Instruction: Generate impression based on findings.

Input: 58 year old male with a history of recurrent atrial fibrillation status-post ablation referred for cardiac MRI prior to repeat ablation. Left VentricleAssessment of systolic function limited by atrial fibrillation. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 133 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 132 ml (normal range 47+/-19), the LV mass index is 20 g/m2 (normal range 85+/-15), and the LV mass is 42 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Right VentricleThe right ventricle is normal in size and has low-normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 130 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Left AtriumThe left atrium is normal in size (91ml). All four pulmonary veins drain normally into the left atrium. There is an early branch of a small pulmonary vein near the ostium of the right superior pulmonary vein. Late gadolinium enhancement images of the left atrium are of limited quality; however, the largest "ablation" gaps were probably around the left upper and right superior pulmonary veins. A smaller "ablation" gap was probably present around the right inferior pulmonary vein. The ablation line around the left inferior pulmonary vein is not well seen. The dimensions of the pulmonary veins at the ostium are:Right superior pulmonary vein: 19 x 15.5 mmRight inferior pulmonary vein: 14.6 x 11 mmLeft inferior pulmonary vein: 10.4 x 11.1 mmLeft superior pulmonary vein: 12.9 x 16.6 mmRight AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size (sinus of Valsalva 36x36x37 mm).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 FindingsThere are small mediastinal lymph nodes present. Multiple high T2-signal hepatic masses noted, which are statistically most likely hemangiomas or cysts. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration .2. The right ventricle is normal in size and has low-normal systolic function (RVEF 50%). 3. Normal left atrial volume.4. Normal pulmonary vein anatomy. 5. Left atrial LGE imaging was of limited quality; however, the largest "ablation" gaps were probably around the left upper and right superior pulmonary veins. A smaller "ablation" gap was probably present around the right inferior pulmonary vein. The ablation line around the left inferior pulmonary vein is not well seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 52-year-old female with a history of a "trigger finger" of the third digit status post release. There is mild volar displacement of the flexor digitorum profundus tendon from the head of the third metacarpal. For reference, the flexor digitorum profundus tendon is approximately 2.3 mm from the volar aspect of the head of the third metacarpal, compared to 1.5 mm in the fourth digit. The flexor digitorum profundus tendon is approximately 1 mm from the volar aspect of the base of the third proximal phalanx, compared to 0.5 mm in the fourth digit. There is further separation of the flexor digitorum superficialis, which is approximately 6 mm from the volar aspect of the head of the third metacarpal, compared to 4.5 mm for the fourth digit. The flexor digitorum superficialis is approximately 4.5 mm from the volar aspect of the base of the third proximal phalanx of the third digit, compared to 3 mm for the fourth digit.There is fluid within the flexor tendon sheath and mild edema extending through the superficial soft tissues along the flexor tendon apparatus. The A2 pully appears intact. The flexor digitorum superficialis tendon itself appears normal and inserts normally upon the middle phalanx. There is mild increased signal intensity within the flexor digitorum profundus tendon as it courses along the proximal phalanx, perhaps reflecting mild tendinosis, but it inserts in normal fashion on the distal phalanx. There is a cyst within the third metacarpal head, of doubtful clinical significance.The remaining visualized bones and soft tissues appear normal.

Output: Surgical changes of trigger finger release with mild volar displacement of the flexor tendons, as described above.


Instruction: Generate impression based on findings.

Input: Male, 52 years old. Reason: labral tear? History: hip pain ACETABULAR LABRUM: There is irregularity along the anterior superior labrum, compatible with a tear.ARTICULAR CARTILAGE AND BONE: Joint is otherwise intact, without significant abnormality. Normal signal of the visualized skeletal structures.SOFT TISSUES: The muscles appear normal. ADDITIONAL

Output: Irregularity along the anterior superior labrum, compatible with a tear.


Instruction: Generate impression based on findings.

Input: Leg weakness, acute onset pain, history of cancer, sciatica. Rule out herniated disc, cord compression other pathology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is disc desiccation of L3-4, L4-5 and L5-S1. There is mild loss of disc height at the L5-S1 level with degenerative changes at the endplate including a Schmorl's node. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The spinal cord terminates appropriately at the L2 level.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is mild facet hypertrophy and ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina.L3-L4: There is a disc bulge with facet hypertrophy and ligamentum flavum thickening which causes mild central canal stenosis. There is no significant compromise to the neural foramina.L4-5: There is a disc bulge and moderate facet hypertrophy and ligamentum flavum thickening which causes mild central canal stenosis. No significant compromise to the neural foramina.L5-S1: There is facet hypertrophy and ligamentum flavum thickening but no significant compromise to spinal canal or neural foramina.

Output: 1.Mild degenerative changes of the lower lumbar spine with mild diffuse disc bulges at L3-4 and L4-5 levels which cause mild central canal stenosis at the L3-4 and L4-5 level. No evidence of herniated disc or significant neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Female 56 years old Reason: goiter with multiple nodules History: none RIGHT LOBE MEASUREMENTS: 7 x 2.2 x 2.5 cmLEFT LOBE MEASUREMENTS: 8.5 x 3.2 x 2.5 cmISTHMUS MEASUREMENTS: 6 mmRIGHT LOBE: Background thyroid is heterogeneous. Again noted multiple nodules within the right thyroid lobe. Largest nodule is in the mid right thyroid lobe and measures 2.3 x 1.7 x 2.6 cm. This is relatively unchanged compared to previous study. This nodule has heterogeneous echotexture and may represent a solid nodule versus a complex cystic nodule.LEFT LOBE: Background thyroid is also heterogeneous. Multiple nodules are also present within the left lobe. Largest nodule is in the inferior aspect of the left thyroid lobe and measures 2.3 x 1.8 x 1.6 cm and not significantly changed compared to previous study.This nodule has heterogeneous echotexture and may represent a solid nodule versus a complex cystic nodule.ISTHMUS: There is a new heterogeneously appearing nodule at the left lower aspect of the isthmus was measuring 2.2 x 1.6 x 2.2 cm. This nodule has complex cystic areas. At the periphery of the nodule there may be solid areas versus complex cystic component.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter and diffusely heterogeneous background thyroid. Bilateral nodules are grossly unchanged. However there is a new complex appearing cystic nodule arising from the left lower aspect of the isthmus.


Instruction: Generate impression based on findings.

Input: Intraventricular meningioma status post radiation therapy: surveillance. There is no significant interval change of the T2 hypointense enhancing mass within the atrium of the left lateral ventricle, which measures up to 1.7 x 1.4 cm in axial cross-section. There is also unchanged surrounding ependymal enhancement and confluent T2 hyperintensity in the left peritrigonal white matter and posterior left thalamus with scattered punctate foci of susceptibility effect. There are unchanged nonspecific scattered punctate foci of cerebral white matter T2 hyperintensity. There is no evidence of acute intracranial hemorrhage, hydrocephalus, or acute infarct. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable.

Output: No significant interval change of the left lateral ventricular mass with persistent ependymal enhancement and vasogenic edema in the adjacent brain parenchyma.


Instruction: Generate impression based on findings.

Input: Right sensorineural hearing loss. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There are numerous scattered areas of predominantly subcortical T2 hyperintensity with a faint striated pattern, suggestive of slightly prominent perivascular space. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Numerous areas of predominantly subcortical white matter T2 hyperintensity likely represent terminal zones of myelination. Nevertheless, follow up MRI in approximately one year may be useful, if clinically warranted.2. No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: 25 year old with strong family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Bilateral patchy areas of parenchymal enhancement especially along the fat and glandular tissue junction are normal. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual surveillance with MRI can be performed. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 53-year-old male with history of necrotizing cholecystitis now with apparent hernia on surgical site. Increased pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodensities in the right and caudate lobe of the liver which are too small to characterize but most likely represent cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right upper quadrant. Incisional hernia containing nonobstructed colon and small bowel segments.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Subtle focal enhancement in the left posterior peripheral zone of the prostate. Correlation with PSA level and/or MRI of the prostate may be helpful.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Large right upper quadrant incisional herniaSubtle focal enhancement in the left posterior peripheral zone of the prostate. Correlation PSA level is recommended.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with left arm pain and possible C6-7 cyst or lesion seen on outside hospital exam. A mild reversal of the normal cervical lordosis is seen. Vertebral body heights are preserved. Mild degenerative endplate irregularity is seen at several levels, most notably C5-6. No worrisome marrow replacement or marrow edema is detected.The visualized spinal cord shows normal morphology and signal characteristics except as discussed below.An oval T2 hyperintense structure measuring up to 5 mm in length is evident within the left C6-7 neural foramen, corresponding to a similar-appearing lesion noted on the prior outside examination. This lesion shows no internal enhancement. A similar-appearing but smaller structure is evident within the left C7-T1 neural foramen.No pathologic marrow space or intraspinal enhancement is seen.C2-3: Unremarkable. C3-4: Left facet hypertrophy. Mild posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac. Mild left foraminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac with slight flattening of the ventral cord but no cord signal abnormality. Mild to moderate bilateral foraminal narrowing. C5-6: Left facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate ventral dural sac effacement with flattening of the ventral cord but no significant cord signal abnormality. The overall spinal canal is moderately narrowed. Severe right and moderate left foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild ventral thecal sac effacement without significant canal stenosis. Mild foraminal narrowing.C7-T1: Unremarkable.

Output: 1.A subcentimeter structure is identified within the left C6-7 neural foramen showing imaging characteristics most compatible with a perineural root sleeve cyst. There is also very likely an additional smaller root sleeve cyst within the left C7-T1 neural foramen.2.Mild to moderate cervical degenerative findings most significantly affecting the C5-6 level where there is a moderate spinal canal narrowing and severe right/moderate left foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Neoplasm of uncertain behavior of brain and spinal cord. Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy Other postprocedural status(V45.89) The patient is status post right temporal craniotomy for right temporal lobe surgery and partial removal of the hippocampus. There is redemonstration of T2 and flair signal hyperintensity adjacent adjacent to the surgical bed compatible with gliosis.There is metal artifact from the patient's dentition which significantly distorts SWI and DWI imaging and obscures visualization of the orbits and paranasal sinuses.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 mastoid air cells are clear. There is mucosal thickening in the left sphenoid sinus. The rest of the paranasal sinuses are not adequately visualized.Incidental note is made of congenital fusion of C2 and C3.

Output: 1.Status post right temporal lobe and hippocampal surgery. The examination is stable when compared to the prior exam2.No left temporal lobe cyst is identified3.Congenital fusion of C2 and C3 can be associated with Klippel-Feil.


Instruction: Generate impression based on findings.

Input: 91-year-old female patient with ulceration. Question of osteomyelitis of the coccyx. There is diffuse, heterogeneous signal abnormality of the marrow on the fat-suppressed T2-weighted images as well as heterogeneous enhancement following contrast administration. This is a nonspecific finding, but we cannot exclude a marrow infiltrating process.There is ulceration with edema of the subcutaneous fat posteriorly. There is also generalized edema type signal involving the paraspinal, pelvic, and hip musculature. Ulceration appears to extend to the coccyx, but the signal intensity of the bone marrow on T1-weighted sequences is preserved arguing against osteomyelitis. There is a rim-enhancing fluid collection adjacent to the left ischial tuberosity that we suspect communicates with the skin surface via a sinus tract. Adjacent signal intensity of the bone itself is preserved on T1 weighted images arguing against osteomyelitis.There is a collection of nonenhancing near fluid signal intensity along the posterior aspect of the proximal left femur that measures approximately 6.5 x 2.5 cm in the transverse dimension and appears to communicate with the skin surface. Although we see no specific findings of osteomyelitis of the underlying femur, evaluation is limited due to artifact from the patient's orthopedic hardware. Poorly defined nonenhancing tissue adjacent to the right ischial tuberosity likely represents phlegmon with preservation of underlying bone marrow signal intensity on the T1-weighted images.Incompletely imaged on this study is a fluid collection along the labia, left of midline, which perhaps represents a cyst.A Foley catheter and air is noted within the bladder. There is small amount of free fluid within the pelvis.

Output: 1. Soft tissue ulceration and additional soft tissue abnormalities as described above, but we see no convincing imaging findings to suggest osteomyelitis.2. Diffuse heterogeneity of the bone marrow is nonspecific, but could perhaps represent a marrow infiltrating process.


Instruction: Generate impression based on findings.

Input: 6 months post ACDF The patient has undergone anterior fusion of C5 through C7 with side plate, screws, and bone graft. The alignment is anatomic. The vertebral body heights are preserved.

Output: Post-operative changes, as above.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:9/12/1959)Reason: right leg pain. History: right leg painPROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH JAVAD HEKMATPANAH 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 a mild disc bulge present at this level. There is mild encroachment of the nerve roots at the lateral recess at this level.At L4-5 there is no significant compromise to the neural foramina. There is some disc desiccation and diffuse disc bulge at this level. There is some mild facet hypertrophy at this level. There is some effacement of fat at the lateral recess bilaterally at this level with encroachment of the nerve roots at the lateral recesses bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present lumbar spine associated with moderate encroachment of the nerve roots at the lateral recess at L4-5 bilaterally.


Instruction: Generate impression based on findings.

Input: 30-year-old male with right knee pain and swelling, concern for re-tear of the medial meniscus. MENISCI: There is linear signal abnormality within the posterior horn and body of the medial meniscus which extends from the tibial articular surface through the peripheral fibers of the meniscus, with formation of small peripheral intrameniscal and parameniscal cysts. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact, and the bone marrow signal is normal.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments as well as the medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Signal abnormality within the medial meniscus extending from the tibial articular surface through the peripheral fibers. This represents a tear, although comparison with prior outside imaging will ensure that the signal abnormality was not previously present.


Instruction: Generate impression based on findings.

Input: 76 year old male with known CAD, has had noted cecrease in LV EF, MRI done to assess. MEDICATIONS: Amlodipine, atorvastatin, carvedilol, clopidogrel, lisinopril, hydrochlorothiazide, spironolactone First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is presence of late gadolinium enhancement in the mid and basal anterior wall, the apical anterior and apical inferior, and basal and mid anterolateral wall, involving up to 50% of the LV wall thickness, suggesting prior myocardial infarction.Left VentricleThe left ventricle is normal in size with mildly decreased ejection fraction. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 202 ml (normal range 142+/-34), the LV end systolic volume index is 54 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 67 g/m2, and the LV mass is 138 g. There is hypokinesis in the mid anterior, mid anterolateral wall and apical cap of the ventricular myocardial wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 210 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 116 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 Findings11.3 x 4.4 cm T2 hyperintense mass in the right axillary region on image 14 of series 201 with internal hypointense lesion or laterally which measures 4.1 x 1.6 cm. 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: Unexpected right axillary, fat-containing mass with probable soft tissue component, as above. Further evaluation with dedicated, gadolinium-enhanced chest wall mass MRI suggested.1. No perfusion defects/ "ischemia" present during hyperemia.2. There is presence of late gadolinium enhancement in the mid and basal anterior wall, the apical cap, and basal and mid anterolateral wall, involving up to 50% of the LV wall thickness, consistent with prior myocardial infarction. There is hypokinesis in the mid anterior, mid anterolateral wall and apical cap of the ventricular myocardial wall. 3. Normal LV size and mildly decreased systolic function (LVEF 46%).4. Normal RV size and systolic function (RVEF 45%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 72 year old woman who presents with congestive heart failure and multiple risk factors. She is referred to rule out ischemia and to evaluate etiology of LV dysfunction.MEDICATIONS: carvedilol, furosemide, aspirin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere was no evidence of myocardial infarction. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal septum and an epicardial late gadolinium enhancement pattern involving the basal inferolateral wall. These findings are atypical for prior myocardial infarction and suggest underlying myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 235 ml (normal range 109+/-23), the LV end systolic volume index is 87 ml/m2 (normal range 18+/-5), the LVESV is 167 ml (normal range 31+/-10), the LV mass index is 83 g/m2, and the LV mass is 159 g. There is global hypokinesis with regional variation.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 128 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 57 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. Mild atherosclerosis is noted in the descending thoracic aorta. 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 FindingsBilateral axillary lymph nodes noted. The largest on the right is 1cm and on the left is 1.2cm. 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; however, the diagnostic sensitivity of vasodilator stress testing in the presence of severe LV dysfunction is reduced.2. There was no evidence of myocardial infarction. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal septum and an epicardial late gadolinium enhancement pattern involving the basal inferolateral wall. These findings are atypical for prior myocardial infarction and suggest underlying myocardial fibrosis, inflammation, or infiltration suggesting a non-ischemic etiology of the cardiomyopathy. 3. Severe LV dilation with severely reduced systolic function (LVEF 29%).4. Normal RV size and systolic function (RVEF 55%).5. Severe left atrial dilation.6. Moderate mitral regurgitation.7. Axillary lymph nodes are noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Detectable PSA after prostatectomy in 2014, evaluate for recurrent disease PELVIS:PROSTATE: Status post prostatectomy. No evidence of disease recurrence.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: Fat containing osseous lesion in the right superior pubic ramus, likely a hemangioma.OTHER: No significant abnormality noted.

Output: No evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: Lower extremity pain and numbness in the face of newly diagnosed multiple slcerosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. However, there is a retroflexed uterus with a subcentimeter low signal focus in the myometrium.

Output: 1. No evidence of significant spinal canal or neural foramen stenosis in the lumbar spine.2. Retroflexed uterus with a subcentimeter low signal focus in the myometrium, which may represent a fibroid. Further evaluation via pelvic ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Weakness, decreased urine, constipation There are numerous lesions throughout the cervical, thoracic, lumbar spine and visualized pelvis consistent with diffuse osseous metastases. Vertebral body heights are maintained. There is mild anterolisthesis of T2 and T3. Alignment is otherwise maintained. There is at least moderate cervical spinal canal stenosis at the C3-C4, C4-C5, C5-C6, and C6-C7 levels related to prominent disk osteophyte complexes and ligamentum flavum buckling in the cervical spine. There is possible T2 signal abnormality involving the cervical cord at the C5-C6 level which may represent myomalacia.There is epidural lipomatosis in the thoracic spine which mildly narrows the thoracic spinal canal. In the lumbar spine there are degenerative changes throughout with severe spinal canal stenosis at the L3-L4 and L4-L5 levels on a degenerative basis.

Output: 1. Diffuse osseous metastatic disease without findings to suggest acute cord compression from metastatic disease.2. Severe degenerative changes in the cervical and lumbar spine which result in severe spinal canal stenosis at L3-4 and L4-5. There is at least moderate spinal canal stenosis in the cervical spine at C3-C4, C4-C5, C5-C6, and C6-C7 levels. There is possible T2 signal abnormality involving the cervical cord at the C5-C6 level which may represent myelomalacia.3. Please note due to the screening nature of this protocol, details including cord signal abnormality are not as evident as dedicated protocols of the spine. If clinically indicated, consider complete spine MRI study for further evaluation.


Instruction: Generate impression based on findings.

Input: Left superificial parotidectomy for Warthin's tumor one year ago with increasing pain and left pharyngeal wall fullness. There has been interval left superficial parotidectomy. There appears to be scar tissue, but no evidence of tumor in the surgical bed. There is no significant cervical lymphadenopathy. The right parotid and bilateral submandibular glands are unremarkable. There is a punctate right thyroid cyst. There is mild prominence of the lingual tonsil, with a 3 mm diameter cystic lesion on the left side. The upper aerodigestive tract is otherwise unremarkable. The orbits and imaged intracranial structures are unremarkable. There is a punctate cystic lesion in the anterior wall of the left external auditory canal, which may represent an inclusion cyst. There is a small left maxillary sinus retention cyst. There is multilevel degenerative cervical spondylosis and findings related to laminoplasty.

Output: 1. Interval left superficial parotidectomy with what appears to be scar tissue, but no evidence of tumor in the surgical bed. 2. Mild prominence of the lingual tonsil, with a 3 mm diameter cystic lesion on the left side, which may represent a retention cyst.


Instruction: Generate impression based on findings.

Input: Paralysis agitans, DBS stage 1 today The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Examination is limited for the purposes of stereotactic guidance for deep brain stimulator placement. There is no intracranial mass lesion or brain hemorrhage identified.MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Generalized abdominal pain [R10.84] / Unqualified visual loss, left eye, normal vision right eye [H54.62], Reason for Study: ^Reason: >1cm vegetation on aortic valve w/ loss of vision. Eval for embolic strokes History: above There are multiple susceptibility lesions on bilateral frontal lobes, left parietal lobe and bilateral occipital lobes without surrounding edema. These findings non specific, thus may suggest parenchymal calcifications, or petechial chronic hemorrhages or cavernous malformations. There is no evidence of acute ischemic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Right mastoid air cells show partial opacifications.

Output: 1. Multiple susceptibility lesions without surrounding edema or mass effects on bilateral hemispheres as described above. Differential diagnosis is wide including calcifications, chronic petechial hemorrhages or cavernous malformations.2. No acute ischemic lesion.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, headaches, worse postpartum. Thinning and mild outward bowing of the calvarium along the right frontal and temporal lobes is unchanged and may be at least in part due to prior interventions. Signal abnormality relating to the tract of a prior ventricular catheter is again seen coursing through the right frontal lobe.Cystic encephalomalacia affecting the inferior right frontal lobe is unchanged. Mild encephalomalacia affecting the anterior right temporal lobe is also unchanged. No new areas of parenchymal signal abnormality are detected. Diffusion weighted images are normal. There is no evidence of parenchymal edema or mass effect. On postcontrast images, no evidence of pathologic parenchymal or extra-axial enhancement is detected.No evidence of acute intracranial hemorrhage is seen. No new abnormal extra axial fluid collections are detected. The size and morphology of the ventricles are normal.

Output: Stable examination with no new findings to account for the patient's worsening headaches.


Instruction: Generate impression based on findings.

Input: 28-year-old man with history of Crohn's on Humira with abdominal cramping. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal in signal and morphology. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is fibrofatty proliferation in the region of the terminal ileum. Prominent subcentimeter mesenteric lymph nodes noted. No significant bowel wall thickening or dilated loops of bowel are noted in the abdomen. Specifically, the terminal ileum appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: An approximately 3.5 cm segment of distal descending colon and proximal sigmoid colon (17/44) appears narrowed without change throughout the examination and circumferentially enhances on postcontrast imaging. Additionally, there is circumferential enhancement of the distal sigmoid colon and the rectum over a length of approximately 6 cm (20/62). The mid sigmoid colon appears relatively spared.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Active inflammatory bowel disease involving the proximal sigmoid colon and distal sigmoid/rectum with sparing of the mid sigmoid colon. Suggestion of focal areas of involvement in the descending colon as well.2.Findings of remote inflammatory bowel disease in the region of the terminal ileum. No evidence of active terminal ileitis.


Instruction: Generate impression based on findings.

Input: 60 old male with bloody diarrhea ABDOMEN:LUNG BASES: 2 x 1.3 cm paracardiac hypodense lesion adjacent to the right atrium, Bessemer number 11, series number 3. This may represent a solid lesion versus pericardial cyst. Further evaluation with MRI may be helpful.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal stones. No hydronephrosis. Bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Wall thickening involving the sigmoid colon and rectum which may indicate colitis. Further ovation with endoscopy is recommended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Wall thickening of the rectosigmoid compatible with colitis.Right nephrolithiasis.Right paracardiac lesion which likely represents a complex pericardial cyst. Further evaluation with cardiac MRI may be helpful to differentiate from paracardiac adenopathy due to its high density..


Instruction: Generate impression based on findings.

Input: This exam is limited as the patient terminated the exam early prior to the completion of susceptibility weighted imaging and coronal T2 weighted imaging. There is no evidence of acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged diffuse marrow replacement. There is an unchanged retention cyst within the right sphenoid sinus. There is unchanged proptosis. There is unchanged T1 and T2 hyperintensity invaginating into the superficial left parotid lobe that likely represents normal fat or possibly a small lipoma.

Output: 1.No evidence of acute ischemia.2.Unchanged proptosis of uncertain etiology or significance.3.Unchanged diffuse marrow replacement that is nonspecific and of uncertain etiology.4.Unchanged right sphenoid retention cyst.


Instruction: Generate impression based on findings.

Input: Evaluate for pituitary abnormality: partial GH deficiency. Pituitary: There is a non-enhancing sliver between the adenohypophysis and neurohypophysis. The pituitary gland is not enlarged. The infundibulum is intact. There is no mass effect upon the cavernous sinus or optic apparatus. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an anterior right frontal lobe developmental venous anomaly. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings suggestive of a minute pars intermedia cyst.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Right anterior frontal lobe developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Confusion and disorientation. Evaluate for ischemic infarct. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Incidental note is a prominent air-filled space inferomedial to the right orbit with some displacement on the ostiomeatal complex although this remains patent. This may be a large Haller cell. CT would provide more information if clinically warranted. Note is also made of a partial empty sella.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Incidentally noted prominent air-filled space inferomedial to the right orbit which may represent a large Haller cell. CT would provide more information if clinically warranted.


Instruction: Generate impression based on findings.

Input: 5-year-old female patient with tethered cord repair, lipomyelomeningocele, yearly MRI. Evaluate for change. Thoracic Spine:Vertebral body heights and disc spaces are within normal limits with anatomic alignment. Bone marrow signal is normal. There is no thoracic cord signal abnormality.Lumbar Spine:There are postoperative findings related to attempted detethering of the filum terminale. Redemonstration of lipomatous mass centered along the dorsal aspect of the thecal sac that extends from the level of L3-S1. This mass has decreased in thickness now measuring 7 mm in maximal thickness, previously 9 mm. The conus medullaris is low in position, distorted, and terminates within the lipomatous mass, unchanged. The cord remains tethered along the dorsal aspect of thecal sac with prone imaging. The lower lumbar and upper sacral vertebral posterior elements are absent.Vertebral body heights and disc spaces are otherwise normal in height and in anatomic alignment. Bone marrow signal is normal. The lower lumbar dorsal subcutaneous fat is prominent, but does not appear to communicate with the intrathecal lesion, unchanged.

Output: Post-operative changes of the lumbosacral spine with a tethered spinal cord and decreased size of an associated intraspinal lipoma.


Instruction: Generate impression based on findings.

Input: 63-year-old male patient with cirrhosis, segment 6/7 arterially enhancing focus. Evaluate liver lesions, masses, HCC screening, hepatic vessel patency. ABDOMEN: LIVER, BILIARY TRACT: Hepatic cirrhosis with sequela of portal hypertension. There are scattered T2 hyperintense foci in the liver compatible with cysts. A nonspecific segment 6/7 1 cm arterially enhancing focus is again identified, but does not demonstrate washout on more delayed images. There is a new 1 cm focus of arterial enhancement within the caudate lobe, which also does not demonstrate washout on more delayed imaging.SPLEEN: The spleen is enlarged measuring 19 cm in length.PANCREAS: A a 0.8 cm cystic lesion within the body of the pancreas which does not demonstrate enhancement likely represents a sidebranch IPMN in addition to two more cystic foci, 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: Trace left pleural effusion. Interval decrease in ascites.

Output: 1.Cirrhosis with sequela of portal hypertension. No definite arterially enhancing lesion with washout to suggest HCC.2.Non-specific segment 6/7 and segment 1 arterially enhancing lesions; these could be perfusional in etiology, however, should continue to be followed on subsequent imaging.


Instruction: Generate impression based on findings.

Input: 62 year old male patient with history of chronic HBV, history of complex cyst. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense nonenhancing lesions are compatible with hepatic cysts, unchanged. No suspicious hepatic lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious hepatic lesion to suggest hepatocellular carcinoma. Scattered hepatic cysts are stable.


Instruction: Generate impression based on findings.

Input: Clinical question: Evidence of malignancy. Signs and symptoms: Patient with focal area of enhancement in right C6 vertebrae which enhances. CT of the cervical spine:Examination demonstrate a lytic lesion in the right superior aspect of C7 vertebrae. There is thinning of the cortex posteriorly and at the level the superior endplate of T1 however without any break/defect of the cortex.Finding correspond to the previously noted enhancing focus in C7 on prior MRI exam. Possibility of malignancy should be considered. There is no evidence of fracture or malalignment. There is also no evidence of any additional foci of cystic change of the column.Limited images through the skull base are also negative.The alignment the vertebral column is within normal.

Output: 1.There is an osseous lytic lesion within the superior right lateral aspect of T7 vertebrae corresponding to the region of enhancement noted on prior MRI. This lesion measures approximately 12 x 8 x 8-mm in size. There is no evidence of extension of the lesion into the cortex and no evidence of fracture. Possibility of malignancy should be considered till proven otherwise.2.Negative nonenhanced CT of cervical spine otherwise.


Instruction: Generate impression based on findings.

Input: Female 37 years old Reason: Right shoulder rotator cuff injury History: Right shoulder pain. ROTATOR CUFF: There is focal poorly defined increased signal intensity seen on the fluid sensitive sequences along the myotendinous junction of the supraspinatus tendon that may represent a strain or perhaps focal degeneration, but we see no discrete tear. There is an insertional undersurface tear of the posterior fibers of the infraspinatus tendon involving just over 50% of the tendon thickness, but sparing the bursal surface fibers. The tear measures approximately 8 mm in the craniocaudal dimension. There is a cyst in the underlying humeral head. There is mild atrophy of the infraspinatus muscle.The teres minor muscle and tendon appear intact.There is thickening and increased signal intensity of the subscapularis tendon that extends into the subscapularis muscle which we suspect is iatrogenic due to infiltration of gadolinium during the procedure.We see no findings to suggest a full thickness rotator cuff tear.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. We see no gadolinium within the subacromial/subdeltoid bursa. There is mildly increased signal intensity within the subacromial/subdeltoid bursa seen on the fluid sensitive sequences that may represent a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased signal intensity and deformity of the anterior superior labrum that may represent a tear, but is of uncertain clinical significance. The inferior labrum appears normal. There is minimal posterior translation of the humeral head relative to the center of the glenoid.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: 1.Partial-thickness undersurface tear of the infraspinatus tendon at its insertion.2.Poorly defined focal increased signal intensity along the myotendinous junction of the supraspinatus may represent a strain, but we see no full-thickness rotator cuff tear.3.Findings suggestive of a mild subdeltoid bursitis.4.Increased signal intensity within the anterior superior labrum may represent a tear, but is of uncertain clinical significance.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with history of neurofibromatosis type II, with worsening gait and ataxia. MRI brain and IACs:Findings are redemonstrated compatible with right parietal and bilateral occipital craniotomy. The dura remains diffusely thickened. Superimposed on this are numerous dural based enhancing tumors compatible with meningiomas scattered throughout the intracranial space. These show no significant interval change in size from the prior examination. Some of these lesions are associated with mild parenchymal edema, particularly at the vertex.Enhancing lesions involving both IACs are also redemonstrated compatible with schwannomas. A bulky lesion on the right measures 36 x 26 x 25 mm, previously of similar size when measured in the same manner. This lesion significantly encroaches upon the CP angle cistern and exerts mass effect on the brainstem and pons similar to prior. A much smaller lesion involving the left IAC measures 15 x 6 x 7 mm, unchanged from prior.A small mildly hemosiderin stained surgical cavity or area of encephalomalacia is unchanged along the right middle frontal gyrus. No new intracranial lesions are detected. No new abnormal fluid collections are seen. The ventricles are stable in size and morphology.MRI cervical spine:Numerous small intramedullary enhancing lesions are seen within the cervical spinal cord which appear unchanged in size and number compared to prior exams. A small lesion along the left dorsal surface of the cord at C3 is unchanged as well. A bulky intramedullary tumor at T1 also appears unchanged from the prior exam.At C7-T1, a large extramedullary tumor which may be both intradural and extradural, spanning the right neural foramen, is unchanged in size. This lesion slightly flattens the right ventral spinal cord similar to prior. A bulky left dorsal dural based tumor at T4 is partially visualized.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. Mild cervical spondylosis is seen with no areas of significant associated spinal canal or foraminal stenosis.A bulky soft tissue mass is partially visualized along the right brachial plexus, as well as another more posteriorly along the right levator scapulae.

Output: 1.No significant interval change in the size of multiple intracranial meningiomas, nor of the bilateral IAC schwannomas. No new intracranial masses are identified.2.Numerous intramedullary lesions are redemonstrated in the visualized spinal cord compatible with primary cord tumors, statistically most likely ependymomas. The lesions show no significant interval change in size or number. Multiple extra-medullary tumors representing a combination of schwannomas and meningiomas are also unchanged.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to transsphenoidal surgery. There is a persistent hypoenhancing nodule that measures up to 4 mm in width in the left pituitary. There is no mass effect upon the optic apparatus. There is minimal leftward deviation of the pituitary stalk. There is hyperintensity on the post-contrast images in the right middle ear and mastoid air cells. There is a partially-imaged right maxillary sinus retention cyst.

Output: 1. Postoperative findings with a persistent nonspecific nodule in the left pituitary.2. Possible right otomastoiditis.


Instruction: Generate impression based on findings.

Input: Left knee pain. Evaluate for left knee meniscus tear. MENISCI: There is bandlike increased signal intensity within the body and posterior horn of the medial meniscus indicating intrasubstance degeneration. Within the posterior horn, the signal abnormality extends to the tibial articular surface, indicating a horizontal tear. Mucoid material also extends through the periphery of the meniscus at the junction of the body and posterior horn, with formation of a small parameniscal cyst. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: I see no fluid-filled articular cartilage defects. Small lobulated foci of signal abnormality in the distal femoral metaphysis and proximal tibial metaphysis likely represent benign enchondromas.LIGAMENTS: The cruciate and collateral ligaments are intact. There is a tiny rounded focus of near fluid signal intensity adjacent to the distal fibers of the anterior cruciate ligament that may represent a small ganglion.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Degeneration and horizontal tear of the medial meniscus with other findings as described above.


Instruction: Generate impression based on findings.

Input: Seizures despite medications. No seizures or epileptiform activity were captured on EEG during this admission. History is suggestive of localization-related epilepsy (complex and simple partial with possibly right temporal lobe onset) that is intractable, without status epilepticus. There is apparent asymmetry of the hippocampi, right smaller than left. The brain parenchyma and otherwise appears unremarkable. 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: Apparent asymmetry of the hippocampi, right smaller than left, without evidence of tumors. This is nonspecific and follow up via a brain MRI with contrast may be useful.


Instruction: Generate impression based on findings.

Input: Right distal tibia and distal femur osteomyelitis after old MVA. Evaluate for acute changes. Two views of the right femur show deformity of the femoral diaphysis likely due to old healed fractures, appearing similar to the prior study, with anterior bowing deformity of the mid-diaphysis. Screw fragments are noted within the mid-femoral diaphysis. Two screws affix a patella fracture in near-anatomic alignment. Heterotopic calcification is noted in the soft tissues lateral to the ilium, unchanged. Moderate osteoarthritis affects the knee. We see no acute process in the femur.Two views of the right tibia/fibula show old postoperative deformity of the right tibia/fibula reflecting healed fractures, appearing similar to the prior study. There is a geographic lucency within the distal tibial metadiaphysis that corresponds to an intramedullary lesion of near fluid signal intensity on a recent outside hospital MRI. This appears more prominent on the current study than the prior study and we cannot exclude an intramedullary abscess.

Output: 1. Post-traumatic deformities as described above.2. Geographic lucency in the right distal tibial metadiaphysis corresponding to a fluid signal intensity lesion on prior OSH MRI appears more prominent on this examination; we cannot exclude an intramedullary abscess.


Instruction: Generate impression based on findings.

Input: Hepatitis B, AFP 4000, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is smooth. Features of portal hypertension: None. Portal vein: Patent. Hepatic veins: Patent.Hepatic artery: Conventional.Lesions: 2.1 x 1.2 cm arterially enhancing lesion in segment IVb demonstrates washout on delayed postcontrast imaging (series 1101, image 247). Contiguous or adjacent punctate focus of parenchymal washout without definite arterial enhancement (series 1101, image 263).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 4B arterially enhancing lesion meets the criteria for HCC.2.Immediately adjacent punctate focus of parenchymal washout without definite arterial enhancement raises the possibility of a satellite HCC, or is just a poorly imaged tiny portion of the primary mass itself.


Instruction: Generate impression based on findings.

Input: Right lower extremity giving out, follow-up laminoplasty, more stiffness. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained. Interval straightening of the cervical spinal curvature is noted compared to the preoperative study, finding which may be in part positional and can be correlated with radiographs. Bone marrow signal is benign.Postsurgical changes of laminoplasty are again seen from C3 through C7 with decompression of the spinal canal. There remains diminished CSF spaces at the C3-C4 level but clearly improved since prior study. Thinning of the cord with T2 hyperintensity involving the dorsal aspect of the cord at the C3-C4 level is again seen and consistent with myelomalacia.No new cord signal abnormality or evidence of residual high-grade spinal canal stenosis is appreciated at any level. There is moderate to severe neural foraminal stenosis at C2-C3, C3-C4, C4-C5, C5-C6, and C6-C7 as seen previously related to pronounced uncovertebral hypertrophy.There is small residual postoperative fluid collection in the posterior paraspinous soft tissues at the C6 level.Lumbar spine: For the purposes of this dictation, consistent with prior reports, the lowest visualized intervertebral disc space is labeled L4-S1. There are 4 nonrib bearing lumbar vertebrae labeled L1-L4Conus terminates normally at the L1 level and is unremarkable in signal. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L2 on L3 which appears slightly worse since prior study from 7/29/2015 and suggests possible instability at this level. There is advanced facet arthropathy in this level with fluid in the facet joints appearing similar to prior.Multilevel degenerative changes include disc desiccation and mild height loss at the L2-L3, L3-L4, L4 S1 levels not significant changed since prior.Individual levels as below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. Mild ligamentum flavum hypertrophy and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge with uncovering of the disc and superimposed central extrusion extending 8 mm superiorly which is similar to prior. Moderate ligamentum flavum thickening and facet arthropathy, left greater than right. Moderate spinal canal stenosis appears slightly worse since prior from 7/29/2015 but slightly better than 7/5/2014 study. There is mild to moderate right and moderate left neural foraminal stenosis at this level which appears worse.L3-L4: Mild disc bulge, ligamentum flavum thickening and facet arthropathy is unchanged. Mild spinal canal stenosis is unchanged. Moderate left and mild right neural foraminal stenosis is unchanged.L4-S1: Diffuse disc bulge, asymmetric to the right, is unchanged. Facet arthropathy and ligamentum flavum thickening is unchanged. No significant central canal stenosis. Narrowing of the right lateral recess with contact of the descending right S1 nerve root is unchanged. Moderate bilateral neural foraminal stenosis is unchanged.

Output: 1. Postsurgical changes of cervical laminoplasty from C3 to C7 with decompression of the spinal canal. No significant change in cord T2 hyperintensity with cord thinning at the C3-C4 level consistent with myelomalacia. No new cord signal abnormality or evidence of residual high-grade stenosis in the cervical spine.2. Moderate to severe neural foraminal stenosis bilaterally from C2-C3 to the C6-C7 levels as seen previously.3. Compared to the preoperative study, there has been some straightening of the cervical spinal curvature. While this may be in part positional, further assessment with radiographs can be considered.4. Please note transitional anatomy in the lumbar spine with numbering scheme as above. Multilevel degenerative changes in the lumbar spine are again seen. Compared to 7/29/2015, there appears to be slight worsening of anterolisthesis at the L2-L3 level and can be correlated with dynamic radiographs for dynamic instability. Moderate spinal canal stenosis at this level also appears slightly worse since 7/29/2015 but improved since 7/5/2014 study, when there was a larger disc herniation. Please see details above regarding neural foraminal stenosis in the lumbar spine.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is about 13.4mm x 14.1mm x 25mm sized soft tissue mass with high T2/FLAIR signal intensity and flow voids along the distal left cervical ICA to the the level of the left jugular bulb. This is suspicious for a paraganglioma (glomus jugulare). There is minimal scattered periventricular and subcortical T2/FLAIR signal hyperintensity which is nonspecific but likely related to small vessel ischemic disease. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse volume loss. The ventricles and basal cisterns are otherwise unremarkable. There is no midline shift or herniation. MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: The left common carotid artery arises from the brachiocephalic trunk which is a normal variant. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. There is enhancement of the likely left side jugular bulb paraganglioma with suggestion of early venous drainage into the adjacent left internal jugular vein.

Output: 1.Large likely left jugular bulb paraganglioma predominately along the petrous portion of the left ICA to the level of the left jugular bulb. No evidence of an acute infarct.2.Questionable partially assessed tongue atrophy which could conceivably be secondary to mass effect on the left hypoglossal nerve by the tumor. Correlate for possible additional CN9-CN11 involvement.3.Prominent left mastoid air cell fluid which is nonspecific but correlate for possible mastoiditis.4.No significant high grade vascular stenosis in the neck or intracranial vasculature.Findings were discussed with the Neurology resident on call, Dr. Santos De Lima (pager 9203) the primary physician taking care of the patient at the time of the finding by Dr. Veronesi, Neuroradiology fellow.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of shoulder dislocation, evaluate for labral tear ROTATOR CUFF: Mild increased signal at the distal supraspinatus tendon consistent with tendinosis. No evidence of discrete tear. Muscles appear normal without atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. No definite labral tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild distal supraspinatus tendinosis. No discrete labral tear.


Instruction: Generate impression based on findings.

Input: 74 years, Male, confusion, preoperative evaluation for brain tumor resection. Examination is limited to sequences for operative planning. Again seen is a heterogeneously enhancing mass with central necrosis centered in the left parietal lobe with extension into the left temporal lobe as well as the anterior aspect of the occipital lobe, similar to prior exam. Mass is again noted to extend to the ependymal surface and also noted to extend slightly across midline at the splenium. Mass measures approximately 5.0 x 4.3 cm in the axial plane and up to 5 cm in the craniocaudal dimension. There is surrounding edema and associated mass effect on the left lateral ventricle. There is also ventriculomegaly which is similar to prior. There is mild rightward midline shift. No uncal herniation. Evidence of recent left transparietal biopsy noted.

Output: Heterogeneously enhancing mass with central necrosis centered in the left parietal lobe with extension into the left posterior temporal lobe, anterior occipital lobe, and slight extension across the splenium into the right parietal lobe. Appearance of the mass is consistent with a high-grade glioma neoplasm.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils are low lying, extending up to approximately 8 mm inferior to the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. No evidence of acute or subacute infarct.2. Low-lying cerebellar tonsils are compatible with Chiari 1 malformation.


Instruction: Generate impression based on findings.

Input: Ms. Davis is a 62-year-old female with family history of breast cancer in mother (diagnosed at age 50), sister (diagnosed at the age of 40), and a paternal cousin. She is of an Ashkenazi Jewish heritage. Mild parenchymal enhancement is noted bilaterally.Right breast: In the right upper outer breast, 10:00 location (posterior depth), there is a stable 9 mm enhancing mass which is unchanged when compared to multiple prior exams. In the right upper outer breast, 11:00 location (anterior depth), there is a 5 mm enhancing focus. This was seen on prior MRI in 2014 and to a lesser extent on MRI from 2012. Left breast: In the left inferior breast, 6:00 location (anterior depth), there are two parallel linear enhancing areas. These were also seen on prior MRI in 2014 and to a lesser extent on MRI from 2012. No abnormal axillary lymph nodes are identified in either axillary region.Drs. Schacht, Abe and Sheth concurred on the management discussed below.

Output: Bilateral enhancing foci which appear slightly more prominent on today's MRI exam. Given that these were seen on prior MRI from 2014 and to a lesser extent on MRI from 2012, a short term MRI examination in 6 months is recommended to confirm stability of these findings. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Images are moderately limited by patient motion, especially postcontrast imaging. Postoperative changes are again seen from a previous right frontal approach biopsy of the thalamus, with a few foci of susceptibility. There is redemonstration of mild subtle residual gyral thickening along the right insula, similar to prior exams. There is no corresponding enhancement.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Continued stable appearance of mild residual asymmetric gyral thickening along the right insula, within motion limitation.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, history of lung cancer metastases to the brain. Minimal if any residual enhancement is seen at the site of a previous lesion along the medial right occipital lobe, similar to the immediate prior examination and improved relative to examinations from August 2014. No reliably detectable enhancement is seen at the site of prior lesions in the right parietal lobe and the right middle frontal gyrus.No new enhancing lesions are seen. Mild periventricular T2 hyperintensity is seen along with a few scattered additional subcortical foci of white matter signal abnormality. Findings are nonspecific and unchanged. No parenchymal edema or mass effect is detected. No significant intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. Ventricles are normal in size and morphology.Patchy nonspecific enhancement persists unchanged within the right parietal bone. Also noted is a 9-mm enhancing lesion which localizes along or within the left orbital roof (see image 14 of series 1001 and image 41 of series 1201). This lesion was not detectable on the first available brain MRI from 1/17/14, and has slowly increased in size on subsequent studies.

Output: 1. No definite evidence to suggest recurrent or new metastatic disease in the brain parenchyma.2. Note is made of a slowly growing 9-mm region of enhancement within or along the left orbital roof. The significance of this finding is uncertain and the differential diagnosis would include both a benign lesion, such as a hemangioma, as well as metastatic disease. Continued attention to this area on subsequent studies is encouraged.


Instruction: Generate impression based on findings.

Input: Male, 29 years old, history double up see with drop attacks, image guidance during laser ablation. Selected sequences are provided for guidance during laser ablation.Two laser ablation fibers are in place, one of which approaches from the right posterior parietal region coursing anteriorly and inferiorly to track along and terminate within the body of the right corpus callosum; the second approaches from the right frontal region and tracks inferiorly and posteriorly through the right corpus callosum genu and terminating at the level of the rostrum.On postcontrast images, a blush enhancement is seen along the distal aspects of both laser fibers compatible with procedure-related disruption to the blood brain barrier. Again seen is encephalomalacia of the anterior right temporal lobe along with evidence of multiple prior bilateral craniotomies.

Output: Image guidance during laser ablation reveals the placement of two laser fibers, one which tracks along the right corpus callosum body, while the other tracks along the right corpus callosum genu and rostrum. Postcontrast images reveal a blush enhancement along the distal aspects of both fibers compatible with procedure-related disruption of the blood brain barrier.


Instruction: Generate impression based on findings.

Input: Lumbago [724.2], Reason for Study: ^Reason: r/o DJD progression/ spinal cord compression History: lower back pain with radiation to left thigh For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is acute compression fracture of L2 vertebral body with about 20% of height loss.There is no definitive evidence of retropulsion of fracture fragment.The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at theL1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: Mild bilateral ligamentum flavum thickening, no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc, previously seen central to left disc protrusion is not shown on today's scan. Instead there is broad based diffuse bulging of disc toward left side foramen causing minimal neural foraminal narrowing but does not show any evidence of direct nerve root compression. L3-L4: Diffuse bulging of disc with bilateral ligamentum flavum thickening causing mild to moderate spinal canal stenosis. L4-L5: Diffuse bulging of disc, minimal spinal canal stenosis. Subchondrosclerosis of bilateral facet joint with the minimal thickening of ligamentum flavum. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Acute compression fracture of L2 vertebral body with the 20% of height reduction.2. Degenerative spondylosis of L-spine.3. Retracted previously seen L23 disc protrusion with remained broad based disc bulging without evidence nerve root compression.Comment: if the back pain is clinically intolerable with conservative management, please contact neurointerventional radiology for percutaneous kyphoplasty if indicated.


Instruction: Generate impression based on findings.

Input: Right lower extremity radiculopathy, S1 Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with focal T1 hyperintensity involving the L3 vertebral body compatible with a hemangioma or focal fat. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge eccentric to the left.. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation and minimal bulge. No spinal canal or neural foraminal stenosis.L5-S1: There is a right paracentral disc extrusion which effaces the lateral recess. Annular fissure is also evident. There is caudal migration of the extruded disc fragment which remains contiguous with the parent disc fragment, without findings to suggest sequestration. There is mass effect on the right S1 nerve root. Left lateral recess and central canal remain patent. Neural foramina also remain patent. Paraspinous soft tissues are within normal limits.

Output: Disc extrusion at L5-S1 with effacement of the right lateral recess and suspected impingement of the right S1 nerve root.


Instruction: Generate impression based on findings.

Input: Other malignant neoplasm without specification of site [199.1], Reason for Study: ^Reason: 21 y/o with h/o metastatic testicular cancer to brain and lung. c/f brain metastasis as well as hemorrhage into metastasis vs. Leptomeningeal disease. Brain MRIThere is subacute hemorrhagic foci on the right precentral gyrus cortex which shows some enhancement with minimal surrounding edema. Considering the patient's clinical history of malignancy, this lesion could represent hemorrhagic metastasis.There are multiple enhancing lesions on the right posterior medulla and right inferoanterior aspect of cerebellar hemisphere, again indicating metastatic lesions.There is no evidence of acute ischemic lesion on this scan.There is no evidence of abnormal leptomeningeal enhancement.The ventricles, sulci and cisterns are symmetric and 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 normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non visualization of the right vertebral artery from the level of C34. Considering the size of proximal right vertebral artery and tapering fashion of the distal visualized portion of the right vertebral artery, arterial dissection can be a differential diagnosis. Axial fat saturation T1 scan of the neck shows intra-luminal high signal intensity on the right vertebral artery which suggest possible intraluminal thrombus or very slow flow. However, due to motion artifacts and low spatial resolution, evaluation of vertebral arterial wall hematoma which could be diagnostic for the possibility of arterial dissection cannot be precisely evaluated.Otherwise, normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries were seen. Bilateral vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. There are multiple lung lesions demonstrated. The largest lesion is on the right upper lung and the size was 21mm.Orbit MRIThe globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.

Output: 1. Multiple metastatic lesions including the right frontal lobe pre central gyrus (hemorrhagic), right posterior medulla and right cerebellar hemisphere.2. No acute ischemic lesion. No abnormal leptomeningeal enhancement.3. Non visualization of right vertebral artery indicating right vertebral artery occlusion. 4. Normal brain MRA. Normal Orbit MRI.


Instruction: Generate impression based on findings.

Input: Headaches No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray/white matter differentiation remains within normal.Limited real paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable.Calvarium is intact. Small densely calcified lesion along the inner table of the skull in the right pterion with extension inferiorly along the greater wing of sphenoid on the right is noted there is a lucent line separating this lesion from the inner table of the skull which may represent the dura. The finding may not present heavily calcified dural (dural plaque) however possibility of heavily calcified meningioma cannot be ruled out. This lesion can be further evaluated with a dedicated MRI examination of brain with contrast. I detect no soft tissue component with this finding which is best appreciated on bone density images 5 through 12.

Output: 1.Negative CT of brain parenchyma.2.Thin densely calcified extra-axial dural based lesion at the level of right pterion may represent a dural plaque or a heavy calcified meningioma. Please see above comments. Follow-up with a dedicated MRI is recommended.


Instruction: Generate impression based on findings.

Input: 34 years, Male, Reason: 34 yo male w/ GBM; s/p 3 resections, RT (59.4 Gy and 33 fractions), BCNU, and TMZ+RT; recently relapsed. Again seen is a left frontal tumor resection cavity with multiple adjacent foci of susceptibility compatible with chronic blood products. Since the prior exam from 7/12/2016, there has been marked increase in nodular and heterogeneous enhancement surrounding the left frontal resection cavity along its lateral, medial, and inferior aspects. Interval increase in enhancement extends across the corpus callosal genu into the right frontal lobe, left basal ganglia inferiorly, posteriorly into the left parietal lobe, as well as across the splenium into the right parietal lobe. Inferior tumor extension is noted now filling the suprasellar cistern with associated mass effect including posterior displacement of the midbrain. Elevated cerebral blood volume is noted with the increased areas of enhancement.There is also increase in T2/FLAIR hyperintensity in the left frontal, left parietal, right frontal, and right parietal lobes. There is worsened mass effect including increased effacement of the left lateral ventricle. There is subfalcine herniation and rightward midline shift measuring approximately 8 mm at the level of the foramen of Monro. The right temporal horn is enlarged indicative of entrapment. The third ventricle is posteriorly displaced and dilated which appears to be related to obstruction at the cerebral aqueduct. There is increase in edema in the midbrain. There is effacement of the bilateral ambient cisterns related to downward herniation.There is restricted diffusion associated with the tumor. No evidence of infarct or new large hemorrhage. Major flow-voids are grossly preserved. Right transparietal shunt catheter is in place with its tip in the lateral ventricle abutting the septum pellucidum, similar to prior.

Output: 1. Compared to 7/12/2016, there is marked progression of known glioblastoma with increased extension in the left frontal and left parietal lobes, increased extension across the corpus callosum, inferior extension into the basal ganglia as well as inferior extension into the suprasellar cistern. 2. Worsened mass effect includes midline shift, dorsal displacement of the midbrain, and downward herniation. There is also increase in dilatation of the lateral and third ventricles which is suspected to be related to obstruction at the level of the cerebral aqueduct.Dr. Ali discussed findings with Dr. Lukas at 1600 hrs on 8/12/2016.


Instruction: Generate impression based on findings.

Input: 54-year-old male with altered mental status. Again seen are patchy areas of low attenuation in the subcortical and periventricular white matter, which are nonspecific and have progressed since recent MRI. Please refer to the MRI report from 5/22/2009 for further detail. There may be a new focus of low attenuation in the right brainstem (image 8/36, series 2), which may be further evaluated with MRI if clinically indicated.There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with normal volume and morphology. There is no midline shift or mass effect.The calvaria and other osseous structures are intact, with no fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. New hypoattenuating focus in the right midbrain, which may be further evaluated by MRI if clinically indicated.2. Progression of extensive white matter abnormality, with differential including demyelinating disease versus underlying metabolic abnormality.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with left upper extremity radiculopathy. Assess for disc herniation. Straightening of the cervical lordosis is demonstrated, similar to prior. Spinal alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. No pathologic marrow replacement or marrow edema is seen.The visualized spinal cord is free of pathologic signal abnormality. Additional details by level as follows:C2-3: Stable tiny subchondral cyst along the C2 endplate. No significant spinal canal stenosis or neuroforaminal narrowing. C3-4: Interval decrease in size of a previously seen central disc protrusion. Small persistent central annular fissure. No significant foraminal narrowing. C4-5: Left facet hypertrophy. Slight interval progression of posterior disc-osteophyte complex formation asymmetric to the left. Mild effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Mild left foraminal narrowing, progressed. C5-6: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing, progressed. Mild right foraminal narrowing, unchanged. C6-7: Posterior disc-osteophyte complex formation with an asymmetric/focal component in the right paracentral zone appearing similar to prior. Mild generalized spinal canal stenosis and slight ventral cord flattening are unchanged. Mild to moderate right neuroforaminal narrowing is unchanged.C7-T1: No spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues are unremarkable. A small Tornwaldt cyst is evident within the nasopharynx.

Output: 1.Decrease in the size of the previously seen central disc protrusion at C3-4.2.Slight interval progression of posterior disc-osteophyte complex formation asymmetric to the left at C4-5 with mild progressive left foraminal narrowing.3.Posterior disc-osteophyte complex formation at C6-7 with mild generalized spinal canal stenosis and mild ventral cord flattening, unchanged.


Instruction: Generate impression based on findings.

Input: Reason: Right knee patellofemoral pain no improvement with PT, NSAIDS or injection evaluate for chondral injury vs meniscus tear History: right knee pain MENISCI: The lateral meniscus appears intact. There is minimal heterogeneity of the undersurface of the posterior horn of the medial meniscus which may reflect minimal undersurface fraying. No fluid-filled or unstable tear is evidentARTICULAR CARTILAGE AND BONE: There is focal partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle, centrally, with a tiny focus of degenerative subchondral signal abnormality. There is subjective thinning of the lateral tibiofemoral articular cartilage. There is full-thickness articular cartilage degeneration along the lateral facet of the patella with focal full-thickness articular cartilage defects and delamination. There is underlying degenerative subchondral signal abnormality. There is a full-thickness articular cartilage cleft along the medial facet of the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Osteoarthritis of the knee most pronounced along the patellofemoral articulation with full thickness articular cartilage defects and delamination as described above. Superficial fraying of the medial meniscus. No fluid-filled or unstable meniscal tear is evident. Other findings as described.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Right hemiparesis and facial droop. There is restricted diffusion and high T2 signal and swelling within the left paramedian pons. A punctate focus of restricted diffusion is also present within the left posterior parietal lobe at the gray-white matter junction. There are a few punctate foci of susceptibility effect in the left pons. The ventricles are within normal limits in size and configuration. There are several foci of T2 hyperintensity are present in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There is a left frontal convexity extra-axial mass that measures up to 7 mm in thickness, without compression of the underlying brain. There is diffuse cerebral volume loss. The skull, orbits, and scalp soft tissues are unremarkable.

Output: 1. Acute ischemic infarct involving the left paramedian pons and an additional punctate focus of acute infarction within the posterior left parietal lobe at the gray-white junction, with petechial hemorrhagic conversion in the pons.2. A small left frontal convexity mass likely represents a meningioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Please evaluate for osteomyelitis in a patient with right knee pain and history of below-the-knee amputation. Again seen are findings related to below the knee amputation. The patient's knee is held in flexion which limits evaluation of the knee joint, proximal tibia, and distal femur.There is sclerosis of the residual proximal tibial diaphysis likely representing chronic osteomyelitis and corresponding to signal abnormality seen on prior MRI. The tibia appears similar to that seen on prior radiographs in July 20, 2015 with no progression of osteolysis.

Output: Surgical changes of below-the-knee amputation with sclerosis of the residual tibia consistent with chronic osteomyelitis without progression of osteolysis.


Instruction: Generate impression based on findings.

Input: Reason: scoli History: scoli Bilateral spinal fixation rods with left-sided pedicle screws entering the T4-L3 vertebral bodies and right-sided pedicle screws entering the T4, T6, T8, T10, L2 and L3 vertebral bodies. There is no radiographic evidence of hardware complication.

Output: Orthopedic fusion of the thoracolumbar spine.


Instruction: Generate impression based on findings.

Input: Male, 85 years old, with weakness, hyperreflexia, spasticity and atrophy. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No worrisome marrow signal replacement or marrow edema is detected. The visualized spinal cord demonstrates normal morphology and signal characteristics.Loss of disc T2 signal is seen throughout the visualized spine. In addition, there is loss of disc height at C5-6 and C6-7. Additional level specific findings are as follows:C2-3: Left facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing.C3-4: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. C4-5: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation. Minimal spinal canal narrowing. Moderate bilateral foraminal narrowing. C5-6: Bilateral facet hypertrophy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C6-7: Bilateral facet hypertrophy. No spinal canal stenosis. Very mild left foraminal narrowing. C7-T1: Bilateral facet hypertrophy. No spinal canal stenosis. No significant foraminal narrowing.

Output: 1.Multilevel cervical spondylosis resulting in scattered mild spinal canal stenosis and mild to moderate neuroforaminal narrowing.2.No evidence of high-grade spinal canal stenosis is seen. No cord impingement or cord edema is suspected.


Instruction: Generate impression based on findings.

Input: History of chronic hepatitis C. Interval follow-up of enhancing liver mass. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of a homogeneously enhancing lesion within segment 2 the liver measuring 1.3 x 1.3 cm (series 102 image 82), previously 1.5 x 1.5 cm. The lesion has mildly increased T2 signal and restricted diffusion and retains contrast on the delayed images and does not show washout.The liver has a nodular surface contour consistent with cirrhosis. Hepatic artery, portal vein, and hepatic veins are patent. No biliary ductal dilatation. No findings to suggest portal hypertension.SPLEEN: No significant abnormality noted.PANCREAS: Mildly atrophic pancreas with diffuse prominence of the main pancreatic duct appearing similar to prior.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. No suspicious mass lesion or hydronephrosis.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.No significant interval change in enhancing focus in segment 2 of the liver. Enhancement characteristics are not compatible with HCC, and the lesion is likely benign. 2.Cirrhotic morphology liver without sequela of portal hypertension.


Instruction: Generate impression based on findings.

Input: Language delay, localization related epilepsy, but normal EEG. There is a submillimeter nodular focus in the mid frontal scalp, with linear extension to the underlying calvarium. There is no evidence of intracranial hemorrhage, mass, or infarct. The brain parenchyma, brainstem, and cerebellum appear unremarkable. There is an appropriate degree of white matter myelination. 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: A submillimeter nodular focus in the mid frontal scalp, with linear extension to the underlying calvarium may represent an atretic encephalocele or related entity, for which ultrasound may provide further characterization. Otherwise, no evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: 38-year-old female with right upper quadrant abdominal pain, nausea, and vomiting ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Cholelithiasis is noted. Small filling defect at the distal common bile duct at the level of the ampulla likely reflects a small gallstone. There is an arterially enhancing lesion in hepatic segment six measuring 1.4 x 1.2 cm (series 13, image 135). Additional arterially enhancing lesions within hepatic segment seven and two. These lesions are isodense to liver parenchyma on subsequent phases.SPLEEN: Probable splenule inferior to the pancreatic tail measuring 1.2 x 1.3 cm.PANCREAS: Mild edema type signal surrounding the pancreatic head may reflect pancreatitis.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.Cholelithiasis with pericholecystic fluid can be seen in the setting of acute cholecystitis.2.Choledocholithiasis with small stone at the distal CBD at the level of the ampulla. Mild edema surrounding the pancreatic head may reflect mild pancreatitis.3.Arterially enhancing lesions within hepatic segment two, six, and seven may represent hepatic adenomas or focal nodular hyperplasias. Follow-up MRI in 6-12 months with FNH protocol is recommended to ensure stability.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with neutropenic fever and altered mental status in a patient with AML status post stem cell transplant. A small focus of T1 hyperintense material, likely blood, is seen within the left superior frontal sulcus. The edges of the sulcus show susceptibility compatible with hemosiderin staining. Similar findings are also evident along several sulci of the right middle frontal gyrus. These findings are new relative to the prior exam.A few scattered foci of T2 hyperintensity are seen within the periventricular white matter which are not significantly changed from prior. A punctate focus of susceptibility within the left frontal lobe is new and compatible with chronic microhemorrhage.No mass effect or parenchymal edema is detected. The ventricles are within normal limits for size but slightly larger than on the prior examination, a finding which may represent interval volume loss.A mucus retention cyst is present in the right maxillary sinus. Patchy mucosal thickening or secretions are evident in the right frontal sinus and left ethmoid air cells.

Output: 1. A small amount of blood product is seen within the left superior frontal sulcus and along some of the sulci of the right middle frontal gyrus. There is no significant associated mass effect or parenchymal edema. No underlying lesions are seen to account for these areas of hemorrhage. Discussed with Dr. Lurain at 8:15 AM on 2/14/15.2. Otherwise no definite evidence of any other acute intracranial abnormality including no findings to suggest acute ischemia or intracranial infection.


Instruction: Generate impression based on findings.

Input: Reason: History of ischemic stroke. There is a small, focal area of signal abnormality centered within the posterior aspect of the left putamen extending into the adjacent left frontal deep white matter which demonstrates increased T2 signal, mixed T1 signal, increased signal on diffusion-weighted images, and isointense signal on ADC images compatible with a subacute infarction. This area corresponds to the hypodensity described on recent CT. The remaining brain parenchyma appears within normal limits for age. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening within the maxillary sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Subacute infarct involving the left putamen and adjacent deep white matter which was also present on recent CT from 7/20/2016.