are multiple marrow replacing lesions scattered throughout the cervical spine and thoracic spine. 2.There is associated epidural extension of the tumor into the spinal canal from the T3-4 disk space level to the T5-6 disk space level with spinal stenosis from epidural extension at the T5 vertebral body level. There is also associated multilevel neural foramen encroachment throughout the thoracic spine as detailed above.3.There a malignant compression fracture present at T12.4.There is a combination of degenerative changes present in the cervical spine and metastatic disease in the cervical spine resulting in mild spinal stenosis at C4-5 and there is muultilevel neural foramina encroachment present due to infiltrating tumor at multiple levels as detailed above.5.There are multiple calvarial-based lesions throughout the skull one of which displaces the superior sagittal sinus. There are no brain parenchymal metastases appreciated however.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 7.Bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: Stated history of anal fistula with bleeding. PELVIS:UTERUS, ADNEXA: The uterus is normal in morphology and size. The uterus measures 6.8 x 2.9 cm in sagittal plane. The endometrial cavity/fluid is normal in signal intensity and thickness. The inner myometrium/junctional zone is normal in thickness measuring 6 mm. No discrete uterine mass. The parametrial soft tissues and vaginal canal are unremarkable.There are numerous predominantly peripheral ovarian follicles which are mildly prominent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a very thin fluid tract extending from approximately the 3:00 of the lower anal canal extending inferiorly in the intersphincteric space and terminating along the left gluteal cleft. This is associated with mild restricted diffusion and postcontrast enhancement. No associated fluid collection. There are small adjacent vessels.There is suggestion of mild hyperenhancement of the visualized rectosigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Intersphincteric low perianal fistula terminating along the left gluteal cleft without associated fluid collection.2. Suggestion of colitis involving the visualized rectosigmoid colon; correlate for potential inflammatory bowel disease. 3. Numerous predominantly peripheral ovarian follicles which are mildly prominent; correlate for clinical signs and symptoms of polycystic ovarian syndrome.


Instruction: Generate impression based on findings.

Input: 26 years, Male, brain biopsy planning.. Examination is limited to sequences for operative planning and intraoperative navigation. Fiducial markers are in place. Again seen are intensely enhancing masses involving the left cingulate gyrus as well as more posteriorly in the precuneus of the left parietal lobe. There is surrounding edema which is minimally increased since prior. Masslike T2 signal abnormality involving the bilateral posterior corpus callosum body is also again seen. Additional nonenhancing foci of T2 hyperintensity involving the bilateral frontal and parietal lobes are also again seen with focus in the left frontal lobe appearing slightly more confluent with the vasogenic edema more posteriorly. These areas demonstrated restricted diffusion previously. Mass effect including downward displacement of the corpus callosum and partial effacement of the lateral ventricles again seen. There is minimal rightward midline shift at the level of the cingulate gyrus with no significant midline shift at the level of the foramen of Monro or evidence of uncal herniation. No hydrocephalus.

Output: Examination for operative planning again demonstrating enhancing left frontal and parietal masses with additional smaller nonenhancing lesions. There is minimal interval increase in edema when compared to 5/26/2016. Lymphoma is again very high in the differential.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are left digital mammographic images (3/9/15), ultrasound images of left breast (3/9/15), right digital mammographic images (3/11/15, 4/28/15), ultrasound images of right breast (3/11/15), images from ultrasound-guided biopsy of left breast and postprocedural left digital mammographic images (3/11/15), breast MRI (3/20/15) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (10/24/15, 11/5/14), ultrasound images of right breast (11/5/14) are available. LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/9/15):The breast parenchyma is heterogeneously dense. A spiculated mass is present in the retroareolar region, measuring 2 cm. A nipple retraction is associated. No suspicious calcifications are seen in the left breast.ULTRASOUND IMAGES OF LEFT BREAST (3/9/15):An irregularly shaped hypoechoic mass is present at retroareolar region measuring 12 x 10 x 15 mm. The mass is attached to the nipple. A few normal appearing lymph nodes are seen in the left axilla.RIGHT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15, 4/28/15):The breast parenchyma is heterogeneously dense. Three circumscribed round masses are present at upper outer quadrant, likely cysts. They are confirmed benign cysts on the Utrasound study (3/11/15) and MRI (3/20/15). The asymmetry, measuring 2 cm, at posterior superior aspect on ML and MLO view. In addition, there is a cluster of amorphic calcifications at posterior lower outer quadrant in the right breast, seen on the magnification views on 4/28/15. Those two lesions need additional work-up.ULTRASOUND IMAGES OF RIGHT BREAST (3/11/15):Two simple cysts at 9:00 position-10:00 position are present in the right breast, corresponding to the mammographic findings.IMAGES FROM ULTRASOUND-GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT DIGITAL MAMMOGRAPHIC IMAGES (3/11/15):Ultrasound guided needle biopsy was performed for the left retroareolar mass, with appropriate needle placement. Postprocedural left on graphic images show a marker clip within the left retroareolar mass.Per outside report, the result was malignant.BREAST MRI (3/20/15):Breast MRI was performed with a protocol outlined in the outside radiology report.Known carcinoma is visualized at left retroareolar region as a spiculated mass measuring 26 x 18 x 31 mm (AP x LR x CC). The mass abuts the nipple, which is enhancing with this mass, suspicious for invasion.A linear non-mass enhancement, measuring 21 x 6 x 11 mm, is seen in the right breast at far posterior upper outer quadrant. This enhancing lesion likely corresponds to the asymmetry on the mammogram.Three simple cysts are seen in the right breast.No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven left breast malignancy, suspicious for invading to the nipple.2. Linear enhancing lesion in the right far posterior upper outer quadrant. This lesion could correspond to the asymmetry on mammogram. Additional work-up for right breast, including the asymmetry at posterior upper outer quadrant and cluster of calcifications at lower outer quadrant is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 70 years Male (DOB:7/7/1946)Reason: Eval grade 2 astrocytoma. Pt on CCNU. History: grade 2 astrocytoma.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is T2 and FLAIR signal hyperintensity involving right basal ganglia, thalamus, insular cortex and adjacent right frontal lobe which extends to involve gray and white matter of the insular cortex and right orbital gyrus and right inferior frontal gyrus as well as the anterior aspect of the right temporal lobe. It does not display any contrast enhancement. On the current exam there is new T2 signal hyperintensity which extends further superiorly and posteriorly into the right frontal lobe white matter and further posteriorly in the right temporal lobe white matter. This is a new T2 signal hyperintensity is higher signal than the rest of the lesion. There is an associated cystic component measuring 35 x 28 mm axial dimension in size within which on the March exam measured 12 x 17 mm axial dimensions. There is an enhancing component which is enlarged relative to the prior exam and encircles a cystic component. It measures 52 x 42 mm axial dimensions on the current exam and previously was rather patchy. The enhancing component demonstrates elevated cerebral blood volume.The patient status post right frontal craniotomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and mucosal thickening elsewhere in the paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is an infiltrating mass involving right frontal lobe, anterior temporal lobe, insular cortex, right thalamus and basal ganglia. Since the prior exam T2 and FLAIR signal hyperintensity associated with the lesion has progressed. It is possible this represents vasogenic edema with or without tumor infiltration. Additionally, the contrast enhancing component of the lesion associated with a cystic lesion which has enlarged since the prior exam and is associated with elevated blood volume suggesting recurrent higher grade infiltrating astrocytoma.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: osteomyelitis History: same No significant skin thickening is evident. There is diffuse reticulation of the subcutaneous fat, particularly along the lateral aspects of both thighs compatible with edema. There is also diffuse symmetric intramuscular and intermuscular edema of the bilateral upper thighs. No drainable fluid collection is evident.There is no joint effusion. The bone marrow signal is normal, and there is no evidence of osteomyelitis. Focus of gas within the bladder likely reflects prior presentation.

Output: Nonspecific edema of the subcutaneous fat and muscular compartment of both thighs, without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: assess for strokes History: right sided weakness and expressive aphasia Brain MRIThere are scattered restricted diffusion areas involving left basal ganglia and frontal and parietal lobe especially left inferior lobule indicating acute ischemic infarct. There is no evidence of susceptibility lesions within the restricted diffusion area indicating no MR evidence of hemorrhagic conversion.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate more than 90% segmental stenosis of the left MCA proximal M1 segment. In addition, there is a suspicious about 50-70% of luminal stenosis on the left internal carotid artery cavernous sinus segment.There are multifocal luminal narrowings involving proximal right MCA M1 segment and proximal right MCA M2 segment.Constellation of above findings indicate intracranial arthrosclerotic disease with significant (more than 70%) arterial luminal stenosis at right MCA proximal M1 segment. Though the possibility of partially recanalized embolus cannot be completely excluded.Vertebrobasilar system appears to be normal.

Output: 1. Acute ischemic infarct without evidence of hemorrhagic conversion involving left basal ganglia, left frontal lobe and left parietal lobe which is left MCA territory.2. Intracranial arthrosclerosis are seen with the multifocal areas degree arterial luminal stenosis. In particular, left MCA proximal M1 segment shows more than 90% luminal segmental stenosis. Differential diagnosis of this stenosis include partially recanalized embolus.


Instruction: Generate impression based on findings.

Input: Pain. Question of rotator cuff tear. ROTATOR CUFF: No rotator cuff tear is identified.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: No evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Left pulsatile tinnitus. Signs and symptoms: Left pulsatile tinnitus. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates few tiny foci of flair hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres which appear more conspicuous compared to prior study. Although nonspecific considering patient's stated age of 71 findings are suspected of very mild chronic nonhemorrhagic small vessel ischemic strokes.The anatomical morphology as well as the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences. Unremarkable study cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified. There is uniformly smaller size of basilar artery which is believed to be secondary to presence of prominent posterior communicating arteries. Unremarkable calvarium and soft tissues of the scalp. Unremarkable orbits, paranasal sinuses and mastoid air cells.Post-enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the orbits.Pre-and post-enhanced brain MRA:The visualized aortic arch and the origins of major vessels are unremarkable.Unremarkable brachial cephalic and bilateral subclavian arteries.Patent and unremarkable bilateral vertebral arteries and including their origins.Patent bilateral common carotid arteries, bilateral internal carotid arteries as well as the external carotid arteries.Minimal vascular lumen irregularity of the left upper cervical internal carotid artery which could represent atherosclerotic disease. There is no evidence of vascular lumen compromise.

Output: 1.Pre-and post-enhanced brain MRI demonstrate no evidence of acute intracranial process. Findings suggestive of very mild nonhemorrhagic chronic small vessel ischemic strokes.2.Unremarkable neck MRA.


Instruction: Generate impression based on findings.

Input: 64 years, Female, Reason: NF1 History: unsteadiness. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss slightly prominent for age. Encephalomalacia is also noted involving the left inferior cerebellar hemisphere as well as evidence of chronic infarct involving the left dorsal medulla. There is small focus of gliosis involving the left anterior aspect of the gyrus rectus. Focus of cortical encephalomalacia is also noted in the left anterior temporal lobe. There is susceptibility effect compatible with chronic blood products involving the foci in the left inferior frontal lobe and the left cerebellum compatible with chronic hemorrhage. Several additional foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease and stable to minimally progressed since 6/8/2009.. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Prominent enhancing soft tissue is noted involving the suboccipital and upper cervical posterior paraspinous soft tissues which may represent a large neurofibroma or perhaps enhancing soft tissue related to prior surgery if there is such history. There is susceptibility artifact related to previously seen coiled embolization involving the left vertebral artery aneurysm at the C1 level.There appears to be enlargement involving the left optic nerve which is not well evaluated but grossly similar to 6/8/2009. Minimal mucosal thickening in the paranasal sinuses.Cervical spine: There is evidence of dural ectasia with scalloping involving the dorsal aspect of the cervical vertebral bodies. There are degenerative changes with small disc osteophyte complexes, relatively more prominent at the C3-C4, and C5-C6 levels, with no evidence of spinal canal stenosis at any level. Differences in technique limit comparison however there is stable to slight enlargement of T2 signal abnormality involving the dorsal aspect of the cervical cord in the midline at the C4-C5 level compared to 6/8/2009. Unchanged exaggerated lordosis of the cervical spine.Left vertebral artery flow-void is severely diminished with evidence of stenosis and prior coil embolization for aneurysm better assessed on prior CT angiogram.No appreciable masses involving the cervical spinal canal or neural foramina to suggest neurofibromas.Multiple small neurofibromas involving the subcutaneous soft tissues are seen with the large lesion extending from the suboccipital soft tissues to the lower C2 level. There is mild right-sided neural foraminal narrowing at the C5-C6 level.

Output: 1. Again seen is evidence of multiple infarcts including the left cerebellum and left dorsal medulla with additional areas of cortical injury involving the left inferior frontal lobe and left anterior temporal lobe. There is also evidence of chronic small vessel ischemic disease which appears stable to minimally progressed since 6/8/2009. No evidence of acute infarct or intracranial mass effect.2. Suspected mild enlargement of the left optic nerve which appears to be present on prior studies. This finding is not well evaluated on this brain MRI study however given history of NF 1 raises suspicion for an optic glioma. Dedicated orbital MRI may be considered for better assessment if clinically indicated.3. Stable to slight enlargement of nonenhancing T2 cord signal involving the cervical cord at the C4-C5 level in the midline compared to 6/8/2009. Finding may represent sequela of prior injury but is nonspecific. No masses involving the cervical spinal canal or neural foramina to suggest neurofibromas. No evidence of spinal canal stenosis at any level.4. Prominent enhancing soft tissue involving the suboccipital and upper cervical posterior paraspinous soft tissues presumably representing a neurofibroma and similar to prior from 2009. 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 PNET status post Whipple (11/2015) with hepatic masses. ABDOMEN:LIVER, BILIARY TRACT: Susceptibility artifact from coils in the right hepatic lobe, cholecystectomy clips, and common bile duct stent.Unchanged, 6.2 x 6.0 cm arterially enhancing mass in hepatic segment eight with a central scar that is T2 hyperintense and demonstrates delayed enhancement compatible with focal nodular hyperplasia. A smaller, adjacent segment 8 arterially enhancing lesion is also unchanged and may represent a focal nodular hyperplasia. Redemonstrated are segment 3 and segment 6 lesions compatible with hemangiomas, unchanged. Two segment 2 lesions are again noted compatible with hemangiomas, unchanged.Moderate intrahepatic biliary ductal dilation in the left liver lobe, increased from the prior examination. Cavernous transformation of the portal vein is again noted. Paraesophageal and gastric varices. SPLEEN: Spleen size is top normal. Splenic vein thrombosis. PANCREAS: Postsurgical changes in the head of the pancreas. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense cyst. No hydronephrosis or mass lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diastasis of the abdominal musculature.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the pelvis. Bilateral adnexal cysts likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple hepatic lesions with the largest lesion in hepatic segment 8, unchanged and compatible with FNH. 2.Additional hepatic lesions are unchanged as detailed above. 3.Interval increase in intrahepatic ductal dilation, raises concern for stent patency; correlation with patient's clinical history and laboratory values recommended. 4.Other findings as above.


Instruction: Generate impression based on findings.

Input: History of right intraocular retinoblastoma s/p intraocular chemotherapy x 2: disease status evaluation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is a lesion that measures approximately 2 x 6 mm in cross section along the posterolateral aspect of the right globe, which is not significantly changed. The right optic nerve appears to be intact and the rest of the right intraorbital structures appear to be unremarkable. The left orbit appears to be unremarkable.

Output: 1. Unchanged treated subcentimeter right intraocular retinoblastoma. 2. No evidence of left orbital tumor.3. No evidence of intracranial tumor to suggest trilateral retinoblastoma.


Instruction: Generate impression based on findings.

Input: History of surgery for pituitary tumor, yearly follow up for change. There is a T2 hyperintense, enhancing lesion within the right anterolateral aspect of the sella, which displaces and compresses the normal pituitary tissue posteriorly, and measures up to 12 x 11 x 9 mm in the AP, transverse, and craniocaudal dimensions. There is no significant change in size allowing for differences in technique. The lesion bulges slightly into the medial aspect of the right cavernous sinuses and abuts the supraclinoid portion of the right internal carotid artery, without clear evidence of cavernous sinus invasion. There is no mass effect upon the optic apparatus. The pituitary infundibulum is intact, but displaced to the left, as before. The posterior pituitary bright spot is diminished but present. Limited evaluation of the brain again demonstrates scattered foci of T2 hyperintensity in the white matter which are nonspecific but compatible with mild small vessel ischemic disease.

Output: Enhancing pituitary mass involving the right anterior lateral aspect of the sella demonstrates no significant change in size since 1/21/2015 and is compatible with residual macroadenoma. There is interval increased enhancement evident within this lesion, which is favored to be related to differences in contrast dose and timing.


Instruction: Generate impression based on findings.

Input: History of gallstone pancreatitis and pancreatic pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Mild central intrahepatic and extrahepatic ductal dilatation. The duct tapers smoothly in the pancreatic head without a discrete mass lesion or filling defect suggesting a benign stricture.No suspicious hepatic lesion. The hepatic vasculature is patent.SPLEEN: The spleen is normal in size. Chronic thrombosis of the splenic vein with collateral vessel formation. There is a stable arterial enhancing lesion measuring 2.6 cm (series 16/52) and the anterior aspect of the spleen which demonstrates T1 weighted isointensity and T2 weighted hypointensity relative to the spleen. This is nonspecific but may represent a sclerosing angiomatoid nodular transformation of the spleen.PANCREAS: Findings suggesting pancreas divisum. Demonstrated again is marked atrophy, decreased intrinsic T1 weighted signal and postcontrast enhancement of the pancreatic neck, body and tail. The pancreatic head is relatively preserved.The pancreatic duct is mildly prominent tortuous and irregular in contour likely reflecting multifocal strictures of chronic pancreatitis. Smooth focal pancreatic ductal narrowing at the pancreatic neck/body. Numerous cystic foci throughout the pancreas likely represent dilated side branch ducts related to chronic pancreatitis and less likely IPMNs.The 1.5 cm simple cystic lesion in the pancreatic head may represent a dilated side branch and is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable findings consistent with chronic pancreatitis with relative sparing of the pancreatic head. The multiple cystic foci likely represent dilated side branch ducts due to multifocal stricturing of the main pancreatic duct and are not significantly changed; small IPMNs without suspicious imaging features cannot be entirely excluded. No evidence of acute inflammation or significant drainable fluid collection. Findings suggesting pancreas divisum. No suspicious pancreatic lesion is evident. Stable additional findings as above.


Instruction: Generate impression based on findings.

Input: Reason: vertigo with vertical nystagmus, headache; eval brainstem ischemia History: s/p nephrectomy, s/p stem cell tx for multiple myeloma. MRI of the brainNo diffusion weighted abnormalities are appreciated. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. 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. There is mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is no evidence for intracranial aneurysm or cerebrovascular occlusion. There is no evidence of abnormality within the anterior posterior arterial circulation. The vertebrobasilar system appears normal, with patent vertebral arteries, PICAs, AICAs, SCAs, and PCAs bilaterally.

Output: Normal MRA and MRI of the brain. No pathologic findings to explain patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of known benign brain/calvarial tumor. Vision changes and motor impairment. There is a destructive calvarial mass involving the left greater than right parietal calvarium measuring 4.5 x 5.9 x 3.1 cm in the AP, transverse, and craniocaudal dimensions. Mass is predominantly low on T1 and T2 weighted images with small areas of cystic change and diffuse enhancement. There is mild mass effect on the adjacent brain parenchyma which includes the left pre and post central gyri. There is also mass effect on the adjacent cortical veins and superior sagittal sinus which is otherwise patent. There is an additional subcentimeter lesion which demonstrates T1 hyperintensity more inferiorly in the midline seen on the sagittal T1-weighted images. No additional enhancing calvarial lesions however are appreciated. Images of the brain parenchyma demonstrate no abnormal parenchymal or meningeal enhancement to suggest intracranial metastatic disease. No other intracranial mass or mass effect. No midline shift or uncal herniation. No extra-axial collections or hydrocephalus. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild age-related white matter changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Sella and orbits are grossly unremarkable.

Output: 1. Destructive calvarial mass measuring 4.5 x 5.9 x 3.1 cm involving the left greater than right posterior parietal calvarium. There is mass effect on the underlying brain parenchyma which includes the medial aspect of the left pre and post central gyri. No associated intraparenchymal edema. Mass is reportedly benign per medical records and signal features are compatible with a benign osseous lesion such as fibrous dysplasia; recommend correlation with CT however to make this determination.2. No abnormal enhancement within the brain is seen to suggest intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Multiple myeloma not having achieved remission [C90.00], Reason for Study: ^Reason: New dx MM, lumbar vertebral fracture, eval for disease burden History: see above C-Spine:Loss of normal cervical lordosis was seen.Spinal cord signal intensity is normal.Multi-level intervertebral disc dessication with osteophytes indicating degenerative changes which includeC23: within normal limitsC34: diffuse bulging of disc with posterior longitudinal ligament calcifications. no spinal canal stenosisC45: Central to left disc protrusion which abuts thecal sac and shows mild spinal stenosis.C56: diffuse bulging of disc associated with central to left disc protrusion which abuts thecal sac and shows mild spinal canal stenosis.C67: diffuse bulging of disc, otherwise unremarkable.C7T1: diffuse bulging of discThoracic spine:There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. L Spine:There are vertebral body lesions involving L1 and S1 which replacing normal fatty marrow. Especially the S1 lesion shows about10-20% of compression.There is about grade 1 spondylolisthesis of L5 on S1.Degenerative changes show;L1-L2: There is myeloma lesion on the posterior superior aspect of the L1 vertebral body. Otherwise unremarkable.L2-L3: Diffuse bulging of disc.L3-L4: Diffuse bulging of disc.L4-L5: Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild spinal cord stenosis.L5S1: Grade 1 spondylolisthesis of L5 on S1 with pseudobulging of disc results mild spinal stenosis.S1-S2: Diffuse bulging of disc.

Output: 1. Degenerative changes of cervical spine with multilevel various degree spinal canal narrowing. Normal spinal cord signal intensity.2. Normal thoracic spine MRI4. Myeloma involvement of the L1 and S1 vertebral body with pathologic compression fracture of S1.5. Degenerative changes of lumbar spine/Comment: if S1 compression fracture is symptomatic, percutaneous cement augmentation can be considered. If indicated, please contact neurointerventional radiology service.


Instruction: Generate impression based on findings.

Input: Severe right shoulder pain The exam is limited by motion artifact and by the patient's body habitus which prevented the use of an optimal shoulder coil.ROTATOR CUFF: There is thickening and increased signal intensity the supraspinatus tendon indicating moderate tendinosis. There is a 5 mm tear involving the insertional fibers of the anterior supraspinatus tendon which may focally disrupt the bursal surface fibers but this is equivocal. The articular surface fibers appear spared. There is an additional 4 mm tear within the supraspinatus tendon more proximally at the 12:00 position which may also focally disrupt the bursal surface fibers but again this is equivocal. The supraspinatus muscle is normal in signal and caliber.The above-mentioned tendinosis of the supraspinatus extends posteriorly to affect the anterior fibers of the infraspinatus tendon but we see no discrete tear of the infraspinatus tendon. The infraspinatus muscle is normal in signal and caliber. The teres minor tendon and muscle are normal. Small cysts are noted on the humeral head at the insertion of the teres minor which are of doubtful clinical significance. There is increased signal intensity of the distal fibers of the subscapularis tendon indicating insertional tendinosis. There is perhaps minimal fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is more focal edema of the distal clavicle which may be degenerative in nature but could also represent a stress fracture in the appropriate clinical context.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior labrum appears attenuated suggesting degenerative tearing. Alignment of the glenohumeral joint is normal and there is no joint effusion.BICEPS TENDON: Evaluation of the intra-articular portion of the biceps tendon is limited by internal rotation; however within the limits of a non-arthrographic study, the biceps appears intact.

Output: 1. Moderate rotator cuff tendinosis with small focal partial-thickness tears of the supraspinatus tendon that may disrupt the bursal surface fibers.2. Mild osteoarthritis of the acromioclavicular joint with more focal edema of the distal clavicle which may be degenerative in nature but could also represent a stress fracture in the appropriate clinical context.3. Additional findings described above.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], stroke? Infection? Seizure? Mass? Examination is limited by extensive motion artifact. The cortical sulci are in proportion to the cerebral ventricles. The gray-white matter differentiation is preserved. There is no evidence for hydrocephalus. No diffusion abnormality is identified to suggest ischemia. There is no evidence for acute intracranial hemorrhage. Multiple scattered punctate foci of T2/FLAIR hyperintensity are demonstrated in the subcortical and periventricular white matter. There is no midline shift appreciated.

Output: No acute intracranial abnormality. Multiple punctate foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter, greater in number than expected for patient's age. Differential considerations are broad and include demyelinating disease, chronic microvascular ischemic change, and/or inflammatory processes such vasculitis.


Instruction: Generate impression based on findings.

Input: Spinal stenosis 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. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is borderline low at the L2-L3 level. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is mild spinal canal stenosis. There is mild left and minimal right narrowing of the neural foramina. L3-L4: There is a disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening contributing to moderate to severe spinal canal stenosis. There is mild bilateral neural foraminal stenosis. L4-L5: There is disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy with severe spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.L5-S1: Mild disc bulge and bilateral facet arthropathy. No significant spinal canal stenosis. There is minimal narrowing of the neural foramina.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine with severe L4-L5 and moderate to severe L3-L4 spinal canal stenoses. 2. Neural foraminal stenoses is relatively worse at the L4-L5 level where there is mild-to-moderate bilateral neural foraminal stenosis.3. Borderline low conus at the L2-L3 level.


Instruction: Generate impression based on findings.

Input: Reason: eval rotator cuff History: R shoulder pain/weakness ROTATOR CUFF: Although fibers of the supraspinatus tendon can be followed to their insertion on the greater tuberosity, the tendon itself is markedly thinned, to the point of being barely perceptible just proximal to the greater tuberosity, suggesting chronic attritional tearing. Furthermore, the anterior fibers of the supraspinatus tendon are replaced with intermediate signal intensity at their insertion on the greater tuberosity, which we suspect represents a full thickness tear filled with granulation tissue. There is moderate atrophy of the supraspinatus muscle. The infraspinatus tendon can be followed to its insertion on the greater tuberosity, but there is moderate to severe atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. There is increased signal intensity within the distal fibers of the subscapularis tendon, suggesting insertional tendinosis. The subscapularis muscle is unremarkable.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is trace fluid in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe osteoarthritis affects the glenohumeral joint, with flattening and fragmentation of the humeral head medially, as well as with underlying signal abnormality in the marrow indicating osteonecrosis. Deformity of the humeral neck may also reflect sequela of old healed fracture. We see no glenohumeral joint effusion. There is degenerative tearing of much of the labrum. BICEPS TENDON: Evaluation of the tendon of the long head of the biceps is limited due to lack of intraarticular contrast, but the tendon is grossly intact.

Output: 1. Severe osteoarthritis of the glenohumeral joint with deformity and fragmentation of the underlying humeral head suggesting prior fracture and avascular necrosis. 2. Marked thinning of the supraspinatus tendon likely reflects chronic attritional tearing, with findings suspicious for full-thickness insertional disruption of the anterior fibers. 3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: There is no diffusion abnormality. There are many punctate and oval T2/FLAIR hyperintense foci within the periventricular white matter, brainstem, and cerebellum. Some of these are oriented perpendicular to the long axis of the lateral ventricles. A lesion within the right posterior parietal lobe demonstrates corresponding T1 hypointensity. There is no significant mass effect, midline shift or herniation. No abnormal enhancement is identified. The ventricles and sulci are are prominent age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRA HEAD

Output: 1.Multiple T2/FLAIR hyperintense foci within the white matter including involvement of the cerebellum, suspicious for demyelinating disease. There is mild T1 burden and moderate T2 burden of disease, with infratentorial involvement. No evidence of acute infarct.2.Patchy T2 hyperintensity within the cervical spinal cord, probably also demyelinating disease.3.Mild cervical spondylosis.4.Normal MRA of the head and neck.


Instruction: Generate impression based on findings.

Input: 39-year-old female with left knee pain and swelling. Evaluate meniscus tear versus ligamentous injury Motion artifact limits examination. The high definition coil could not be utilized secondary to patient's body habitus resulting in slightly suboptimal image quality.MENISCI: The lateral meniscus appears intact. There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There are foci of increased signal abnormality which extend to the tibial articular surface consistent with undersurface fraying. There is no linear signal abnormality which extends to either articular surface or fluid filled defects to suggest an unstable tear.ARTICULAR CARTILAGE AND BONE: Suboptimal evaluation of the articular cartilage of the patellofemoral joint articular cartilage secondary to the aforementioned limitations. No overt full-thickness or near full-thickness articular cartilage defects are identified. Heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow. There is increased signal abnormality within the posterior aspect of the tibial plateau with a subcentimeter focus of fluid signal intensity at the insertion site of the PCL which may reflect degenerative signal abnormality.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is mild increased signal abnormality within the distal fibers of the patellar tendon just proximal to its insertion on the tibial tubercle which may reflect a very mild tendinosis.ADDITIONAL

Output: 1. Undersurface fraying and degeneration of the medial meniscus as described above.2. Small joint effusion.


Instruction: Generate impression based on findings.

Input: 49 year old woman with a history of possible adriamycin cardiomyopathy and prior history of breast cancer. She presents with fatigue and is referred to rule out ischemia and evaluate cardiac structure and function.MEDICATIONS: aspirin, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact was noted on the basal slice.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 64 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with normal systolic function. The shape of the right ventricular base is distorted by compression from the sternum; however, there is no evidence that this is causing a hemodynamic problem. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 112 ml/m2 (normal range 69+/-14), the RVEDV is 185 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMild sternal deviation (but enough to describe it as pectus excavatum) is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate LV dilation with normal wall thickness and systolic function (LVEF 62%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Moderate RV dilation with normal systolic function (RVEF 57%). The shape of the right ventricular base is distorted by compression from the sternum; however, there is no evidence that this is causing a hemodynamic problem. 5. Moderate biatrial dilation.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma of the right pterygopalatine fossa with right V 2 numbness. Pituitary: The pituitary gland is normal in size and displays normal signal and enhancement characteristics. There is no evidence of mass lesions within the pituitary gland or elsewhere in the sella. The optic apparatus is intact. However, there is enhancing tumor within the right cavernous sinus extending from the right foramen rotundum and pterygopalatine fossa. Brain: There is no evidence of intracranial hemorrhage or acute cerebral infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. No evidence of pituitary gland lesions.2. Perineural tumor spread along the second division of the right trigeminal nerve into the cavernous sinus.


Instruction: Generate impression based on findings.

Input: Memory decline. Assess for structural cause. There is mild diffuse cerebral and cerebellar volume loss. There are mmild scattered foci of subcortical and periventricular white matter T2 hyperintensity. There is also a punctate focus of susceptibility in the right occipital lobe compatible with a small prior microhemorrhage. There are mildly prominent perivascular spaces in the bilateral basal ganglia. There is no evidence of acute intracranial hemorrhage, mass, or acute infarction. The expected intracranial vascular flow voids are present. There is mild scattered paranasal sinus mucosal thickening and retention cyst in the right sphenoid sinus. There are bilateral lens implants.

Output: 1. Mild scattered cerebral white matter T2 hyperintensities which are nonspecific, but likely represent chronic small vessel ischemic disease.2. Nonspecific diffuse cerebral and cerebellar volume loss. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with personal history of benign left breast biopsy in 2012. She has family history of breast cancer in a paternal cousin diagnosed in her 40s She presents with lumps in the right axilla for about 6 months. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal 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: Pelvic pain The examination is limited by motion artifact and inability to optimally position the patient. Tendons: The gluteus medius and gluteus minimus tendinous insertions on the greater trochanter are intact. The iliopsoas tendon is intact. There is increased signal at the attachment of the right hamstring tendons at the ischial tuberosity although the tendinous insertions appear intact.Joints: The hip joints are normal. The sacroiliac joints appear unremarkable and without evidence of erosion or significant degenerative change. There is increased signal within the right pubic symphysis although no discrete fracture is appreciated. Joint effusion/Bursa: No evidence of joint effusion. No significant trochanteric bursitis present.Muscles: There is diffuse atrophy of the pelvic musculature, particularly the gluteal. Increased signal is seen surrounding the hamstring tendons and there is a focus of increased signal with susceptibility artifact overlying the right posterior thigh representing the area of known decubitus ulceration.Bone marrow: No focal marrow replacing lesions are identified. There is no fracture.

Output: 1. Essentially normal appearance of the sacrum and hips without evidence of acute osseous abnormality.2. Increased signal at the origin of the hamstrings and surrounding the right posterior thigh which is likely reactive given the known decubitus ulceration in the sacrum.


Instruction: Generate impression based on findings.

Input: 63-year-old man with non-small cell lung cancer with metastases to brain. Presented with seizure and right-sided paralysis. No new seizures on medications. Improved right sided strength with Decadron. Evaluate status of brain. The left frontal metastasis (series 2 image 23) now measures 1.0 x 0.8 cm compared to 1.0 x 0.9 cm on study dated 6/30/2008. The amount of peritumoral edema is stable from CT dated 7/31/2008 slightly increased from the study dated 6/30/2008. A smaller left frontal lesion visible on MRI is once again not seen on the CT.The right frontal metastasis (series 2 image 18) now measures 1.2 x 0.8 cm compared to 1.4 x 0.8 cm on the prior study. The amount of peritumoral edema is stable from the study dated 7/31/2000.The left temporal metastasis seen on the MRI is still not clearly visible on CT. The associated peritumoral edema has stable CT appearance from the prior study.The metastatic lesion in the cerebellar vermis is not visible on CT.There is no mass-effect, midline shift, hydrocephalus, or CT evidence of hemorrhage. The ventricles and 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.

Output: 1. Multiple brain metastases with peritumoral edema stable from study dated 7/31/2008. Peritumoral edema remains increased from study dated 6/30/2008.


Instruction: Generate impression based on findings.

Input: BRAIN: There are numerous (greater than 15) supratentorial and infratentorial T2 hyperintense periventricular and subcortical oval as well as punctate white matter lesions predominantly showing high DWI signal without corresponding low ADC signal. However, a few lesions demonstrate a partial peripheral rim of subtle diffusion restriction, located in the right centrum semiovale and medial right periatrial white matter. Overall, there has been interval improvement with decrease in size of multiple lesions including the left brachium pontis lesion, confluent T2 hyperintense lesion in the right centrum semiovale, left frontal lobe subcortical white matter lesion adjacent to the left frontal horn. A large right medullary lesion is also again identified. There is slight increased size of the lesion in the right posterior temporal lobe deep white matter on 601/15 and 701/18 and also involving the diffusion restricting right periatrial lesion.Most of the lesions do not enhance except a lesion adjacent to the atrium of the right lateral ventricle on series 2901 image 15 which did not show enhancement previously, and a lesion in the right centrum semiovale on series 2901 image 21 which showed enhancement previously, correlating with areas of mild diffusion restriction noted above. On delayed post contrast orbital images, there is also suggestion of faint enhancement associated with a right frontal deep white matter lesion as seen on 3401/33.There is no acute infarct. The ventricles and basal cisterns are prominent, consistent with mild global volume loss slightly greater than expected for patient's stated age. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. ORBITS: The globes and extraocular muscles are intact with normal signal intensity and caliber. The lens are not dislocated. The optic sheaths and optic nerves are within normal limits in caliber and signal intensity without enhancement. There is no suspicious enhancement within the orbits. There is no proptosis. The pituitary gland is not enlarged. There is no mass effect on the optic chiasm. The pituitary stalk is midline. The cavernous sinuses are symmetric in enhance normally. There is no enlargement of the superior ophthalmic veins.CERVICAL: There is normal alignment, vertebral body and disk heights, as well as normal osseous marrow and cord signal. There is no suspicious enhancement in the cervical spine. There is no significant disk herniation or spinal stenosis at any level in the cervical spine. There is partial visualization of the focal right medullary demyelinating lesion.

Output: 1.Numerous supratentorial and infratentorial T2 hyperintense white matter lesions consistent with known underlying disease, many of which have decreased in size. Many of these lesions which were enhancing on the prior exam and no longer enhance with the exception of one right centrum semiovale lesion demonstrating persistent enhancement as described above. Associated incomplete diffusion restriction in this location as well as in the right periatrial lesion which demonstrates new enhancement, with additional incompletely evaluated right sided corona radiata enhancing lesion only seen on delayed post contrast orbital images. Slight increased extent of abnormal signal associated a few right-sided supratentorial lesions. Overall, minimal T1 and mild-moderate T2 burden of disease.2.No signal abnormality or enhancement in the optic apparatus or cervical cord to suggest involvement by demyelinating disease.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, 50 years old, with epilepsy, functional MRI requested for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation maps along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the verb generation and sentence completion paradigms. Language laterality is left dominant. Cortical activation representing the putative Broca's area maps as expected to the left inferior frontal gyrus (primarily pars orbitalis). Cortical activation representing the putative Wernicke's area maps as expected along the posterior aspect of the left superior temporal sulcus.

Output: Successful functional MRI for sensorimotor and language mapping. The sensorimotor and visual cortices are identified. Language laterality is left dominant with Broca's and Wernicke's areas identified in their customary locations.


Instruction: Generate impression based on findings.

Input: Right leg pain. There is facet joint arthropathy in the lower lumbar spine and ligamentum flavum thickening with associated mild neural foraminal narrowing at L4-5 and L5-S1 bilaterally, but no significant spinal canal stenosis. There is also a subcentimeter posterior synovial cyst associated with the left L5-S1 facet joint. There is no significant neural foraminal or spinal canal stenosis at the other lumbar spine levels. The lumbar vertebral column alignment is anatomic without subluxations. The vertebral bone marrow signal is unremarkable. The vertebral body heights are maintained. The conus is normal in signal and morphology and terminates at the L1-2 level. There is no intraspinal hematoma or mass. The paraspinal structures are unremarkable.

Output: Facet joint arthropathy in the lower lumbar spine and ligamentum flavum thickening with associated mild neural foraminal narrowing at L4-5 and L5-S1 bilaterally, but no significant spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left C8 radiculopathy. There is straightening of the cervical lordosis, which may relate to patient position. The vertebral bodies are preserved in height. Marrow signal show no suspicious abnormality. There is loss of the disc heights from C3-C4 through C6-C7 associated with disc-osteophyte complexes indenting the anterior aspect of the thecal sac as described below. The spinal cord shows no abnormal signal or significant compression. Major neck vessels are patent. Small lymph nodes in the upper neck are nonspecific.C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Disc osteophyte complex minimally indents the thecal sac. Right more than left uncovertebral and facet proliferative changes result in mild-to-moderate right foraminal stenosis.C4-C5: Disc osteophyte complex mildly narrows the spinal canal. There is mild to moderate bilateral foraminal stenosis by uncovertebral and facet proliferative change.C5-C6: Disc osteophyte complex also mildly narrows the spinal canal. Left more than right uncovertebral proliferative change is associated with severe left and moderate right foraminal stenosis.C6-C7: Disc osteophyte complex causes no significant spinal canal narrowing. Mild uncovertebral and facet reactive change cause mild-to-moderate left and mild right foraminal narrowing.C7-T1: There is a disc bulge that mildly indents the anterior aspect of the thecal sac causing mild narrowing of the canal. There is left more than right facet and uncovertebral proliferative change associated with mild left foraminal stenosis. T1-T2: There is no spinal canal or foraminal stenosis.

Output: Multilevel cervical spondylosis is most pronounced at C5-C6 where there is severe left and moderate right foraminal stenosis. At C7-T1, there is mild left foraminal stenosis. Spinal canal narrowing is at most mild, as described above.


Instruction: Generate impression based on findings.

Input: 74-year-old male. Evaluate for prostate cancer. Most recent PSA was 6.9 on 11/24/2015. He underwent TRUS biopsy on 1/8/2016 which revealed the following: RBM - Gleason 3+3=6 adenocarcinoma of the prostate, 2.0mmRBL - HGPINRMM - Gleason 3+3=6 adenocarcinoma of the prostate, 3.0mmRML - HGPINRAM - Gleason 3+3=6 adenocarcinoma of the prostate, 3.0mmRAL - Gleason 3+3=6 adenocarcinoma of the prostate, 1.0mmLBM - benign prostateLBL - Gleason 3+3=6 adenocarcinoma of the prostate, <1.0mmLMM - small foci of atypical glandsLML - HGPINLAM - benign prostateLAL - benign prostate PELVIS:PROSTATE:Prostate Size: The prostate measures 5.3 cm in transverse, 4.1 cm in AP, and 5.4 cm in length.Peripheral Zone: Suspicious subcentimeter focus in the right paramedian mid gland with ADC and T2 hypointense signal intensity (series 901 image 16, series 503 image 304). Suspicious subcentimeter focus in the right lateral apex with ADC and T2 hypointense signal intensity (series 901 image 10, series 503 image 24). Central Gland: In the anterior midline, there is a dominant lesion demonstrating ADC and T2 hypointense signal intensity (series 503 image 344, series 901 image 18) measuring 18 x 14 mm. There is loss of the capsular margin to the left of the midline (series 901 image 14) concerning for extracapsular extension.Seminal Vesicles: No significant abnormality noted. Extracapsular Extension: As described above.BLADDER: No significant abnormality noted.LYMPH NODES: No suspicious pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant lesion demonstrating ADC and T2 hypointense signal intensity in the anterior midline transitional zone with suspected left paramedian extracapsular extension.2.Suspicious subcentimeter ADC and T2 hypointense signal foci in the right paramedian mid gland and right lateral apex.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:1/8/1952)Reason: evaluate for lumbar disc disease History: left lumbar radiculopathyPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU MAGDALENA ANITESCU Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a left lateral recess and neural foramen disc protrusion present which compresses the nerve root at the left neural foramen and mildly displaces the nerve that the left lateral recess. The nerve root at the left neural foramen is displaced inferiorly and courses along the inferior aspect of the neural foramen; above the nerve root within the neural foramen is foraminal fat. There is also some displacement of the nerve roots at the left lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a minor disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and a disc bulge at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.There is a Schmorl's node present at superior endplate of T12.

Output: 1.There is a disc protrusion at the left neural foramen at L5-S1 which compresses the nerve root within the neural foramen. This particular nerve root is displaced inferiorly within the neural foramen. The disc protrusion also displaces the nerve roots at the left lateral recess at this level.2.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma status post chemotherapy and transplant. There are otherwise unchanged post-treatment and post-biopsy findings with patchy T2 hyperintensity and associated susceptibility effect in the right cerebellar hemisphere and left anterior cingulate gyrus. There is also unchanged focal susceptibility effect in the right globus pallidus. There are unchanged areas of high T2 signal in the cerebral white matter. There is no evidence of acute 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 major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of recurrent central nervous system lymphoma with stable post-treatment findings in the right cerebellar hemisphere and left cingulate gyrus.2. Unchanged areas of cerebral white matter signal abnormality in the cerebral white matter are otherwise nonspecific.


Instruction: Generate impression based on findings.

Input: Male 74 years old Reason: rectal cancer History: rectal cancer Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: There is a small lymph node within the left posterior lateral mesorectal fat measuring 0.8 x 0.7 cm (5/26), 4 mm from the mesorectal fascia. From this node, there is extension of soft tissue nodularity along vessels in the mesorectal fat, likely representing lymphovascular invasion (5/20). This soft tissue extends 5 mm from the mesorectal fascia.Lymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor:Size: Circumferential thickening distally measuring 1.3 cm in thickness (4/19). There is a more nodular component along the right anterolateral aspect measuring 2.4 x 1.7 cm (5/29).Tumor appearance on T2-weighted images: Hyperintense with areas of susceptibility artifact distally, likely reflecting hemosiderin deposition from prior biopsy.Tumor location: Middle-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 8 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 4 cmCircumference of the rectum involved: Entire circumference.Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): The tumor invades through the muscularis propria at the mid aspect of the tumor, approximately 7 mm into the mesorectal fat, both along the left lateral aspect and posterior aspect (5/29). There is no involvement of the mesorectal fascia. There is no involvement of the prostate, seminal vesicles or bladder. MRI T-stage: T3c - Tumor invades >1cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: 1.1 cm (image 29/series 5).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Circumferential rectal cancer measuring 5 cm in length, invading into the mesorectal fat, consistent with a stage 3c tumor by MR.2.Enlarged mesorectal lymph node 4 mm from the mesorectal fascia with soft tissue extending along small vessels in the mesorectal fat, likely representing lymphovascular invasion.


Instruction: Generate impression based on findings.

Input: Syncope.IMAGE ACQUISITIONS: 5-mm contiguous axial CT sections of the brain without contrast infusion. No acute intracranial hemorrhage, mass effect or shift of midline structures.There are multiple patchy areas of low attenuation in cerebral white matter both in deep white matter and in juxtacortical white matter, a nonspecific finding but atypical for age, either representing chronic ischemic/degenerative change or possibly demyelination. Consider follow-up MRI of the brain for further evaluation, as indicated clinically.There is no depressed calvarial fracture. Craniofacial structures are unremarkable.

Output: Extent of patchy white matter low attenuation is greater than expected for patient's age. If there is underlying risk for accelerated atherosclerosis such as diabetes or hypercholesterolemia, or if the patient has hypertension, the finding could be explained by this. Demyelination is not excluded. Follow-up as indicated clinically.


Instruction: Generate impression based on findings.

Input: 48 years Female (DOB:11/23/1967)Reason: low back pain History: as abovePROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a broad-based central disc protrusion at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There are some mild to moderate facet hypertrophy at this level. There is also some ligamentum flavum hypertrophy at this level. There is some narrowing of the thecal sac at this level resulting from the facet hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is facet and ligamentum flavum hypertrophy at this level associated with a mild disc bulge and some triangulation of the thecal sac with some mild crowding of the nerve roots. Overall there is a mild degree of spinal stenosis.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a mottled appearance of the marrow signal with foci of low signal on T1 and some foci of high signal on T1 spinal marrow. It is nonspecific. An MRI of the cervical spine from 6/9/2015 demonstrates similar findings.

Output: 1.There are multilevel degenerative changes present in the lower lumbar spine with mild degrees of spinal stenosis at L3-4 and to a lesser degree L4-5. This canal narrowing is predominantly due to facet hypertrophy. There is a broad-based central disc protrusion at L5-S1.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with bilateral upper extremity weakness and dysphagia, evaluate for central lesion. Brain:Again noted is severe crowding of the foramen magnum, suprasellar cistern, and perimesencephalic cistern, unchanged. Artifact secondary to right frontal approach ventriculostomy catheter limits evaluation of adjacent structures. Ventriculostomy catheter tip is located at the level of the right foramen of Monro. No abnormal enhancement is noted intracranially. Overall the size of the ventricles appears similar to prior CT from 12/1/2016.Fluid intensity is noted in bilateral mastoid air cells and middle ears. Bilateral prior glands demonstrate a nodular appearance.Cervical spine:Again noted is diffuse central T2 hyperintensity is seen within the visualized cervical spinal cord beginning at the C2 level, with a more focal area of abnormal signal intensity at the C2-C3 level, extending beyond the field of view inferiorly but grossly appearing similar to prior exam. The signal changes appear to be predominantly in the gray matter of the spinal cord. The cord is expanded diffusely. No significant enhancement is associated with the signal abnormalities.As noted on prior examinations, the posterior fossa is crowded with a tapered appearance of the cerebellar tonsils which appear to herniate below the foramen magnum, demonstrating 20 mm of caudal extension of pointed cerebellar tonsils beyond the foramen magnum.Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. There is only minimal disc degeneration is seen which causes no significant spinal canal or foraminal stenosis.Note is made of prominence of soft tissues along the pharynx, with narrowing of the airway, likely due to reactive lymphoid tissue.

Output: 1.Crowding of foramen magnum and basal cisterns, similar to prior exam and with no abnormal intracranial enhancement or mass.2.Diffuse abnormal signal affects the central portion of the spinal cord beginning at C2 and continuing throughout the remainder of the visualized spinal cord which is expanded, grossly appearing similar to prior exam. The differential diagnosis remains broad and would include infectious, postinfectious or autoimmune phenomena, or related to altered CSF dynamics in the context of Chiari I malformation.


Instruction: Generate impression based on findings.

Input: 30 years, Male, Reason: recurrent pancreatitis evl for ductal abnormalities. PLEASE PERFORM W GADOLINIUM + SECRETIN History: recurrent pancreatitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal hepatic lesions. No evidence of cholelithiasis or choledocholithiasis. SPLEEN: No significant abnormality noted.PANCREAS: There is diffusion restriction within the pancreatic neck and body suggesting inflammation. A minimal rim of enhancement is noted along the anterior aspect of the pancreas in this region.The main pancreatic duct is normal in caliber measuring 3 mm and dilates to 5 mm following the administration of secretin, within normal limits. There is conventional ductal anatomy. No strictures are evident. There is normal excretion of secretion to the third portion of the duodenum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Diffusion restriction within the pancreatic neck and body suggests underlying inflammation.2.A minimal rim of enhancement is present on which may be seen in the setting of autoimmune pancreatitis. Recommend correlation with IgG-4 levels.


Instruction: Generate impression based on findings.

Input: 57 year old man with no significant cardiac history and recent dyspnea with exertion, found to have new systolic dysfunction on echocardiogram with question of non-compaction. He was referred for cardiac MRI to evaluate for etiologies of his cardiomyopathy. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 249 ml (normal range 142+/-34), the LV end systolic volume index is 98 ml/m2 (normal range 25+/-9), the LVESV is 192 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There is global hypokinesis. There is no apical thrombus. The ratio of non-compacted to compacted myocardium is 1.5, which is not consistent with a diagnosis of ventricular non-compaction. T2 STIR sequences do not demonstrate evidence of myocardial edema. There is subepicardial late gadolinium enhancement noted in the anteroseptum and inferoseptum, from the basal to mid portion. Additionally there is possible subepicardial late gadolinium enhancement in the anterolateral wall. This is atypical for infarction, but is consistent with an underlying fibrosing, infiltrative, or inflammatory process, such as prior myocarditis.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 120 ml/m2 (normal range 82+/-16), the RVEDV is 237 ml (normal range 142+/-31), the RV end systolic volume index is 96 ml/m2 (normal range 31+/-9), and the RVESV is 189 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve is trileaflet and opens widely and there is no significant aortic regurgitation.Mitral ValveThere is bileaflet tethering and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (31mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a 12 x 12 mm rounded area of increased signal intensity in the lateral aspect of the liver, which is non-enhancing and may warrant further dedicated imaging. 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. Moderately dilated left ventricle with severely reduced systolic function (EF 23%).2. No evidence of LV noncompaction.3. There is subepicardial late gadolinium enhancement noted in the anteroseptum and inferoseptum, from the basal to mid portion. Additionally there is possible subepicardial late gadolinium enhancement in the anterolateral wall. This is atypical for infarction, but is consistent with an underlying fibrosing, infiltrative, or inflammatory process. The constellation of findings could be consistent with a prior myocarditis.4. Mildly dilated right ventricle with severely reduced systolic function (EF 20%).5. Mild to moderate mitral and tricuspid regurgitation.6. Biatrial enlargement 7. Mildly dilated main PA8. See extra cardiac findingsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 78 year old male with metastatic colon cancer in lung and liver. Staging. CHEST: LUNGS AND PLEURA: Scarlike opacities and postsurgical changes are seen in both lungs. In the left upper lobe, there is a 1.5 x 1.4 cm nodule consistent with metastatic disease. A smaller and more irregularly shaped nodule in the right lower lobe measures 1.1 x 1.4 cm, consistent with a metastasis. Small right pleural effusion has resolved. MEDIASTINUM AND HILA: Atherosclerotic calcifications in the thoracic aorta and coronary arteries. Normal heart size. No pericardial effusion. Borderline enlarged right hilar lymph node. Small mediastinal lymph nodes.CHEST WALL: Right chest wall Port-A-Cath with the tip in the superior vena cava. There is possibly partial collapse of the L1 vertebral body which is incompletely visualized on this study. Right-sided venous access device is in expected position.ABDOMEN:LIVER, BILIARY TRACT: Intra- and extra-hepatic biliary ductal dilatation to the level of the ampulla. No obstructing mass is identified.Large mass noted in the right lobe of the liver without enhancement. This mass has an exophytic component. It measures 4.7 x 7.7 cm (image 82, series #3). A second, smaller lesion with similar characteristics is noted inferior to the dominant mass that also is compatible with a metastasis. Additional, subcentimeter lesions are scattered throughout the liver with typical features of benign cysts on the MRI exam. Cholelithiasis noted.SPLEEN: No significant abnormality noted. Calcified splenic granulomata. PANCREAS: Prominent pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression deformity at the superior endplate of L1.OTHER: IVC filter is in the expected position. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid diverticulosis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Benign calcifications in the left groin and left spermatic cord.

Output: 1. Minimal intra- and extra-hepatic biliary ductal dilatation to the level of the ampulla. No obstructing mass is identified; however, cannot rule out obstructing ampullary stricture.2. Hepatic metastases are stable since the prior MRI exam.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, history of brain metastases, assess for new lesion. Evidence of prior right parietal craniotomy and tumor resection are again seen. The resection bed is stable in size and morphology. Curvilinear enhancement within the resection bed is unchanged.Mild patchy gyriform diffusion restriction is seen along the right central sulcus and within the posterior right temporal lobe and right occipital lobe. The cortex is mildly edematous in these areas with at least one area of corresponding gyriform enhancement in the right occipital lobe.No additional new enhancing lesions are seen. Extensive confluent T2 hyperintensity within the periventricular white matter of the cerebral hemispheres, contiguous with abnormal signal surrounding the right parietal resection bed, have otherwise not significantly changed. No generalized mass effect is detected. Ventricular size and morphology are unchanged.

Output: 1.Redemonstrated are postoperative findings compatible with resection of tumor from the right parietal region. The operative bed has not significantly changed.2.Scattered areas of mild diffusion restriction and cortical edema are seen involving the parenchyma along the right central sulcus, the posterior right temporal lobe and the right occipital lobe. Mild corresponding enhancement is also seen within the right occipital lobe. The differential for these findings would include ischemic injury, probably subacute; an inflammatory or infectious etiology; or perhaps an atypical presentation of recurrent disease. A close interval follow-up can be considered to help distinguish these possibilities.


Instruction: Generate impression based on findings.

Input: 61 year old with history of congestive heart failure and valvular heart disease requiring mitral and tricuspid valve surgery, COPD, CKD and coronary artery disease presenting for cardiac evaluation prior to implantable cardioverter defibrillator. Left VentricleThe left ventricle is moderately dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 108 ml/m2 (normal range: 65+/-11), the LVEDV is 188 ml (normal range 109+/-23), the LV end systolic volume index is 69 ml/m2 (normal range 18+/-5), the LVESV is 120 ml (normal range 31+/-10), the LV mass index is 81 g/m2 (normal range 67+/-11), and the LV mass is 140 g (normal range 114+/-24). The systolic dysfunction is global with regional variation. There is an apical inferior subendocardial late gadolinium enhancement (LGE) (60-80% thickness) and basal-mid anterolateral LGE (40-50% thickness) consistent with myocardial infarction. No left ventricular thrombus. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 133 ml/m2 (normal range 69+/-14), the RVEDV is 231 ml (normal range 110+/-24), the RV end systolic volume index is 93 ml/m2 (normal range 22+/-8), and the RVESV is 161 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is consistent with previous surgery. There is evidence of mitral regurgitation that appears valvular.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 common trunk with right innominate and left common carotid (normal variant). The aortic root is normal in size, the ascending aorta is ectatic (40 x 42 at ascending aorta, not orthogonal dimension).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (40 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. The coronary sinus is dilated. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a stable right adrenal nodule and right hepatic calcified cyst (better characterized on previous cross-sectional imaging)

Output: 1. The left ventricle is moderately dilated with moderate-severely reduced systolic function (LVEF 36%). There is an apical inferior subendocardial and basal-mid anterolateral LGE consistent with myocardial infarction.2. The right ventricle is severely dilated with severely reduced systolic function (RVEF 30%)3. Severe Biatrial enlargement4. Dilated pulmonary artery5. Ectatic ascending aorta.


Instruction: Generate impression based on findings.

Input: Follow-up of thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.4 x 1.6 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.0 x 1.6 cmISTHMUS MEASUREMENTS: 1 mmRIGHT LOBE: Slightly heterogeneous echotexture with no dominant nodules.LEFT LOBE: Slightly heterogeneous echotexture with an unchanged inferior nodule measuring 0.6 x 0.6 x 0.4 cmISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted. LYMPH NODES: Small nonpathologic bilateral lymph nodes as noted previously.OTHER: No significant abnormality noted.

Output: Stable exam.