Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic thyroid cancer to bone, brain and lung. Pre-chemotherapy. Signs and symptoms: metastatic thyroid cancer. Enhanced CT of soft tissues of neck:Limited view of intracranial content demonstrates small enhancing metastatic lesion in the left frontal lobe measuring 7-mm times 10-mm. This could be further evaluated on dedicated CT of brain.Images through the skull base demonstrate a lytic lesion in the clivus with no change since prior exam. This lesion has a sclerotic rim. This is believed to represent postoperative changes of the sphenoid sinus with packing material.Cavernous sinuses and bilateral Petrus bones remain within normal limits.Images through the neck and demonstrate no evidence of a mass or pathologic adenopathy. No evidence of residual enhancing thyroid tissue. The esophagus appears dilated and contains air. This may represent reflux. Trachea appears ectatic.CT of brain with enhancement: Lytic changes of clivus with a sclerotic rim and internal calcific fragments remains stable since prior CT of head and neck study and MRI of brain. This lesion believed to represent non-pneumatized sphenoid sinus or may be result of prior surgical inflammation (transphenoidal hypophysectomy) and with packing of the sinus. There is no interval change since prior exams and there is no abnormal enhancement of this finding on MRI examination. Please correlate with patient's past history.Images through the posterior fossa demonstrate a well demarcated low-attenuation within the vermis with no enhancement at the site of previously noted metastatic lesion. Surrounding vasogenic edema still is present. The finding may represent post treated metastatic lesion. This lesion measures approximately 16.2 mm in transverse axis and 14.4-mm in AP axis. This is a smaller than prior measurements of the enhancing mass in this location which measured 21 mm times 18-mm.At enhancing tumor measuring approximately 9 mm times 7-mm in the inferior left frontal lobe with surrounding vasogenic edema is again identified. This mass on prior MRI examination measured 5-mm x 4.5-mm. there is no evidence of any new additional metastatic lesions to the brain or leptomeninges.Calvarium is intact. 65 cc of Omnipaque 350 was utilized for the above studies.

Output: 1.Stable CT of soft tissues of neck with no evidence of recurrence of tumor or pathologic adenopathy in neck.2.Minimally larger left inferior frontal metastatic focus with surrounding vasogenic edema. This lesion measures 7 mm times 9-mm on current exam.3.Patient is known enhancing metastatic lesion in the vermis demonstrates no enhancement on the current exam and measures smaller than prior exam.4.No evidence of new additional metastatic lesion to the brain or calvarium.


Instruction: Generate impression based on findings.

Input: 25 years Female (DOB:6/15/1991)Reason: 3 t scanner ccm protocol, qsm/permiablility assess for cavernomas History: assess for cavernomasPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 3 mm signal hypointense focus present in the right lateral pontine tegmentum adjacent to the origin of the right superior cerebellar peduncle. It is in the expected locations of the right lateral meniscus, spinothalamic tract and central tegmental tract This is associated with a developmental venous anomaly. It has blooming effect on the susceptibility images. No associated lesions are appreciatedNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Findings are compatible with a small cavernoma located along the right pontine tegmentum near the superior cerebellar peduncle.


Instruction: Generate impression based on findings.

Input: History of renal cancer status post left nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity without a focal lesion or biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. In the adjacent dorsolateral retroperitoneal space there are several soft tissue nodules that demonstrate postcontrast enhancement, the largest conglomeration of which measures 2.4 x 1.4 cm (series 12 101/2024), slightly increased in size when measured on the prior outside hospital study where it measured approximately 2.2 x 1.1 cm (series 12 image 31). Another discrete nodule more inferiorly measures 8 mm (series 12 101/154), compared to 6 mm previously (series 12 image 41). There is a discrete parasplenic implant on the left lateral transversalis fascia (series 1201/324), increased in size. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: In the lower left lateral abdominal wall musculature there is a 1.8 x 1.0 cm enhancing nodule (series 1201/4), unchanged.OTHER: No significant abnormality noted.

Output: Status post left nephrectomy with enhancing soft tissue nodularity in the left retroperitoneal compartment along the fascial planes suspicious for residual or locally recurrent disease, slightly increased in size compared to the prior. Nonspecific enhancing soft tissue nodule in the left lateral abdominal wall musculature may represent a site of metastatic disease.


Instruction: Generate impression based on findings.

Input: There is no evidence of cord compression.There is straightening of the entire spine in the sagittal plane with dextroscoliosis of the lower thoracic spine.Conus terminates at approximate mid-L1 level. There is a diffuse plaque-like T1 hyperintensity along the dorsal thecal sac from the level of L1-L2 that becomes thicker caudally to the end of the thecal sac. The maximal thickness is 9 mm. At the level of L5 there is additional ventral thecal sac T1 hyperintensity. There is corresponding drop out of signal on STIR, suggesting that the intrathecal finding is fat. There does not appear to be true layering of the abnormal signal in the thecal sac to suggest blood products, although axial images are not available.Annular fissure is seen at L4-L5. There is desiccation of the L4-L5 disc. Diffuse desiccation is seen in the cervical disks.

Output: 1. No evidence of cord compression.2. Probably fatty filum/lipoma in the lower lumbar spine. Recommend dedicated lumbar spine MRI on nonurgent basis to include prone imaging for further evaluation.3. Mild spondylotic change of L4-L5.


Instruction: Generate impression based on findings.

Input: Acute stroke status post TPA. History of well-differentiated colonic adenocarcinoma. There are few punctate foci of restricted diffusion along the medial margin of the otherwise chronic right lateral temporal and inferior parietal infarct, where there is also diffuse susceptibility effect. There are also numerous scattered punctate foci of susceptibility effect in the cerebellum, brainstem, and bilateral thalami. There is diffuse cerebral white matter T2 hyperintensity. There is ex vacuo dilatation of the right lateral ventricle superimposed upon diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a T1 hypointense lesion in the right frontal bone that measures up to 20 mm.

Output: 1. Acute punctate infarcts along the medial margin of the otherwise chronic right middle cerebral artery territory infarct, where diffuse susceptibility effect may represent prior petechial hemorrhages and/or cortical laminar necrosis.2. Diffuse background of what likely represents chronic small vessel disease and scattered chronic hypertensive microhemorrhages.3. A T1 hypointense lesion in the right frontal bone is nonspecific, but may represent metastatic disease. Follow up via MRI with contrast may be useful.


Instruction: Generate impression based on findings.

Input: 44 years, Female, Reason: evaluate uterine fibroids History: heavy periods. PELVIS: FemaleUTERUS, ADNEXA: Uterus is anteverted. There are hypoechoic, enhancing lesions within the uterus which likely represent fibroids including a posterior body lesion measuring 4.3 x 3.1 cm (501/22), posterior body lesion measuring 1.3 x 0.9 cm (501/24), anterior body lesion measuring 4.5 x 2.5 cm (501/23) and anterior body lesion measuring 1.7 x 1.2 cm (501/20). An ill-defined hypoechoic lesion in the fundus measuring 3.1 x 2.5 cm (501/20) likely represents a focal adenomyoma.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: Multiple uterine fibroids as above.


Instruction: Generate impression based on findings.

Input: The patient is a 13-year-old female with history of neurofibromatosis. Cerebellar tumor resection in June 2005. Tinnitus, vertigo, ear pain and decreased hearing. Again seen is hypodensity in the left cerebellar hemisphere partially surrounded by calcified rim which appears unchanged from the prior study. Midline posterior craniectomy defect and postoperative changes in posterior fossa appear similar to the prior study.Ventricular shunt catheter tubing enters the a right frontal approach with tip terminating near midline, also unchanged from the comparison study.There is no evidence of intracranial hemorrhage, mass or edema. The internal auditory canals are normal in caliber and symmetric. However, for evaluation of tumor at this site, MRI is recommended. The cerebral hemispheres, brainstem and remainder of the cerebellum are normal in morphology and attenuation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Normal caliber internal auditory canals. For evaluation for possible tumor at this location, we recommend MRI.2. Stable postoperative findings.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, status post transphenoidal resection of a pituitary tumor in December 2011, yearly surveillance to ensure stability. Redemonstrated is deformity of the pituitary gland associated with low parenchymal volume compatible with surgical alteration, unchanged in appearance. As before. the pattern of glandular enhancement remains somewhat heterogeneous, but again without discrete mass, which is unchanged and likely attributable to surgery. No new or developing lesions are seen. The pituitary stalk sits at midline and enhances normally. Right maxillary sinus inflammation is demonstrated with mucosal thickening and fluid, similar to the prior exam.

Output: Stable postsurgical appearance of the postoperative pituitary gland without evidence of recurrent lesion.


Instruction: Generate impression based on findings.

Input: 39 year old BRCA mutation with strong family history of breast cancer in maternal grandmother, maternal cousin, paternal grandmother, and paternal aunt. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: h/o newly diagnosed small cell lung cancer; eval for mets prior to beginning urgent chemotherapy History: see above Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Patchy scattered FLAIR/T2 high signal intensities on periventricular white matter and bilateral centrum semiovale indicate nonspecific small vessel ischemic disease.There are several lacunar infarcts seen on bilateral basal ganglia and left side anterior pons.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Left mastoid air cells show fluid collections.Cervical and Thoracic Spine MRIThere are multifocal vertebral body lesions which replacing normal fatty marrow on both cervical and thoracic vertebral bodies including C7, T1, T2, T3, T5, T10, T11 and T12 indicating multifocal metastatic lesions.Specifically, there are associated soft tissue mass left side neural foramen at the level of C7T1 and T12 with large paravertebral likely extrapleural soft tissue mass.There are also multilevel bilateral pleural thickening on thoracic vertebral levels as well as right posterior lobe of the liver indicating possible metastatic lesions.There is no evidence of vertebral body compression fracture on this scan. Cervical spine shows straightening with degenerative changes of cervical spine. In particular, there are disc dessication with disc height decrease at C45, C56 and C67.There is broad based a bit irregular disc protrusion which abuts thecal sac at the level of C34, however, no evidence of bilateral neuroforamen stenosis.Spinal cord signal intensity is normal.There is no evidence of spinal canal stenosis or neuroforaminal narrowing on thoracic spine.

Output: 1. No evidence of metastatic lesion intracranially.2. Multiple vertebral body metastatic lesions involving both cervical and thoracic vertebral bodies with paravertebral soft tissue mass formation at T1 and T2 level as described above.3. Multifocal extra vertebral metastatic lesions including bilateral extrapleural or pleural spaces and right lobe of the liver.4. Degenerative changes of cervical spine C45 to C67.


Instruction: Generate impression based on findings.

Input: 40 year old with history of left modified radical mastectomy in January 2015 for left breast IDC with DCIS and metastatic left axillary lymph node, presents for MRI study. Status post left mastectomy.There is extreme amount of fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast or in the left mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 56-year-old man with history of rectal cancer status post resection of left lobe hepatic metastasis, now with new lesions seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Patient is status post partial left hepatectomy. In comparison to 6/2016, there are two new hepatic parenchymal lesions identified. A segment 4 lesion (13/17) measures 17 x 13 mm, has increased peripheral T2 signal, and enhances. In segment 6 at the site of previously seen hypoattenuating liver lesion (13/30) there is a 19 x 13 mm subcapsular T2 hyperintense area which retracts the capsule and does not enhance. No additional focal hepatic lesions are identified.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Accessory splenule noted, the spleen is otherwise unremarkable.PANCREAS: A few punctate foci of T2 hyperintensity along the pancreatic duct probably represent small sidebranch IPMNs. The pancreatic parenchyma otherwise appears normal. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cysts, the kidneys are otherwise unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: Scarring in the right lower quadrant anterior abdominal soft tissues likely from prior ostomy.OTHER: Along the surgical margin (13/27) there is minimally increased, amorphous T2 and diffusion signal. There is no evidence of enhancement.

Output: 1.Segment 4 lesion suspicious for metastasis.2.Segment 6 surgical defect without evidence of enhancing tumor.3.Signal along the left lobe resection margin nonspecific but may represent postoperative inflammation/scarring.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered foci of mucosal thickening can be found throughout the paranasal sinuses, and there is engorgement of the mucosal surfaces in the left nasal vault. The Mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's tremor.


Instruction: Generate impression based on findings.

Input: Male, 12 days old, with left frontal encephalomalacia, IUGR. The ICAs demonstrate relatively normal and symmetric caliber. The right A1 segment is not visualized and may be congenitally hypoplastic or absent. The ACAs and MCAs are visualized to approximately the level of the third order branches and are free of significant focal stenosis or occlusion. Beyond this point, image quality does not permit accurate assessment. The vertebrobasilar system appears within normal limits. The PCAs are not well visualized but this is felt to be technical in nature.

Output: The proximal intracranial vessels demonstrate a relatively normal and symmetric caliber. The more distal vessels also appear relatively normal to the level of the third order branches. Beyond this point, image quality does not allow for accurate assessment.


Instruction: Generate impression based on findings.

Input: History of metastatic renal cell cancer, uncontrolled nausea/vomiting, evaluate for intracranial metastases No intracranial mass or abnormal parenchymal or meningeal enhancement is seen to suggest metastatic disease. No diffusion restriction is seen to suggest acute ischemia. Periventricular white matter T2/FLAIR hyperintense foci are compatible with mild small vessel ischemic disease, unchanged from the prior study. Additional T2/FLAIR hyperintense areas are seen in the right putamen/head of caudate and right post central gyrus are likely from prior infarction. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. A small lesion is seen in the right prepontine cistern which follows CSF signal and likely represents an arachnoid cyst, unchanged from the prior study. There is no significant mass effect from this lesion. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Nonspecific enhancing scalp foci are seen in the left parietal and right frontal scalp. This may be secondary to prior inflammation/infection and are unchanged from the prior study. Given their stability, dermal metastases are considered unlikely.A subcentimeter right parotid nodule is present, likely representing a lymph node.

Output: 1. No evidence of intracranial metastatic disease.2. Chronic infarcts involving the right basal ganglia and right post central gyrus. Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 66-year-old female with significant ecchymosis and hemarthrosis. Evaluate MCL, ACL, MPFL, patellofemoral articulation. Due to patient's body habitus, the high-definition coil could not be utilized resulting in slightly suboptimal image quality. MENISCI: There is globular signal abnormality within the body and posterior horn of the medial meniscus that appears to extend to the free edge, indicating intrasubstance degeneration with degenerative tearing. The anterior horn appears spared. There is globular signal abnormality within the body of the lateral meniscus, which extends to the free edge, indicating intrasubstance degeneration and degenerative tearing. There is intrasubstance degeneration affecting the posterior horn of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is focal discontinuity of the cortex along the medial aspect of the patella which we suspect represents an avulsion fracture at the site of attachment of the medial patellofemoral ligament. There is mild edema within the underlying medial aspect of the patella as well as mild edema within the anterior aspect of the lateral femoral condyle likely reflecting prior transient patellar dislocation. There is full-thickness cartilage loss along portions of the lateral facet of the patella. The medial facet of the femoral trochlea appears abnormally small relative to the lateral facet, likely representing dysplasia. The trochlear depth appears shallow. There is focal depression of the articular surface of the medial femoral condyle just above the posterior horn of the medial meniscus that may represent an old impaction injury, but this is not associated with edema on this examination. There are small tricompartmental osteophytes.LIGAMENTS: The ACL, PCL, and LCL appear intact. There is a small amount of edema along the medial collateral ligament which may represent a mild sprain, but the ligament itself appears intact. EXTENSOR MECHANISM: The quadriceps tendon appears intact. There is mild increased signal intensity within the medial fibers of the patellar tendon at its patellar attachment, suggesting a sprain injury. The medial retinacular structures are ill-defined with adjacent edema indicating injury. As stated previously, we suspect there is an avulsion fracture of the medial aspect of the patella at the attachment of the medial patellofemoral ligament. The ligament, including its femoral attachment, is not well visualized. There is also slight thickening and edema along the lateral retinacular structures, although we see no gross disruption.ADDITIONAL

Output: 1. Findings indicating prior transient lateral dislocation of the patella, including disruption of the medial patellofemoral ligament and probable medial patellofemoral ligament avulsion fracture at the medial aspect of the patella. There are also findings of femoral trochlear dysplasia.2. Possible mild sprain of the MCL which otherwise appears intact. The ACL appears intact.3. Full-thickness cartilage loss along the lateral facet of the patella.4. Degeneration and degenerative tearing of the menisci.5. Joint effusion and Baker's cyst.


Instruction: Generate impression based on findings.

Input: History of cavernous hemangioma with recurrent right peripheral blurry vision. There are postoperative findings related to right orbital tumor resection, without evidence of gross tumor recurrence. There is redemonstration of a lamina papyracea fracture with orbital frat herniation and deformity of the medial and inferior rectus muscles. The rest of the right orbital and the left orbital contents are unremarkable. There is a nonspecific punctate focus of T2 hyperintensity in the frontal lobe white matter bilaterally. There are small left maxillary and ethmoid sinus retention cysts.

Output: 1. No evidence of gross tumor recurrence in the right orbit.2. Redemonstration of a lamina papyracea fracture with orbital frat herniation and deformity of the medial and inferior rectus muscles.


Instruction: Generate impression based on findings.

Input: There are unchanged findings related to left-sided craniotomy with a similar extent of susceptibility effect surrounding the posterior left temporal lobe resection cavity, which likely represents hemosiderin deposition. There is persistent linear branching enhancement in the region of the resection cavity, which likely represents a residual developmental venous anomaly. There is no evidence of acute infarction or hemorrhage. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or mass effect. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Unchanged postoperative findings related to left temporal lobe cavernous malformation resection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 40 year old male patient with abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. No intra- or extrahepatic biliary ductal dilatation. The gallbladder is unremarkable. The hepatic vasculature is patent.SPLEEN: There is an accessory splenule. 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: Unremarkable examination of the upper abdomen.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is mild increased signal intensity of the supraspinatus and infraspinatus tendons indicating tendinosis however there is no discrete fluid-filled rotator cuff tear identified. The supraspinatus muscle is normal in caliber and signal but there is moderate fatty atrophy of the infraspinatus muscle. An ovoid focus of intermediate to low signal is noted within the myotendinous junction of the infraspinatus which may represent old hematoma or heterotopic ossification from an old/chronic tear. The teres minor muscle and tendon are intact. There is mild thickening of the subscapularis tendon reflecting mild tendinosis but there is no evidence of tear. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is minimal osteoarthritis of the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe osteoarthritis of the glenohumeral joint with diffuse loss of the articular cartilage of the glenoid. Marrow edema and cystic changes of the glenoid and humeral head are likely degenerative in nature. There is degenerative tearing of the labrum. There is a moderate-sized joint effusion which contains areas of intermediate signal intensity indicating synovitis. There are multiple loose bodies seen anterior to the neck of the scapula. BICEPS TENDON: There is thickening of the biceps tendon at its transition from the rotator interval to the intertubercular groove which indicates tendinosis.

Output: Severe osteoarthritis of the glenohumeral joint with synovitis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 56 year old woman with history of palpitations, 1st degree AV block and likely scleroderma, referred for cardiac MRI for further evaluation of possible underlying infiltrative disease. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 101 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 36 ml (normal range 31+/-10), the LV mass index is 24 g/m2 (normal range 67+/-11), and the LV mass is 24 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying focal or replacement fibrosis, infiltration, or obvious inflammation. Her native myocardial T1-times are borderline elevated (1050-1100ms), which could represent low grade inflammation or fibrosis; however, very little is published about native myocardial T1 times in scleroderma patients and the clinical relevance of this finding is unknown.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 97 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 65%) without underlying late gadolinium enhancement (i.e. replacement/ focal myocardial fibrosis, obvious inflammation, or infiltration). The native myocardial T1-times are borderline elevated (1050-1100ms), which could represent low grade inflammation or fibrosis; however, very little is published about native myocardial T1 times in scleroderma patients and the clinical relevance of this finding is unknown.2. Normal RV size and systolic function (RVEF 70%).3. Normal pulmonary artery size. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: CNS nocardia, now with numbness and tingling in fingers and visual change. There is an unchanged avidly enhancing mass with susceptibility effect in the splenium of the corpus callosum, which measures up to approximately 25 mm. There is unchanged associated extensive vasogenic edema that extends into the bilateral posterior cerebral hemispheres. There are multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral and cerebellar hemispheres. There is also an unchanged branching area of susceptibility effect in the right pons with associated patchy enhancement and corresponding calcifications depicted on CT. There are unchanged scattered foci of T2 hyperintensity in the cerebral white matter, which may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is a partially empty sella. 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. No significant interval change in the lesion within the splenium of the corpus callosum with associated extensive surrounding vasogenic edema may represent stigmata of alleged central nervous system nocardiosis, although other infectious or inflammatory processes versus neoplasm are alternative considerations. MR perfusion and spectroscopy may be useful for further evaluation.2. Unchanged punctate foci of susceptibility effect in the bilateral cerebral and cerebellar hemispheres may also represent stigmata of nocardiosis, but are nonspecific and could alternatively represent chronic microhemorrhages related to amyloid angiopathy, for example.


Instruction: Generate impression based on findings.

Input: Male 5 years old Reason: s/p Fontan operation Systemic venous return is into the pulmonary artery. SVC and IVC caliber are normal. There is a functional single ventricle with small, and slightly hypoplastic left posterior ventricle. The apex is forming right ventricle. Right and left AV valves are normal with no significant regurgitation. There is a left aortic arch and aortic arch vessels are branching normally. The ascending aorta is anterior and quite large (25 mm). The main pulmonary artery valve is atretic. Complete Fontan pathway is unobstructed. IVC extracardiac conduit and the SVC connected to the right main pulmonary artery. The SVC is connection is directed towards the left pulmonary artery whereas the SVC connection is more directed towards the right pulmonary artery.No evidence of venous-venous or arteriovenous collaterals.Extracardiac Findings Partial view of the hollow viscus and solid organs of the upper abdomen are normal.

Output: 1. Completely patent Fontan pathway with no evidence of venous or arterial collateralsDr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for cause of severe bilateral leg pain involving calves, thighs, groin. 65-year-old female with metastatic pancreatic cancer. Signs and symptoms: As above. Pre- and post enhanced lumbar MRI:Examination demonstrates multiple osseous metastatic lesion of the thoracolumbar and sacral spine without intravenous fracture or malalignment and without evidence of epidural or paraspinal soft tissue is present. Metastatic lesions are noted in the partially visualized anterior body of and the left pars articularis of T11, large metastatic lesion involving nearly entire vertebral body of L2 and the base of the base of the spinous process, small metastatic lesion in the dorsal inferior midline body of L4, large metastatic lesion involving vertebral body of L5 and extending into the left pedicle, left articulating facet and left transverse process and a large metastatic lesion involving extensively the vertebral body of S1. The lesions demonstrate T1 hypointensity, T2 hyperintensity and with enhancement.Visualized lower thoracic cord, conus and cauda equina demonstrate no detectable abnormal enhancement to suggest metastases.Moderate degenerative changes at L4-L5 and mild bilateral facet and ligamentum flavum hypertrophy as well as bilateral facet effusion results in moderate central spinal stenosis without neural foraminal compromise.No evidence of spinal stenosis at any other level. Degenerative changes at L5-S1 however results in significant bilateral neural foraminal compromise. Partially visualized iliac wings also demonstrate a metastatic lesion on the left measuring approximately at 10 x 15 mm in transaxial dimensions.Findings on this exam were discussed with the clinical service Kwang Jin Choi # 5662 at the time of review of exam.

Output: 1.Multiple intraosseous metastatic lesions involving lower most visualized thoracic spine, lumbar spine and sacral spine as well as left iliac wing detailed above. No evidence of extraosseous spread of tumor.2.No detectable leptomeningeal enhancement.3.Extensive degenerative changes at L4-L5 results in moderate central spinal stenosis without neural foraminal compromise.4.Degenerative changes at L5-S1 results in significant bilateral neural foraminal compromise and without central spinal stenosis.5.No spinal stenosis or neural foraminal compromise at any other level.


Instruction: Generate impression based on findings.

Input: Assess for cervical spondylosis. Neck pain and stiffness. There is partial fusion of the C6 and C7 vertebrae. Otherwise, the vertebral column alignment is within normal limits and the vertebral body heights are preserved. There are multilevel degenerative changes in the cervical spine with endplate edema and small posterior disc-osteophyte complexes. There is associated mild neural foramen stenosis at C2-3 and C3-4, eccentric to the left. There also appears to be mild left C3-4, right C4-5, and right C5-6 neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Multilevel degenerative changes in the cervical spine with endplate edema and small posterior disc-osteophyte complexes with associated mild neural foramen stenosis at C2-3 and C3-4 and what appears to be mild left C3-4, right C4-5, and right C5-6 neural foramen stenosis. 2. Partial fusion of the C6 and C7 vertebrae may be congenital in nature.


Instruction: Generate impression based on findings.

Input: Male, 22 years old, with seizures, concern for HSV encephalitis. No definite restricted diffusion is seen. A few scattered small foci of FLAIR hyperintensity and questionable DWI hyperintensity within the sulci, including one within the posterior right sylvian fissure, are nonspecific and could potentially be artifactual. Two or three additional punctate foci of parenchymal FLAIR hyperintensity are nonspecific as well.No evidence of edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is observed. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. Ventricular size and morphology are within normal limits. The mesial temporal lobes are normally formed, symmetric and free of focal signal abnormality.

Output: No definite findings are seen to account for the patient's symptoms. A few foci of hyperintense signal involving scattered cerebral sulci are nonspecific and could potentially be artifactual. While a subtle infectious process cannot be entirely excluded, no findings characteristic of an HSV encephalitis are seen on this exam.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:7/8/1951)Reason: new right precentral gyrus stroke History: left sided paresis and sensory deficitsPROVIDER/ATTENDING NAME: DAVID A HARTER RICHARD KRAIG MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The MRA exam is mildly degraded due to patient motion.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small to medium sized. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Exam is somewhat degraded due to patient motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for effusion vs lipoma at the left knee History: pain, swelling at left knee There is intrasubstance degeneration of the posterior horn of the medial meniscus. Some of the signal extends to the tibial articular surface with associated deformity of the posterior horn indicating degenerative tearing. The lateral meniscus appears intact. No full-thickness or near full-thickness articular cartilage defects are identified. There is a large fluid collection anterior to the patella with foci of low signal intensity internally which likely represents a prepatellar bursitis although a hematoma could be considered, particularly if there is a history of trauma. There are multiple internal septations. There is a small amount of fluid within the deep infrapatellar bursa which is not necessarily of any clinical significance.

Output: Findings indicating a prepatellar bursitis. Other findings as described.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: etiology of new onset seizures The CSF spaces are appropriate for the patient's stated age with no midline shift. There is mild cerebellar atrophy present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Mild cerebellar atrophy is a nonspecific finding. There are no intracranial mass lesions or other abnormalities to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Reason: quad tendon rupture. Had prior surgery History: right quad tendon pain MENISCI: There is distorted morphology and abnormal signal morphology of the body of the medial meniscus, best seen on coronal proton density fat saturated images, representing complex tearing. This tearing also extends into the posterior horn, which is attenuated and shows increased undersurface signal intensity. The anterior horn of the medial meniscus appears relatively intact. There is also increased signal intensity along the undersurface of the posterior horn of the lateral meniscus, suggesting undersurface fraying/tearing. ARTICULAR CARTILAGE AND BONE: There is moderate osteoarthritis of the knee, particularly affecting the patellofemoral and medial tibiofemoral compartments, with areas of near-full thickness cartilage loss. There is also delamination of the articular cartilage anterior to the posterior horn of the medial meniscus. There are tricompartmental osteophytes. We see no bone marrow edema. LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. EXTENSOR MECHANISM: There are vertically oriented linear bands of abnormal signal within the patella, which likely represent surgical fixation tracts from prior quadriceps tendon repair. The distal quadriceps tendon is thickened with abnormally increased signal intensity, likely representing a combination of tendinosis and scarring, but we see no fluid signal intensity within the tendon to indicate rupture. Small foci of ossification are noted along the tendon, as seen in prior radiographs. There is linear increased signal intensity within the proximal fibers of the patellar tendon laterally, with edema in the adjacent soft tissues, suggesting a focal tear, that extends from the anterior to the posterior margins of the tendon. We see no rupture of the patellar tendon. ADDITIONAL

Output: 1.Findings of quadriceps tendon repair with tendinosis and scarring of the quadriceps tendon but no evidence of acute rupture. 2.Focal incomplete tear of the proximal fibers of the patellar tendon. 3.Osteoarthritis with medial and lateral meniscal tears.


Instruction: Generate impression based on findings.

Input: 74 year old woman with AF, referred for evaluation of function prior to ablation. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 25%, the LV end diastolic volume index is 98 ml/m2 (normal range: 65+/-11), the LVEDV is 186 ml (normal range 109+/-23), the LV end systolic volume index is 74 ml/m2 (normal range 18+/-5), the LVESV is 139 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 100 g (normal range 114+/-24). There is global hypokinesis with regional variation. No evidence of myocardial iron overload. There is a moderately increased native myocardial T1 relaxation time along the mid and apical septum, suggesting the presence of fibrosis in these regions. Left AtriumThe left atrium is severely dilated. The LA volume is 219 ml.Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 121 ml/m2 (normal range 69+/-14), the RVEDV is 223 ml (normal range 110+/-24), the RV end systolic volume index is 90 ml/m2 (normal range 22+/-8), and the RVESV is 170 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Mild aortic valve sclerosis is noted.Mitral ValveThe mitral valve leaflets are thickened and calcified with changes consistent with rheumatic mitral valve disease. The leaflet excursion is significantly restricted and suggestive of at least moderate mitral stenosis. There is additionally at least moderate mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. Small pericardial effusion.Extracardiac FindingsModerate right pleural effusion, small left pleural effusion. Small (<1cm) bilateral axillary lymph nodes. 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. Moderate LV dilation with severely reduced systolic function (LVEF 25%). The native myocardial T1 relaxation time is moderately elevated in the mid to apical septum suggesting the presence of fibrosis in this territory. Late gadolinium enhancement imaging was not performed given patient's renal function. 2. Moderate RV dilation with severely reduced systolic function (RVEF 26%).3. Mitral valve is thickened and calcified with changes suggestive of rheumatic mitral valve disease. The opening of the valve is restricted suggestive of at least moderate mitral stenosis. There is additionally at least moderate mitral regurgitation.4. Severe tricuspid valve regurgitation. 5. Severe biatrial dilation. 6. See extra-cardiac findings. 7. Suggest quantification of severity of valvular heart disease using echo; however, if that is not feasible for some reason, she can be brought back for additional CMR images at no charge to get extra-images needed for quantification of mitral regurgitation and mitral stenosis (Q-flow of aorta, mitral inflow, pulmonary, and planimetry of mitral orifice area at leaflet tips).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The comparison is limited due to motion on the previous comparison study.Extensive confluent T2 hyperintensity is again evident within the periventricular white matter bilaterally and throughout the thinned corpus callosum. Extensive white matter signal abnormality is also evident within the midbrain, pons, bilateral middle cerebellar peduncles, and medulla. Most of these lesions seem not to have significantly changed, with the exception of an area of FLAIR hyperintensity in the posterior right parietal lobe white matter which appears to be new with associated enhancement along the posterior medial aspect of the lesion (47/11 and 801/52). There is also a ring enhancing lesion in the right frontal lobe (801/61). An additional enhancing punctate lesion is seen in the left corona radiata. Many of the lesions demonstrate T1 hypointensity.

Output: Extensive white matter lesions consistent with known demyelinating disease, with a new area of FLAIR hyperintensity seen in the right parietal lobe white matter with minimal associated enhancement, consistent with a new area of demyelination. Additional enhancing lesions in the right frontal lobe and left corona radiata consistent with active plaques. Overall, moderate T1 and moderate-severe T2 burden of disease, including infratentorial lesions.


Instruction: Generate impression based on findings.

Input: 64 year old male with a history of coronary artery disease, myocardial infarction, and new onset systolic heart failure who presents today for a second opinion regarding heart failure management. First Pass PerfusionDuring hyperemia, there were perfusion defects in the basal inferior, inferolateral, and inferoseptal walls; the mid inferoseptal, inferolateral, and anteroseptal walls; and in the apical inferior and septal walls.  Viability/ Myocardial ScarThere was transmural myocardial infarction involving the basal anteroseptal wall, mid anterior, anteroseptal, and inferoseptal walls, and the apical anterior and septal walls. The segments are unlikely to be viable. The remainder of the myocardium is viable. Left VentricleThe left ventricle is severely dilated with severely systolic function. The overall LV ejection fraction is 18%, the LV end diastolic volume index is 159 ml/m2 (normal range: 74+/-15), the LVEDV is 343 ml (normal range 142+/-34), the LV end systolic volume index is 130 ml/m2 (normal range 25+/-9), the LVESV is 281 ml (normal range 47+/-19), the LV mass index is 54 g/m2, and the LV mass is 116 g. There is thinning and akinesis of the LAD territory. There is hypokinesis of the remainder of the other other coronary territories. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 53 ml/m2 (normal range 82+/-16), the RVEDV is 115 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 44 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.There is significant amount of ischemia and viability in the RCA and LCx territories.2.There is a very large myocardial infarction in the LAD territory which is not viable. 3.Severely dilated LV with severe systolic dysfunction (LVEF 18%). There is a large akinetic region involving much of the LAD territory.4.Normal RV size and systolic function (RVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 55 years, Female, multiple sclerosis, follow-up progression. Paresthesias. Leg weakness. Brain: There are greater than 20 T2/FLAIR hyperintense lesions involving the periventricular and subcortical white matter with a distribution and morphology consistent with known demyelinating disease. Compared to outside MRI from 8/6/2014, no new lesion is demonstrated. Multiple foci of T1 hyperintensity also noted, particularly associated with a periventricular/pericallosal lesions. Multiple infratentorial lesions are also seen including the right dorsal and left lateral pons as well as few foci in the bilateral cerebellar hemispheres. Motion artifact limits evaluation. There is new enhancing focus involving the right parietal lobe, series 4801, image 50, with surrounding confluent FLAIR hyperintensity in the right parietal white matter not significantly changed since prior. Apparent enhancement involving the suprasellar cistern is most likely artifactual. No intracranial mass or mass effect. No hydrocephalus. No midline shift or herniation. There is an enhancing focus involving the right parietal calvarium with intrinsic T1 hyperintensity, likely representing a hemangioma. Bone marrow signal is otherwise within normal limits.Cervical Spine: Multiple T2 hyperintense lesions are seen throughout the cervical cord consistent with demyelinating plaques. There is a relatively large lesion at the C2 level, a small right C2-C3, dorsal C3-C4, ventral C4, left C4-C5, and right C6-C7 lesions. No new lesions within the cervical spine or evidence of pathologic enhancement in the cervical spine is appreciated.Vertebral body heights and alignment are within normal limits. Bone marrow signal is benign. Mild degenerative changes are seen without significant spinal canal or neural foraminal stenosis.Thoracic Spine: There are multiple T2 hyperintense lesions throughout the thoracic cord as seen before. There are more prominent lesions at the right dorsal T2-T3 level with mild volume loss ventral T4-T5, right lateral T7-T8, right dorsal T8, left ventrolateral T8-T9, and right lateral T12. Some of these lesions appear more prominent on the current study which is favored to be related to differences in technique.There is mild loss of height involving the T9 vertebral body compatible with chronic compression fracture similar to prior. Vertebral body heights and alignment are otherwise maintained. No significant spinal canal or foraminal stenosis is appreciated.No significant change in appearance of subcentimeter enhancing lesion involving the T7 vertebral body favored to represent an atypical hemangioma but is nonspecific.

Output: 1. Numerous foci and confluent regions of T2/FLAIR hyperintensity in the supratentorial and infratentorial white matter are consistent with known demyelinating disease and not significant changed since prior. There is a new enhancing focus involving the right parietal lobe, series 4801, image 50, with surrounding confluent FLAIR hyperintensity in the right parietal white matter not significantly changed since prior. 2. Multiple T2 hyperintense lesions throughout the cervical and thoracic cord which allowing for differences in technique are not appreciably changed in the interval. No abnormal enhancement to suggest active demyelination in the spinal cord.


Instruction: Generate impression based on findings.

Input: 62 year old female patient with PSC. Cholangiocarcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Multifocal, irregular stricturing within the intrahepatic right and left biliary ducts is not significantly changed. The common bile duct is irregular with a long segment stricture distally, appearing similar to the prior study. There is mild intrahepatic biliary ductal dilatation. Peripheral T2 hyperintensity in the right hepatic lobe with delayed enhancement likely represents confluent fibrosis. There is mild delayed enhancement of scattered biliary ducts, which is compatible with primary sclerosing cholangitis. No suspicious hepatic lesion is identified to suggest cholangiocarcinoma. The hepatic vasculature is patent.SPLEEN: There is an accessory splenule. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple right renal cysts, including one with a septation, are stable.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.Grossly stable intra- and extrahepatic biliary stricturing compatible with primary sclerosing cholangitis.2.No suspicious hepatic lesion to suggest cholangiocarcinoma.


Instruction: Generate impression based on findings.

Input: C5-6 partial laminectomy for cervical decompression and tumor resection. There are postoperative findings related to recent C5-6 partial laminectomy for cervical decompression and tumor resection, with a drain in the right posterior paraspinal surgical bed. There is no longer compression of the spinal cord, although mild deformity and signal abnormality persist. There appears to be residual tumor in the right paraspinal region and within the C5 and C6 vertebrae, which overall measures up to approximately 45 mm and abuts and possibly encases the right vertebral artery, although the flow void remains intact. There is also a residual posterior disc-osteophyte complex at C5-6. There is no vertebral subluxation and the vertebral body heights are essentially intact. There is a bosselated T2 hyperintense mass in the right parotid gland, which measures up to 25 mm. There is a partially imaged posterior mediastinal tumor.

Output: 1. Postoperative findings related to recent C5-6 partial laminectomy for cervical decompression and tumor resection, without residual compression of the spinal cord, although mild deformity and signal abnormality persist. Residual tumor is present in the right paraspinal region and within the C5 and C6 vertebrae, with possible encasement of the right vertebral artery.2. A partially imaged posterior mediastinal tumor likely represents metastatic disease. Please refer to the recent chest CT report for additional details.3. A mass in the right parotid gland, which measures up to 25 mm, may represent a pleomorphic adenoma, although additional metastatic disease is a consideration.


Instruction: Generate impression based on findings.

Input: Parietal craniotomy for repeat resection of atypical meningioma on 3/8/16. There are interval postoperative findings related to posterior parietal cranioplasty for resection of recurrent meningioma. There is nodular enhancement that measures up to 20 mm in the left posterolateral aspect of the resection cavity and persistent extensive vasogenic edema in the surrounding brain parenchyma. There is mild susceptibility effect and areas of restricted diffusion along portions of the surgical margins related to blood products, as well as regional prominent leptomeningeal enhancement. There is also sulcal prominent susceptibility effect in the right frontal and left parietal lobes, which may represent hemorrhage or cortical vein thrombosis. There is swelling and fluid in the overlying scalp. There are unchanged scattered foci of nonspecific cerebral white matter T2 hyperintensity in the anterior frontal lobes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are bilateral lens implants. There are persistent secretions in the left frontal sinus.

Output: Postoperative findings related to repeat parietal convexity meningioma resection with what appears to be residual tumor that measures up to 20 mm in the left posterolateral aspect of the resection cavity and persistent extensive vasogenic edema in the surrounding brain parenchyma.


Instruction: Generate impression based on findings.

Input: History of metastatic GYN adenocarcinoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. There is susceptibility artifact within the bilateral basal ganglia, likely reflecting mineralization. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. Incidental note is made of cavum septum pellucidum and cavum vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild vessel thickening and fluid signal in bilateral mastoid air cells. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial mass.2. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 29 years, Female, status post trans-sphenoidal hypophysectomy. Examination is mildly motion degraded. Interval postsurgical changes of transsphenoidal hypophysectomy are seen. There appears to be near total resection involving the sellar and right suprasellar mass. There is residual mildly enhancing soft tissue along the right cavernous sinus wall compatible with small amount of residual tumor, with partial encasement of the right cavernous ICA suspected. This tissue measures approximately 6 mm in thickness in the transverse dimension. There is also more avidly enhancing soft tissue along the left lateral aspect of the resection cavity measuring approximately 3 to 4 mm in thickness also compatible with residual tumor, adjacent to normal pituitary tissue. Infundibulum is leftward displaced but improved in the interval. Optic chiasm is well decompressed. Paranasal sinus opacification, particularly the sphenoid sinuses compatible with postoperative change. Brain parenchyma is within normal limits for age. No restricted diffusion to suggest acute ischemia. No other intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. There is edema and enhancement involving the left frontotemporal as well as left lateral suboccipital scalp which may postsurgical.

Output: Interval postsurgical changes of transsphenoidal hypophysectomy with near total resection of the sellar and suprasellar tumor. Residual tumor is noted in the sella along the lateral aspects of the resection cavity bilaterally with suspected invasion of the right cavernous sinus. The right-sided residual tumor enhances to a lesser degree than on the left which may be related to prior necrosis. Optic chiasm is well decompressed.


Instruction: Generate impression based on findings.

Input: T4N2c squamous cell carcinoma of the floor of the mouth and ventral tongue status post induction chemotherapy and radiotherapy. There is diffuse edema involving the soft tissues of the lower face/upper neck, including the larynx, which is likely treatment-related. The midline enhancing, infiltrative mass involving the floor of the mouth and the ventral aspect of the tongue has decreased in size, measuring approximately 20 x 25 mm in axial cross-section, previously 25 x 30 mm, and is more necrotic. The associated reference left level 1B pathologic lymph node is also not significantly changed in size, measuring 15 x 19 mm compared to 14 x 20 mm previously. The reference right level 3 lymph node measures 12 mm x 14 mm, previously also 12 mm x 14 mm. The submandibular glands, parotid glands, and thyroid are unchanged. The osseous structures are unchanged. There is a right internal jugular venous catheter.

Output: The infiltrative tumor involving the floor of the mouth and the ventral tongue has decreased in size. However, the associated cervical lymphadenopathy has not significantly changed in size.


Instruction: Generate impression based on findings.

Input: Incidental finding of parotid mass seen on sinus CT. There is a well-defined, lobulated cystic lesion with multiple septations in the deep lobe of the left parotid gland, which measures up to 16 mm. The rest of the left parotid gland and other salivary glands are unremarkable. There is no significant lymphadenopathy in the imaged portions of the neck. There is scattered mucosal thickening in the ethmoid sinuses. There is partially-imaged periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is a partially-empty sella. The orbits are unremarkable. There is degenerative spondylosis of the imaged portions of the cervical spine.

Output: A well-defined cystic lesion with multiple septations in the deep lobe of the left parotid gland, which measures up to 16 mm, may be nonneoplastic versus cystic degeneration of a benign tumor.


Instruction: Generate impression based on findings.

Input: History of fistulous small bowel Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver dome is not included in the coronal field-of-view. The visualized liver 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: Post-surgical changes from an ileocecectomy with neo-terminal ileum formation. The small bowel is normal in caliber without wall thickening or abnormal enhancement or adjacent inflammatory changes. The bowel demonstrates normal peristalsis on dynamic imaging without any fixed stricture evident. There is no abnormal restricted diffusion. BONES, SOFT TISSUES: Mild rectus muscle diastases. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of active inflammation or significant stricture. No fluid collections.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with worsening neck pain and history of cervical disc herniation seen in 2009. The cervical lordosis is straightened. Vertebral body heights are preserved. No evidence of pathologic marrow replacement or edema is seen. Signal alteration compatible with the presence of a hemangioma is seen within the T1 vertebral body and right pedicle, unchanged.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Loss of disc height with posterior disc-osteophyte complex formation slightly improved from prior. Minimal flattening of the ventral cord. No significant spinal canal stenosis. No foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation with a small superimposed left paracentral protrusion, slightly increased in size from prior. However, there is no clear impingement of the spinal cord and no significant canal stenosis. The neural foramina are patent. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Minimal increase in size of a left paracentral protrusion at C6-7. However, there is no evidence of spinal cord impingement or significant canal stenosis at this level.2.Improvement in the size of a disc osteophyte at the C5-6 level, again without significant spinal canal stenosis.3.The neural foramina are patent throughout.4.No other significant interval changes are seen to account for the patient's worsening pain.


Instruction: Generate impression based on findings.

Input: Paresthesias. Evaluate for demyelinating disease. There are foci of T2 hyperintensity involving the right dorsal cord at C6-7 and medial dorsal cord at C7-T1. There is an additional, more subtle area of T2 hyperintensity involving the dorsal midline cord at C2. On the sagittal images, there is also subtle signal abnormality involving the T2 level. The cord volume appears maintained. The craniocervical junction is normal. There is kyphotic angulation of the cervical spine at C4-5. The vertebral body heights are preserved. Bone marrow signal is benign. There is disc desiccation from C2 to C5, consistent with disc dessication. There is no spinal canal or neural foraminal stenosis. The paraspinal soft tissues are unremarkable.

Output: Multiple small lesions in the cervical and partially imaged upper thoracic cord are highly suspicious for demyelinating disease. No comparison studies are available.


Instruction: Generate impression based on findings.

Input: Diagnosis: Mantle cell lymphoma, lymph nodes of multiple sitesClinical question: assess for leptomeningeal lymphoma The CSF spaces are appropriate for the patient's stated age with no midline shift. There several subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some enlarged perivascular spaces are present in the region of the basal gangliaNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a couple minor opacities The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for intracranial lymphoma or leptomeningeal disease.2.There are several subcortical white matter lesions present which are nonspecific and likely of little clinical significance as they are most likely simply age related.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval for septic emboli, stroke History: few days ago patient became acutely unresponsive and hypercarbic No evidence of acute ischemic or hemorrhagic lesion.Previously seen middle cranial fossa extra-axial lesion located anterior inferior aspect of the left inferior temporal gyrus is not as conspicuous as it was before due to lack of contrast infusion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Due to lack of contrast infusion, previously seen left middle cranial fossa extra-axial lesion is not as conspicuous as it was before.


Instruction: Generate impression based on findings.

Input: 24 years, Male, vision loss. There is diminished parenchymal volume centered in the right occipital lobe which is replaced with a cystic cavity that communicates with the right lateral ventricle most suggestive of porencephaly. There is however mild FLAIR hyperintensity within this region suggesting gliosis/encephalomalacia. There is deformity of the overlying gyri favored to represent volume loss related to same injury. There is irregularity involving the cortex of the superior frontal gyrus abutting the superior frontal sulcus, axial T2 image 28, suggesting polymicrogyria but can be better assessed with high-resolution 3-D T1 sequences on 3 Tesla.The splenium of the corpus callosum is small favored to represent Wallerian degeneration. There is mild nonspecific T2/FLAIR hyperintensity involving the periventricular white matter. No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus. No evidence of acute ischemia or recent hemorrhage. No abnormal enhancement. Major flow-voids are preserved. Pituitary gland and infundibulum are grossly unremarkable. Extracranial soft tissues are also grossly unremarkable.The optic nerves and chiasm appear small in volume without focal signal abnormalities. Bilateral orbits appear otherwise unremarkable. No masses or abnormal enhancement within the orbits.

Output: 1. Findings are most compatible with sequela of prenatal injury centered in the right occipital lobe where there is a porencephalic cavity communicating with the lateral ventricle.2. Question of polymicrogyria adjacent to the right superior frontal sulcus. Suggest high resolution 3D T1 sequence at 3 Tesla to better assess cortical abnormalities.3. Diminutive caliber of the bilateral optic nerves and chiasm.


Instruction: Generate impression based on findings.

Input: 66 year old female, evaluation for cardiac sarcoidosis Left VentricleThe left ventricle is normal in size with mildly decreased systolic function. The overall LV ejection fraction is 50%. The LVEDV is 148 ml (normal range 109+/-23), LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), LVESV is 74 ml (normal range 31+/-10), and LV end systolic volume index is 33 ml/m2 (normal range 18+/-5). The LV mass is 178 g (normal range 114+/-24) and the LV mass index is 78 g/m2 (normal range 67+/-11). There is presence of concentric hypertrophy, more severe in the lateral wall (measured up to 20mm in end diastole). There are no regional wall motion abnormalities present. There is no convincing evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process on current scanner (3T).The native T1 myocardial relaxation time is not obtainable due to patient movement artifact. Left AtriumThe left atrium is normal.Right VentricleThe right ventricle is normal in size with mildly decreased systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsHepatic and renal lesions are present, as described on prior abdominal CT imaging. Upper lung pulmonary fibrosis and left lung effusion are present, as noted on prior chest CT imaging. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is normal in size with mildly decreased systolic function. The overall LV ejection fraction is 50%. There are no regional wall motion abnormalities present. 2. There is no convincing evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process on current scanner (3T).3. There is presence of concentric hypertrophy, more severe in the lateral wall (measured up to 20mm in end diastole). Therefore, an infiltrative process cannot be completely excluded even given absence of delayed hyperenhancement. 4. Right ventricle is normal in size with mildly decreased systolic function. The overall RV ejection fraction is 44%.5. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of Guillain Barre with unilateral right-sided retroorbital headache (sharp pain without radiation) gradual onset, with visual disturbance. There appears to be mildly elevated T2 hyperintensity and perhaps minimal swelling of the left hippocampus. There is no evidence of intracranial hemorrhage 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, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left sphenoid sinus.

Output: 1. Incompletely characterized apparent abnormality in the left hippocampus, which may represent encephalitis or perhaps less likely a neoplastic process, for example. Further evaluation via a seizure protocol MRI with contrast may be useful.2. Mild mucosal thickening in the left sphenoid sinus.


Instruction: Generate impression based on findings.

Input: 78 years Female (DOB:5/16/1937)Reason: symptoms consistent with glossopharyngeal neuralgia; please assess CN; RT planning History: RT planningPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The eyeball lenses are thin.At C3-4 there is a disc bulge present associated with posterior ligamentous hypertrophy and spinal stenosis.

Output: 1.No intracranial mass lesion is appreciated. The T2 exam is mildly degraded due to patient motion and the exam is limited for the purposes of treatment planning.2.Findings are suggestive of spinal stenosis at the C3-4 level. If clinically appropriate. Imaging of the cervical spine may be of further benefit.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease and nausea vomiting and diarrhea. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The liver is normal in morphology, size and signal intensity. No suspicious lesion or biliary ductal dilatation.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: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained. The terminal ileum is well seen.The small bowel is normal in caliber and wall thickness without abnormal signal intensity, restricted diffusion, postcontrast enhancement or adjacent inflammatory changes such as mesenteric vessel engorgement or fibrofatty perforation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is normal in caliber and wall thickness without adjacent inflammatory changes, improved from prior.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained. The terminal ileum is well seen.The small bowel is normal in caliber and wall thickness without abnormal signal intensity, restricted diffusion, postcontrast enhancement or adjacent inflammatory changes such as mesenteric vessel engorgement or fibrofatty perforation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is normal in caliber and wall thickness without adjacent inflammatory changes, improved from prior.BONES, SOFT TISSUES: Demonstrated again is a transsphincteric fistula extending from the 4 o'clock position into the left ischioanal fossa associated with a small subcentimeter collection. It splits anterolaterally towards the left obturator muscle and posteromedially to the skin in the midline, unchanged from the prior. There is minimal thickening of the rectum compatible with mild active disease.OTHER: No significant abnormality noted.

Output: 1.Previously improved descending/sigmoid colon wall thickening and enhancement has improved. No specific evidence of active bowel inflammation, fibrostenotic or sinus/fistulous disease. 2.No significant change in the left ischioanal fistula with a small abscess as described above.


Instruction: Generate impression based on findings.

Input: 44 year old woman with NICM, referred for evaluation of underlying scar. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 6%, the LV end diastolic volume index is 130 ml/m2 (normal range: 65+/-11), the LVEDV is 328 ml (normal range 109+/-23), the LV end systolic volume index is 123 ml/m2 (normal range 18+/-5), the LVESV is 309 ml (normal range 31+/-10). LV dysfunction is global with regional variation. The delayed enhancement images are non-diagnostic, thus determination of late gadolinium enhancement is not possible on this study. Morphology of the left ventricle myocardium is sugegstive of LV non-compaction. There is an extensive LV thrombus present in the apex as, but also extending up the walls of the LV to the mid LV cavity.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 10%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 219 ml (normal range 110+/-24), the RV end systolic volume index is 79 ml/m2 (normal range 22+/-8), and the RVESV is 197 ml (normal range 35+/-13). Right AtriumThe right atrium is mild-moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve is not well visualized.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is not well visualized.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is not well visualizedVenous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLeft chest ICD present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 6%. LV dysfunction is global with regional variation. 2. The right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 10%. 3. There is an extensive LV thrombus present in the apex as, but also extending up the walls of the LV to the mid LV cavity.4. Morphology of the left ventricle myocardium is suggestive of LV non-compaction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62-year-old male with widespread Gleason 3+4 = 7 prostate cancer. Evaluate for surgical planning.Per pathology report: Prostate, left lateral mid; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6.Prostate, left lateral apex; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6.Prostate, left medial base; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6.Prostate, left medial mid; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7.Prostate, right lateral base; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7.Prostate, left base lateral; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7.Prostate, right medial base; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+3=6.Prostate, right medial mid; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.3 cm.Peripheral Zone: There are multiple lesions demonstrating T2 hypointensity with corresponding low ADC signal and enhancement consistent with patient's known adenocarcinoma. Left base lesion measures 0.8 x 0.8 cm (series 1601, image 18). Midline mid gland lesion measures 1.2 x 0.8 cm with mild capsular bulging (series 1061, image 17). Right apex lesion measures 0.5 x 0.4 cm (series 1601, image 12). Additionally, there are regions of T1 hyperintensity in the peripheral zone consistent with post-biopsy hemorrhage.Central Gland: The central gland is mildly heterogeneous consistent with benign nodules.Seminal Vesicles: The seminal vesicles are unremarkable.Extracapsular Extension: No evidence of extracapsular extension or perineural spread.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple prostatic lesions as above consistent with known adenocarcinoma without evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: T4aN2cMx cancer of the oral cavity. There is an infiltrative oral tongue mass that spans the midline and measures up to approximately 5 cm. The tumor extends along the anterior floor of mouth and gingiva, with invasion of the mandible. The tumor does not invade the masticator space, pterygoid plates, or skull base. There is no evidence of internal carotid artery encasement. There are multiple abnormal suprahyoid lymph nodes bilaterally. For example, a right level 1 lymph node measures 29 x 49 mm in axial cross-section and a left level1 lymph node measures 11 x 20 mm in axial cross-section. The right submandibular gland is compressed and perhaps even invaded by the adjacent lymphadenopathy. The other salivary glands are intact. The thyroid gland is unremarkable. There is multilevel degenerative cervical spondylosis. The imaged intracranial structures are unremarkable.

Output: 1. The oral cavity squamous cell carcinoma measures up to 5 cm and involves the oral tongue, the anterior floor of mouth, and gingiva, with invasion of the mandible. 2. Multiple bilateral suprahyoid lymph nodes are compatible with metastases.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis and seizures of increased frequency. There is a unchanged 7 mm avidly enhancing lesion at the grey-white matter junction along the anterior right superior frontal sulcus with associated surrounding T2 hyperintensity. There are postoperative findings in the right parietal lobe with unchanged associated scattered punctate foci of susceptibility effect and linear T2 signal abnormality surrounding the resection cavity, which likely represents gliosis and encephalomalacia. There is also unchanged linear T2 hyperintensity in the right forceps minor region. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Unchanged enhancing lesion in the right superior frontal sulcus grey-white matter junction, which may represent a hamartoma or perhaps a neoplasm associated with underlying transmantle dysplasia.2. Unchanged postoperative findings in the right parietal lobe.3. Unchanged signal abnormality in the right right forceps minor region, which likely represents transmantle dysplasia with radial migration band.


Instruction: Generate impression based on findings.

Input: Male 69 years old Reason: eval for lesions, assess hepatic vessel patency History: cirrhosis, s/p liver and kidney transplant 4/05 ABDOMEN:LIVER, BILIARY TRACT: Allograft liver with lobulated contour and heterogenous signal intensity consistent with chronic liver disease. No focal hepatic lesions are identified. There is no significant biliary ductal dilatation, decreased from prior. The common bile duct measures up to 5 mm in diameter. The hepatic vasculature appears patent. There is once again mild narrowing at the portal vein and hepatic artery anastomoses appearing similar to prior.SPLEEN: The spleen is normal in size measuring up to 11.0 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Severely atrophic kidneys with multiple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: Transplant kidney is partially visualized in the right iliac fossa.

Output: 1.Allograft liver with signs of chronic liver disease without focal lesion. 2.Patent hepatic vasculature with mild anastomotic narrowing appearing similar to prior. 3.No significant biliary ductal dilatation, improved from prior.


Instruction: Generate impression based on findings.

Input: 20 year-old female with pain status post fall and trauma to head and positive loss of consciousness. There is no evidence of intracranial hemorrhage, mass or edema. A nonspecific focus of low attenuation is present within the white matter just adjacent to the right frontal horn which appears to represent encephalomalacia. This is nonspecific and of unknown etiology. Correlation with clinical history and possibly further evaluation with MRI as clinically indicated to further determine etiology.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE: There is minimal straightening of the visualized cervical spine secondary to positioning for the examination. Cervical spine alignment is within normal limits without evidence of spondylolysis or spondylolisthesis. Vertebral body heights and intervertebral disk spaces are within normal limits. The pre-and paravertebral soft tissues are within normal limits. The airway is patent.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. If there is clinical concern for spinal cord or ligamentous injury, an MRI may be considered.

Output: 1. No evidence of fracture or intracranial hemorrhage.2. Normal cervical spine without evidence of fracture or malalignment.3. Focus of low attenuation adjacent to right frontal horn appears to represent encephalomalacia. This is nonspecific and of unknown etiology. Correlation with clinical history and possibly further evaluation with MRI as clinically indicated to further determine etiology.


Instruction: Generate impression based on findings.

Input: 65 years Female (DOB:12/5/1950)Reason: hx cervical fusion. eval for stenosis above/below or abnormality History: neck spasms, shooting neck pain to occiputPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. The patient status post anterior fusion from C4 through C7 using anterior plate and screws. This partially obscures visualization from C4 through C7 especially the neural foramina.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a disc bulge present associated with some endplate and uncovertebral osteophytes and effacement of spinal fluid anterior and posterior the spinal cord. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally within the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal .At C5-6 there is no significant compromise to the spinal canal .At C6-7 there is no significant compromise to the spinal canal .At C7-T1 there is no significant compromise to the spinal canal or neural foramina.Some T2 signal hyperintensity is present within the brainstem on T2 imaging. The right vertebral artery flow voids very small and not readily perceptible distally. There is also on MRI internal auditory canals from 4/11/2016 which also demonstrates loss of the vertebral artery flow-void proximal to the right posterior inferior cerebellar artery origin.

Output: 1.Status post cervical spine anterior fusion from C4 through C7. There is a mild to moderate degree of spinal stenosis present at C3-4 associated with encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.2.Findings are suspicious for occlusive disease involving the right vertebral artery. If clinically appropriate additional imaging of the right vertebral artery may be of benefit. Please note that there is a prior MRI of the internal auditory canals which also demonstrates right vertebral artery occlusive disease3.There are T2 signal changes within the brainstem which are suspected to be vascular related.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: 61 yo M with metastatic thyroid cancer to brain s/p SRS to L putamen and L posterior parietal resection cavity, known R frontal lesion; eval for progression and new mets The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left parietal craniotomy for left parietal lobe surgery. There is redemonstration of some susceptibility effect along the medial aspect of the left parietal lobe within the precuneus where there was previously a mass. There is no evidence for local recurrence at this time.There is a punctate focus of enhancement present along the anterior aspect of the left putamen. It measures currently 3 mm in diameter and previously measured 5 mm in diameter. It is associated with susceptibility effect. There was also identified in the 7/13/2015 exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient status post left-sided craniotomy for removal of a left precuneus mass. There is no evidence for local.2.There is redemonstration of a tiny lesion in the left putamen which appears smaller on the current exam and is now associated with susceptibility effect. This susceptibility effect is likely treatment related.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Ms. Novack is a 47 year old female with a strong family history of breast cancer in mother (diagnosed at the age of 42) and maternal grandmother (diagnosed at the age of 43). There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable intramammary lymph node of the left medial breast, far posterior depth. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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