Instruction: Generate impression based on medical findings.

Input: 65-year-old female with history of NSCLC with leptomeningeal carcinomatosis. Receiving IT chemo. MRI BRAIN: When compared to the prior MRI brain study dated 10/1/2015 there is been interval placement of a right frontal approach Ommaya catheter with tip terminating within the left lateral ventricle near the foramen of Monro. There is T2/FLAIR hyperintensity surrounding the course of the catheter which may represent edema or gliosis. Small amount of pneumocephalus. There is abnormal layering diffusion signal within the occipital horns of the lateral ventricles which may be related to blood products or other material.No abnormal parenchymal or leptomeningeal enhancement. No intracranial mass or mass effect. No midline shift or herniation. The paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.MRI COMPLETE SPINE: Cervical spine:Alignment is maintained with no acute fractures or subluxation. No abnormal marrow signal or enhancement is noted. The craniocervical junction is maintained. The ligamentous structures are intact. The cervical spinal cord is normal in signal without abnormal enhancement. C2/3 demonstrates no significant spinal canal or neural foraminal stenosis. C3/4 demonstrates left uncinate and facet hypertrophy with associated moderate left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis. C4/5 demonstrates left facet hypertrophy causes mild left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis. C5/6 demonstrates severe left facet hypertrophy. There is mild-to-moderate left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis. C6/7 demonstrates mild bulging of the disc, bilateral uncinate and facet hypertrophy. There is mild to moderate neural foraminal stenosis bilaterally. No significant spinal canal stenosis. C7/T1 demonstrates bilateral facet hypertrophy associated with mild bilateral neural foraminal stenosis. No significant spinal canal stenosis. Thoracic spine: T1 shortening in the T9-T12 bodies suggests prior radiation therapy. No abnormal marrow signal or enhancement is noted elsewhere. T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates a tiny midline disc protrusion causing slight flattening of the anterior cord surface without intrinsic cord signal abnormality. T5/6 demonstrates a small midline disc protrusion causing slight flattening of the anterior cord surface without intrinsic cord signal abnormality.T6/7 demonstrates a tiny right paramedian disc protrusion without cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates a large central disc extrusion extending above the disc level causing anterior cord flattening without intrinsic cord signal abnormality. T9/10 demonstrates a large central disc extrusion extending above the disc level causinganterior cord flattening without intrinsic cord signal abnormality.T10/11 demonstrates a small left paracentral disc protrusion without cord encroachment. There is moderate to severe narrowing of the right neural foramen with enhancing tissue noted on the current and prior study. Finding may be related to scarring but recommend attention on follow-up. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Significant artifact limits evaluation on the postcontrast sequences of the lumbar spine however there appears to be improvement in the extent of nodular enhancement of the leptomeninges on the surface of the conus and cauda equina nerve roots. There does remain abnormal leptomeningeal enhancement which is better assessed on the sagittal sequences, however the nodularity appears improved.Alignment is anatomic. There are no fractures or subluxations. No abnormal marrow signal or enhancement is identified.L1/L2 demonstrates mild facet hypertrophy with no significant neural foraminal or spinal canal stenosis.L2/3 demonstrates mild bulging of the disc no significant neural foraminal or spinal canal stenosis. L3/4 demonstrates mild disc bulge and mild bilateral facet hypertrophy without significant neural foraminal or spinal canal stenosis. L4/5 demonstrates Diffuse annular disc bulge, ligamentum flavum thickening, severe left facet hypertrophy, moderate right facet hypertrophy, and a tiny left facet effusion. There is mild to moderate neural foraminal stenosis on the left and mild neural foraminal stenosis on the right. L5/S1 demonstrates mild bulging of the disc, ligamentum flavum thickening and facet hypertrophy with no significant neural foraminal or spinal canal stenosis. There is partial sacralization of L5.

Output: 1. No evidence of intracranial metastatic disease. Since the prior MRI brain study dated 10/1/2015 there has been interval placement of a right frontal approach Ommaya catheter. There is T2/FLAIR hyperintensity along the catheter tract which may represent edema or gliosis. No associated mass effect. There is small amount of pneumocephalus as well as abnormal layering diffusion signal related to dependent debris/blood products within the occipital horns of the lateral ventricles. These findings may be related to recent catheter manipulation/injection.2. There has been interval improvement in the extent of nodular enhancement of the leptomeninges on the surface of the conus and cauda equina nerve roots. 3. There is enhancing tissue filling the right T10-T11 neural foramen which is similar to prior. Finding may possibly be related to scarring but recommend attention on follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: R shoulder pain, eval for rotator cuff tear History: see above. ROTATOR CUFF: Mild intermediate signal intensity within the supraspinatus tendon suggests mild tendinosis, similar to prior. There is an elongated focus of fluid signal intensity measuring just under 2 cm in length along the myotendinous junction of the supraspinatus tendon, representing an intrasubstance cyst, but we see no full-thickness or discrete surface tear of the supraspinatus tendon. The supraspinatus muscle is otherwise normal.Tiny focus of high signal intensity within the distal infraspinatus tendon at its insertion, representing a concealed interstitial tear measuring 2 to 3 mm, new from prior. The infraspinatus muscle is normal.The teres minor tendon and muscle are normal. The subscapularis tendon and muscle are normal.SUPRASPINATUS OUTLET: There is perhaps minimal spurring along the the acromion, otherwise, the AC joint appears normal. There is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is within normal limits. Within the limits of this non-arthrographic study, the glenoid labrum appears intact.BICEPS TENDON: There is minimal increased signal intensity within the intra-articular tendon of the long head of the biceps, which may reflect mild tendinosis, not necessarily of any clinical significance.

Output: 1.Small cyst within the supraspinatus tendon with mild tendinosis, but no discrete surface or full-thickness tear.2.Tiny concealed insertional tear of the infraspinatus tendon, of questionable clinical significance.


Instruction: Generate impression based on medical findings.

Input: Female 47 years old Reason: eval meniscus, patellofemoral joint, prev ACL History: left knee pain MENISCI: The menisci appear intact with only mild intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is focal partial-thickness tearing of the articular cartilage of the medial facet of the patella, similar to prior study. The superior femoral trochlea appears slightly shallow superiorly, perhaps reflecting mild dysplasia, but the clinical significance is of this is uncertain. Articular cartilage of the tibial femoral compartment appears intact.LIGAMENTS: The patient has undergone ACL reconstruction with the graft appearing intact. Small ganglion along the tibial interference screw is of doubtful clinical significance. MCL tear seen previously has healed. LCL and PCL appear normal. There is a subcentimeter focus of low signal intensity along the anterior fibers of the ACL which could reflect focal fibrosis.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Surgical changes of prior ACL reconstruction with graft appearing intact.2.Focal degeneration of articular cartilage of the medial patellar facet.3.Normal appearing menisci; other findings as above.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with knee pain Due to the patient's body habitus a high-definition knee coil could not be used. Use of the alternative coil results in slightly suboptimal image qualityMENISCI: There is mild intrasubstance signal within the medial and lateral menisci with perhaps mild fraying along the undersurface of the posterior horn of the medial meniscus, but no discrete tear.ARTICULAR CARTILAGE AND BONE: There is moderate articular cartilage thinning along the undersurface of the lateral patellar facet without focal defect. There is perhaps mild subjective thinning of the articular cartilage of the tibiofemoral joint compartment.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact.ADDITIONAL

Output: Degeneration of the articular cartilage of the patella and mild meniscal degeneration without discrete tear. Small loose bodies within the posterior aspect of the knee joint.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: CervicalgiaClinical question: radiculopathySigns and Symptoms: pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.There is ill-defined T2 signal hyperintensity and T1 signal hypointensity within the C6 vertebral body centered anteriorly.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is a fairly large right lateral recess disc extrusion present with disc material extending into the ventral aspect of the spinal canal. It is centered in the right hemicanal where it compresses the thecal sac as well as the nerve roots at the right lateral recess. Disc material extends across the midline and effaces spinal fluid ventral to the spinal cord. Some disc material tracks behind the C6 vertebral body and effaces CSF space ventral to the spinal cord at the C6 vertebral body level. A small amount of disc material also extends behind the lower and right aspect of the C5 vertebral body especially at the right lateral recess. Overall there is a moderate degree of spinal stenosis present at this level. There is also encroachment of the right-sided exiting nerve roots within the right lateral recess and neural foramen at C5-6.At C6-7 there is a disc bulge present associated with mild narrowing of the neural foramina - right side more than left.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a large disc extrusion present at the C5-6 level which extends behind the C6 and to a lesser degree C5 vertebral bodies along the right hemicanal which encroaches on the right-sided exiting nerve roots at C5-6 and also creates spinal stenosis at the C5-6 level and the C6 vertebral body level.2.Signal changes within the C6 vertebral body can be explained on the basis of reaction to the patient's disc extrusion.3.There is a disc bulge at C6-7 which mildly encroaches on the exiting nerve roots (right worse than left)


Instruction: Generate impression based on medical findings.

Input: Cortical/subcortical foci of T2 hyperintensity are present in bilateral cerebral hemispheres, the pons, the right dorsal brainstem, and bilateral cerebellum. There is some associated restricted diffusion within cortical watershed areas, in conjunction with with these aforementioned T2 hyperintense abnormalities.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. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered fluid can be found throughout the paranasal sinuses and mastoid air cells, likely secondary to the patient's intubated status. There is no abnormal enhancement within the brain.

Output: The constellation of MRI abnormalities found within both the supratentorial and infratentorial brain are most consistent with posterior reversible encephalopathy syndrome (PRES). Differential considerations include postictal seizure foci with ischemia considered less likely.


Instruction: Generate impression based on medical findings.

Input: 34 years, Female, history of mechanical mitral valve presenting with TIA/?CVA. Thrombus on the mitral valve on TEE. Monocular blindness. No restricted diffusion to suggest acute ischemia. No intraparenchymal mass or mass-effect. The ventricles are within normal limits in size and configuration. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. There also few scattered foci of susceptibility such as in the left frontal lobe and left temporal lobe deep white matter compatible with chronic microhemorrhages. 5 mm pineal cyst is incidentally noted. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct.2. Few nonspecific scattered foci of T2/FLAIR hyperintensity in the white matter which may represent mild chronic small vessel ischemic changes, related to prior inflammation, or less likely demyelination. There are also a few nonspecific foci of chronic microhemorrhage.


Instruction: Generate impression based on medical findings.

Input: Malignant pleural effusion [J91.0], Reason for Study: ^Reason: malignant pleural effusion, possibly lung cancer History: cough Motion artifact degraded exam quality.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Subtle FLAIR high signal intensities around periventricular white matter and a couple of FLAIR high signal lesions on white matter which are nonspecific.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 and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.3. Non specific FLAIR high signal lesions seen at periventricular white matter.


Instruction: Generate impression based on medical findings.

Input: Male 77 years old Reason: liver lesion interpreted as hemangioma on US, please confirm History: hep C s/p eradication, s/p kidney transplant ABDOMEN:LIVER, BILIARY TRACT: Liver has mildly widened fissures but does not have an overt cirrhotic morphology. Within the right lobe of the liver there is a mildly T2 hyperintense lesion that measures 9 x 10 mm. The lesion does not show enhancement centrally or peripherally. It is unchanged in size from the prior study where it measured approximately 12 mm. No new suspicious lesions have developed. There are few scattered hypervascular arterial enhancing foci that do not demonstrate definite washout. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter cystic focus in the pancreatic head possibly represents a small I PMN. Pancreatic duct normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: End-stage kidneys with scattered small cysts. There is a right lower quadrant allograft without hydronephrosis. There is a small amount of adjacent ascites or fluid.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.Anteriorly located right hepatic lobe lesion without significant size change from 2005. The lesion does not show enhancement. Differential considerations include a small thrombosed hemangioma, or complex cyst. The hypervascular lesion along the posterior aspect of the right hepatic lobe seen during the 2005 MR is not present on the current study.2.No suspicious hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Pain. Evaluate for fracture. There is soft tissue swelling, but I see no acute fracture. Osteoarthritis affecting the midfoot appears similar to that seen on the prior study. The distal Achilles tendon silhouette appears thickened which may simply reflect overlying soft tissue swelling, but if there is clinical concern for Achilles tendon tearing, then MRI may be considered for further evaluation.

Output: Soft tissue swelling without fracture evident. If there is clinical concern for tendon injury, then MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old, history of breast cancer with metastases to the brain status post SRS. Several (up to four) subcentimeter enhancing lesions are evident within the right cerebellar hemisphere. These were all present on the prior examination and show interval decrease in size. For example, the paramedian lesion now measures 8 x 4 mm, previously 9 x 5 mm. A small enhancing lesion within the anterior left frontal lobe has also decreased in size by a similar degree.None of these lesions is associated with any significant parenchymal edema. No new pathologic intracranial enhancement or signal abnormality is seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: 1.Interval decrease in size of several subcentimeter enhancing intracranial lesions.2.No new or progressing lesions are seen.


Instruction: Generate impression based on medical findings.

Input: Ms. Johnson is a 46 year old female presenting for a short-term 6 month follow-up of a left nipple mass, suspected to be a papilloma. She denies skin changes or bloody nipple discharge. Upon physical exam, no discrete mass is appreciated in the left nipple.A targeted left ultrasound was performed at the nipple. There is reidentification of a circumscribed isoechoic mass in the left nipple, now measuring 7 x 3 x 4 mm (previously 6 x 3 x 4 mm), grossly unchanged in size allowing for technical differences. This corresponds to the enhancing area seen in the left nipple on breast MRI 8/6/2014 and likely represents a papilloma.

Output: High probability benign mass in the left nipple, likely representing a papilloma. The patient is due for her annual bilateral diagnostic mammogram in July 2016. This area can be evaluated mammographically at that time. Additional imaging, including ultrasound examination, can be performed as clinically warranted. All results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with generalized abdominal pain. History of scleroderma. Rule out obstruction. ABDOMEN:LUNG BASES: Moderate cardiomegaly. Moderate pericardial effusion. Interstitial lung disease at both lung bases may be due to scleroderma. Diffuse esophageal wall thickening and dilatation.LIVER, BILIARY TRACT: Diffuse infiltrative changes in the liver, especially the right hepatic lobe, narrows the hepatic veins near the intrahepatic IVC. This may be due to fatty infiltration or other etiology. Dedicated hepatic CT or MRI examination may be helpful for further evaluation, if indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: A mesenteric lymphadenopathy is present, most prominently at the mesenteric root. For reference, a mesenteric node measures 1.3 x 2.4 cm axial image 71/144 of series 3.BOWEL, MESENTERY: Diffuse small bowel wall thickening. No definite evidence of bowel ischemia. Normal appendix in the right lower quadrant. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites is present.PELVIS:UTERUS, ADNEXA: Uterus is atrophic or absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted

Output: Cardiomegaly with moderate pericardial effusion. Ascites. Infiltrative changes in the right hepatic lobe, see above. Chronic changes in lung and bowel from scleroderma. Mesenteric lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 45 years Female (DOB:2/6/1971)Reason: right vestibular schwannoma, history resection with yearly follow up for growth History: yearly follow up for tumor growthPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM The patient status post right posterior fossa surgery for removal of an acoustic neuroma. There is a punctate focus of enhancement redemonstrated deep within it currently measures approximately 2 x 4 mm and previously measured approximately the same in axial dimensions. The right internal auditory canal.There is some mild encephalomalacia along the right cerebellar hemisphere which has been stable since prior exams. There are some postoperative changes present along the right posterior fossa. These are also stable.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.Examination is stable. The patient status post right posterior fossa surgery for removal of an acoustic schwannoma. There is a small focus of enhancement within the deep portion of the right internal auditory canal. This could represent scar tissue or residual tumor. It has been stable since prior exams. There are also some associated postoperative changes and mild encephalomalacia along the right cerebellar hemisphere.


Instruction: Generate impression based on medical findings.

Input: 31 year old man s/p microdiscectomy at L5-S1 and blood patch with persistent headache. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the normal lumbar lordosis, otherwise alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is a mild disc bulge without significant spinal canal or neural foraminal stenosis.L5-S1: There are postoperative findings of S1 left hemilaminectomy and L5/S1 partial discectomy. There is a 12 x 10 mm focus of disc extrusion which demonstrates high T2 signal suggesting a new left paracentral extruded fragment. There is thick peripheral enhancement surrounding this extruded fragment which is greater than the area of T2 signal abnormality, likely representing postoperative scar formation from recent discectomy. This protrusion causes effacement of the anterior thecal sac, left lateral recess, and compression of the left S1 nerve root.Additionally, there is a defect in the dura along the left posterolateral aspect of the spinal canal (series 6, image 42) with fluid extending through the epidural space and laminectomy into the left paraspinal muscles forming a well-defined 23 x 23 mm collection. There is circumferential CSF signal extending superiorly along the epidural space to the level of T12/L1 and extending inferiorly to S2. This epidural fluid causes mild mass effect on the anterior thecal sac. The paraspinal soft tissues are otherwise within normal limits.

Output: 1.Fluid extending from the left posterolateral aspect of the thecal sac at the surgical site through the laminectomy into the left paraspinal muscles and also circumferentially in the epidural space from T12/L1 level to S2. This finding is most compatible with postoperative CSF leak at the surgical site.2.New/recurrent left paracentral L5/S1 disc extrusion with resultant sinal stenosis, lateral recess compromise and impingement on the left S1 nerve root.


Instruction: Generate impression based on medical findings.

Input: Pelvic mass. Evaluate proximity to nerves, vessels, and ureter. PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted. No hydroureter.LYMPH NODES: 6.1 x 3.2 x 5.0 cm heterogeneously enhancing left obturator soft tissue lesion, suspicious for metastatic nodal mass, similar to prior. Lesion is situated between the left external and internal iliac veins, and it compresses without occluding the left external iliac vein. Lesion abuts the adjacent sigmoid colon, without invasion. The visualized left obturator nerve passes just posterior to the aforementioned lesion, no secondary signs of nerve impingement such as muscle atrophy seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The visualized musculature is symmetric bilaterally.There is nonenhancing soft tissue prominence about the left vaginal cuff (series 601, image 23), likely postsurgical. The punctate focus of hypermetabolic activity in the pelvis posterior to the lesion alluded to above seen on the prior PET, corresponds to a nonenhancing nonspecific thin linear focus of low T2 signal, may reflect scarring.OTHER: Subcentimeter Tarlov cysts noted.

Output: Left obturator lesion suspicious for metastatic nodal disease or implant unchanged, associated compression of left external iliac vein seen, left obturator nerve passes just posteriorly, no evidence of neurovascular involvement otherwise.


Instruction: Generate impression based on medical findings.

Input: 53 old female with acute altered mental status. There is a hypodense region in the left frontal lobe which is unchanged from yesterday, but new compared to CT from 12/20/08. MRI is recommended for further evaluation of this lesion.The ventricles and basal cisterns are normal in size and configuration.There is a lytic lesion in the right parietal calvarium which was seen on the prior scan and may represent metastases. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1- Hypodense lesion in the left frontal lobe unchanged from yesterday. MRI is recommended for further evaluation.2- Right parietal calvarial lesion doesn't appear to have significantly changed from prior and likely represent metastases.


Instruction: Generate impression based on medical findings.

Input: The study is degraded by motion. There are no T2/FLAIR abnormalities. Ventricular size is normal with no midline shift. Basal cisterns are patent. There are no restriction or susceptibility abnormalities. There is no abnormal enhancement. There are no structural abnormalities. Vascular flow voids are normal.There is fluid in the maxillary sinus bilaterally.

Output: 1. There are no structural brain abnormalities. Specifically there is no MRI evidence of AVM.2. Fluid is noted within the maxillary sinuses bilaterally.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old, with remote history of TIA, hypertension, diabetes, presenting with altered mental status and fever to 40.5, now improved status post antibiotics. No restricted diffusion is seen. Minimal scattered small foci of T2 hyperintensity are seen in the cerebral white matter, a nonspecific finding. No parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is observed. A developmental venous anomaly is noted in the right cerebellum. No abnormal extra-axial fluid collection is detected. There are no findings to suggest acute intracranial hemorrhage. The ventricular system is within normal limits.

Output: No acute intracranial abnormality or other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: The conus terminates at approximately the lower L4 level, the determination including an expansile CSF signal intensity cystic structure along the distal conus, which measures 4 x 5 mm in greatest axial dimensions, x 1.8 cm CC. This scan the L2-L3 to the lower L4 level. In addition, there is a prominent rounded area of fat signal intensity just distal to this cystic structure which measures up to 5 x 4 mm which extends from the lower L4 level to at least S1-S2, consistent with a filar lipoma. On prone imaging, there is only slight ventral motion of the distal cord and conus.A skin surface marker is identified in the L5-S1 level down to the upper aspect of the gluteal cleft which presumably designates a sacral dimple. At the mid S3 level, there is a minimal underlying linear T1/T2 hypointensity (1701/34), although no clear patent tract is identified. The linear abnormality extends deep to the superficial aspect of the gluteal musculature without definite direct connection to the spinal canal contents. There is questioned linear T1 hypointense signal along the midline of the L5 posterior elements which could suggest a minimal occult dysraphism. No definite significant spinal dysraphism is appreciated on this MRI.The thoracic and lumbar spine are in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine. A few rounded T2 hyperintense structures within the pelvis bilaterally likely relate to the ovaries.

Output: 1.Approximate conus termination at the the lower L4 level, although exact level is difficult to determine secondary to the associated conus cyst. This most likely represents an associated conus syrinx, less likely a terminal ventricle or cystic neoplasm, although postcontrast images through the conus is recommended for complete evaluation.2.Additional finding of focal filar/intraspinal lipoma measuring up to 5 mm with only mild ventral motion of the distal cord and conus on prone imaging. Please correlate clinically for possible tethered cord.3.Small subcutaneous sinus tract suggested just deep to the caudal aspect of the skin surface marker presumably in the location of the sacral dimple at the approximate mid S3 level, without definite connection to the spinal canal contents. Questioned linear cleft in the midline of the posterior elements of L5. CT would better delineate any possibility of occult dysraphism.4.Unremarkable MRI of the thoracic spine.


Instruction: Generate impression based on medical findings.

Input: 27 year old admitted with troponin elevation and left ventricular systolic dysfunction being evaluated for etiology of cardiomyopathy. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 267 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 173 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 127 g (normal range 164+/-36). There left ventricular dysfunction is global. There is an area of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in the mid-basal inferoseptal wall in a pattern atypical for myocardial infarction and may represent an area of myocarditis .Left AtriumThe left atrium visually is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 137 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 74 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.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 a small pericardial effusion, there is no hemodynamic compromise relating to the effusion. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%.There left ventricular dysfunction is global. There is an area of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process in the mid-basal inferoseptal wall in a pattern atypical for myocardial infarction and may represent an area of myocarditis.2. The right ventricle is normal in size with mildly reduced systolic function (RV ejection fraction is 46%). 3. Left atrial enlargement


Instruction: Generate impression based on medical findings.

Input: Ms. Konicek is a 60 year old female with a strong family history of breast cancer in six maternal cousins and BRCA1 mutation carrier. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old, with history of melanoma and a left-sided brain lesion. fMRI is requested for surgical planning purposes. All tested language paradigms produced reliable language related cortical activation. Language is left dominant. Broca's area activity is seen as expected within the left inferior frontal gyrus (primarily the pars triangularis and pars opercularis). Wernicke's area activity is seen as expected along the posterior aspect of the left superior temporal gyrus and sulcus. Both Broca's and Wernicke's areas are well removed from the patient's left middle frontal gyrus lesion. Of note, however, there is evidence of secondary language related activity located anterior, medial and superior to the lesion.

Output: Successful fMRI for pre-surgical language mapping. Language is left dominant. Broca's and Wernicke's areas are well removed from the left middle frontal gyrus lesion. Evidence of secondary language related activity is seen in the vicinity of the lesion, as above.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: History of neuroblastoma: daily headaches. The images are partly degraded by dental artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions in the right posterior ethmoid sinuses. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or ventriculomegaly, within the limitations of dental artifact.


Instruction: Generate impression based on medical findings.

Input: A 37 year old male with end stage renal disease on dialysis, hypertension, with repeated admission due to chest pain and pulmonary edema. An echocardiography (4/2015) showed hyperdynamic systolic function with severe left ventricular hypertrophy. Now hospitalized and referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is moderately dilated with hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 116 ml/m2 (normal range: 74+/-15), the LVEDV is 208 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 58 ml (normal range 47+/-19), the LV mass index is 161 g/m2 (normal range 85+/-15), and the LV mass is 290 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Diffuse concentric left ventricular hypertrophy, maximal at basal septum up to 23mm. T1 time was above 1100ms at base, between 1050-1000ms at middle segments and between 1000-1050ms at the apex. These T1 time values represent most likely abnormal values at base, borderline at middle segments and probably normal at the apex. No myocardial iron overload is noted.No intracavitary thrombus is noted.In the context of this patient, these findings support the diagnosis of cardiac amyloid.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 118 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is dense calcification along the inferolateral mitral annulus with low density within the central portion of calcification which is demonstrated on recent CT. This is shown on MRI with low signal on the steady-state free precession sequences. This low density in the central calcification is suggestive of caseous necrosis. This contributes to slight decreased excursion of the basal posterior leaflet of the mitral valve. No significant mitral stenosis is visualized.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 pericardial effusion.Extracardiac FindingsIron overload is noted in the liver. Previous mediastinal lymphadenopathy from CT 7/15 does not appear as prominent on the current examination.

Output: 1. The left ventricle is moderately dilated with hyperdynamic systolic function, the LVEF is 72%. There are no regional wall motion abnormalities present. Diffuse concentric left ventricular hypertrophy, maximal at basal septum up to 23mm. T1 time was above 1100ms at base, between 1050-1000ms at middle segments and between 1000-1050ms at the apex. These T1 time values represent most likely abnormal values at base, borderline at middle segments and probably normal at the apex. In the context of this patient, these findings support the diagnosis of cardiac amyloid.2. The left and right atrium are dilated. 3. The right ventricle is mildly dilated with normal systolic function, the RVEF is 62%.4. Evidence of iron deposition in the liver and possibly in the spleen.


Instruction: Generate impression based on medical findings.

Input: Worsening back pain. There is multilevel degenerative spondylosis. At L1 through L3, there is minimal disc bulging without significant spinal canal stenosis and perhaps minimal neural foraminal narrowing. However, at L3-4, there is left neural foraminal disc protrusion superimposed upon a small disc bulge and facet hypertrophy, which impinges upon the exiting nerve roots. There is also at least mild right neural foraminal narrowing at L3-4. At L4-5, there is bilateral facet hypertrophy and ligamentum flavum hypertrophy, as well as a disc bulge, with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. At L5-S1, there is disc bulging and bilateralfacet and ligamentum flavum hypertrophy with mild spinal canal narrowing and severe right, but mild left neural foraminal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The spinal cord displays normal signal and morphology. However, there is persistent clumping of the right cauda equina nerve roots at the L5 level. There is an unchanged high T1 signal focus within S1, which likely represents a hemangioma. The paravertebral soft tissues are unremarkable.

Output: 1. Multilevel degenerative spondylosis. In particular, a left neural foraminal disc protrusion superimposed upon a small disc bulge and facet hypertrophy impinges upon the exiting nerve roots at L3-4 and disc bulging and bilateral facet and ligamentum flavum hypertrophy results in mild spinal canal narrowing and severe right, but mild left neural foraminal stenosis at L5-S1. 2. Persistent clumping of the right cauda equina nerve roots at the L5 level may represent arachnoiditis.


Instruction: Generate impression based on medical findings.

Input: As seen on the recent MRI neck, there is enhancing mass in the left posterior cerebellum, measuring 1.4 x 1.6 cm in greatest axial dimensions, with prominent surrounding T2/FLAIR hyperintensity and effacement of the cerebellar sulci, due to localized mass effect from the vasogenic edema. No other enhancing lesion is identified. There is a nonspecific focus of T2/FLAIR hyperintensity in the left parietal centrum semiovale without enhancement.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Marrow signal within the clivus and inferior occipital bone appears fatty, relative to other areas which may be related to post radiation changes in the field of prior treatment.

Output: 1. Redemonstration of left cerebellar metastasis with prominent surrounding vasogenic edema and minimal localized mass effect. No other definite intracranial metastatic disease identified.2. Single punctate focus of nonenhancing T2/FLAIR hyperintensity in the left parietal centrum semiovale which is nonspecific.


Instruction: Generate impression based on medical findings.

Input: Ms. King is a 40 year old female with personal history of BRCA2 mutation and strong family history of breast cancer including her mother (diagnosed at the age of 44) and maternal grandmother (diagnosed at the age of 63). There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: Eval meningiomas. History: meningiomas. Multiple extra axial enhancing mass lesions are seen. Though the number of lesions appears to be unchanged, some of lesions especially one on the right frontal lobe in front of the pre-central gyrus (14.8mm x 15.4mm, was 13.7mm x 13.4mm) as well as a couple of falx lesions especially anterior aspect of the falx (11.4mm, was 11.1mm and 9mm was 7.6mm) demonstrate interval increase in size.Other lesions do not show any significant interval change in terms of size since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion.Redemonstrated and unchanged right posterior temporal lobe susceptibility lesion since prior scan.About 4 mm sized enhancing lesion within the left internal auditory canal is again seen, unchanged in size and enhancement pattern.Right frontal parietal craniotomy with multifocal underlying foci of encephalomalacia indicating postoperative changes, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. 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. Subtle interval increase of measured maximum diameter of extra axial enhancing lesions most likely meningiomas including right frontal precentral gyrus lesion and anterior aspect of falx lesions. Other lesions do not show any significant interval changes.2. No evidence of acute ischemic or hemorrhagic lesion.3. Right temporal susceptibility lesion as well as left internal with technical enhancing lesion do not show any significant interval change since prior scan.


Instruction: Generate impression based on medical findings.

Input: Ms. Walker is a 56-year-old female presenting for further evaluation of a suspicious right breast mass. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST: In the right inferior breast, 6:00 location, there is an irregular enhancing mass identified measuring approximately 2.0 x 1.3 x 1.9 cm (AP x ML x SI). Seen just superomedial to this is an additional irregular enhancing mass measuring approximately 1.0 x 0.8 x 0.7 cm. The total span of abnormal enhancement (index mass + suspected satellite lesion) measures approximately 2.7 cm in the AP oblique dimension. In addition, there is a circumscribed enhancing mass seen in the right upper outer breast, 10:00 location, measuring approximately 0.6 x 0.9 cm. This corresponds to the sonographically identified intramammary lymph node. There is an additional circumscribed enhancing mass seen in the right inferior breast, 6:00 location, measuring 0.6 x 0.7 cm. An ultrasound will be performed to further evaluate this lesion.LEFT BREAST: A few enhancing foci are seen in the left breast, none of which are more suspicious than the rest. There is no abnormal enhancement seen in the left breast. AXILLAE: There is an abnormal morphology lymph node identified in the right axilla, measuring approximately 1.1 x 0.8 x 1.1 cm. There are no abnormal lymph nodes identified in the left axillary or internal mammary region.

Output: (1) 2.0 cm suspicious mass in the right inferior breast, for which an ultrasound-guided biopsy and clip placement will be performed immediately after MRI.(2) Additional suspected satellite lesion seen just superomedial to the index malignancy. An MR directed ultrasound will be performed for confirmation of this finding.(3) Abnormal right axillary lymph node, for which ultrasound-guided biopsy and clip placement will be performed immediately after MRI.(4) 0.9 cm intramammary lymph node in the right upper outer breast, for which ultrasound-guided biopsy and clip placement will be performed immediately after MRI.(5) Additional circumscribed enhancing mass in the right inferior breast, suspected to be a benign intramammary lymph node. An MR directed ultrasound will be performed for confirmation of this finding.(6) No MRI evidence for malignancy in the left breast. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient with large right renal mass concerning for extension into the IVC. Has new SOB and need MRI for surgical planning History: As above. ABDOMEN: Limited exam without the use of intravenous contrast.LUNG BASES: Bilateral small to moderate size pleural effusions, greater in the left. 1.1 x 1.2 cm left lower lobe pulmonary nodule (series 801 image 48) suspicious for metastases. Please see separately dictated MRI chest performed on the same day. Retrocrural lymph node measures 1.3 x 1.4 cm (series 801 image 32).LIVER, BILIARY TRACT: Several mildly T2 hyperintense intense, T1 hypointense lesions with restricted diffusion and ill-defined margins in the right lobe of the liver suspicious for metastases. The largest in segment 8 measures 2.0 x 1.9 cm (series 801 image 34). Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: In the expected location of the right adrenal gland, there is a 3.9 x 3.6 x 5.3 cm heterogeneous mass with restricted diffusion and signal characteristics similar to the separate right renal mass (series 801 image 31, series 701 image 22). The normal right adrenal gland is not visualized. The left adrenal gland is unremarkable.KIDNEYS, URETERS: In the right lower pole, there is a large heterogeneous mass with well-defined margins and restricted diffusion measuring 10.4 x 8.2 x 8.7 cm (series 801 image 16, series 701 image 22). There is extension of this mass into the left renal vein and IVC (series 801 image 23-28; series 701 image 14). The tumor extends superiorly just proximal to the level of the intrahepatic IVC and inferiorly to the level of L3. Moderate to severe left hydronephrosis that extends to the pelvis, outside the field of view. Nonspecific urothelial wall thickening of the proximal left ureter. RETROPERITONEUM, LYMPH NODES: Aortocaval lymph node measures 2.3 x 2.8 cm (series 801 image 21). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered perineural or synovial cysts. Focal T2 hyperintense, T1 hypointense lesion in the left L1 posterior vertebral body with extension into the pedicle suspicious for metastasis. OTHER: No significant abnormality noted.

Output: 1.Large right renal mass suspicious for renal cell carcinoma with extension into the right renal vein and IVC. 2.Retroperitoneal lymphadenopathy. 3.Probable hepatic, pulmonary, and osseous metastases.4.Moderate to severe left hydroureteronephrosis that extends into the pelvis. No obstructive lesion identified within the abdomen, although the pelvis is not imaged. Nonspecific proximal ureteral wall thickening.


Instruction: Generate impression based on medical findings.

Input: 92-year-old female with ongoing left hip pain and mild osteoarthritis on recent radiographs. Mild osteoarthritis affects the left hip. There is a small amount of fluid within the joint, but no frank joint effusion. Evaluation of the labrum is limited due to lack of intra-articular contrast, however, there is linear intermediate signal intensity traversing the superior labrum suggesting a tear. There is severe fatty atrophy of the gluteus minimus muscle bilaterally. There is mild atrophy of the left gluteus medius muscle. On the large field-of-view images, there is mild osteoarthritis of the right hip. Severe degenerative disc disease and facet joint osteoarthritis affects the lower lumbar spine with spinal stenosis that could be better evaluated with dedicated spine imaging if clinically warranted. There is mild increased signal intensity within the adductor musculature and gluteal musculature of the hip, on T2-weighted images, which may reflect early denervation atrophy with a mild myositis considered less likely. We see no findings to suggest a stress fracture. The bone marrow signal intensity is within normal limits.

Output: 1. Mild osteoarthritis of the left hip.2. Severe degenerative disc disease and osteoarthritis of the lower lumbar spine and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 87 year old man with elevated iron markers, referred for cardiac MRI to evaluate for cardiac iron overload. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 83 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 47 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Based on T2 Star imaging, there is no evidence of myocardial iron overload (T2star 26 msec). There is borderline LVH with LV wall thickness of 10mm.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 62%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 127 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace 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 FindingsT2star value in the liver is 11.4 msec. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%.3. There is no evidence of myocardial iron overload. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old, with headache and tremor. Concern for CADASIL. Diffusion imaging is unremarkable. A single focus of nonspecific FLAIR hyperintensity is seen within the orbital gyrus of the left inferior frontal lobe. No other significant parenchymal signal abnormality, edema or mass effect is observed. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology. There may be a small cystic structure within the posterior aspect of the sella, incompletely evaluated on this exam. The osseous structures of skull show normal signal characteristics. A mucous retention cyst is present in the right maxillary sinus.

Output: 1.No findings are seen to account for the patient's symptoms. In particular, no imaging evidence of CADASIL is present.2.There appears to be a small cystic structure within the posterior aspect of the sella. This lesion is incompletely evaluated on the present study, but could represent a Rathke cleft cyst or some other intrinsic pituitary lesion. If clinical concern warrants, dedicated pituitary imaging can be considered.


Instruction: Generate impression based on medical findings.

Input: Right arm numbness. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral body heights are intact. There is mild multilevel disc height loss. At C2-3 and C7-T1, there is no significant compromise to the spinal canal or neural foramina. At C3-4, there is a disc osteophyte complex and small right foraminal disc protrusion with facet hypertrophy, mild spinal canal stenosis and mild right neural foraminal narrowing. At C4-5, there is a disc osteophyte complex, facet hypertrophy and moderate right neural foraminal narrowing. There is no left neuroforaminal spinal canal stenosis at this level. At C5-6, there is a disc osteophyte complex and facet hypertrophy with moderate left neuroforaminal narrowing. There is no spinal canal stenosis at this level. At C6-7, there a disc osteophyte complex and facet hypertrophy with mild spinal canal stenosis and moderate to severe bilateral neural foraminal narrowing. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative cervical spondylosis of the cervical spine most prominently involving the bilateral C5-6 and C6-7 neural foramina, left worse than right, as well as at most mild spinal canal stenosis at the C3-4 and C6-7 levels.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with intermediate risk for prostate cancer status post prostatectomy in 2013 with positive left lateral anterior margin and rising PSA of 0.76. PELVIS:PROSTATE:The prostate gland is surgically absent. Between the bladder and the rectum, there is a soft tissue focus which measures 1.4 x 0.6 cm (series 901, image 7; series 1001, image 1223) with early enhancement and washout.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small soft tissue focus with early enhancement and washout concerning for recurrent disease.


Instruction: Generate impression based on medical findings.

Input: Patient with neurofibromatosis 1. Evaluate margins of the plexiform tumor. Scattered lesions within the skin and soft tissues with increased T2 signal are compatible with neurofibromas.There is moderate inflammation of the left gluteal soft tissues extending to the left labia with associated atrophy of the musculature in this region. Additionally the left inferior pubic ramus appears chronically deformed. These findings are likely postsurgical in etiology. Within the postsurgical site, there is a residual plexiform neurofibroma adjacent to the medial left ischium measuring approximately 2.8 x 1.8 x 2.7 cm. This lesion demonstrates enhancement.Additionally, along the course of the left sciatic nerve at the level of the mid femur there is a plexiform neurofibroma measuring approximately 3.5 x 2.8 x 5.7 cm. Along the course of the right sciatic nerve on the contralateral side at a level just inferior to the lesser trochanter there is an another plexiform neurofibroma measuring approximately 4.8 x 3.7 x 6.9 cm. These lesions demonstrate enhancement.There is enlargement of the lumbosacral nerve plexus along with enlargement of the foramina. Small ovarian cysts are noted bilaterally, likely physiologic in nature.

Output: 1. Small residual plexiform neurofibroma in the surgical bed.2. Additional plexiform neurofibromas along the course of the bilateral sciatic nerves as above.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of unspecified site of unspecified female breast [C50.919], Reason for Study: ^Reason: Hx: metastatic breast cancer on letrozole and Denosumab now with worsening upper arm pain, not reproducible on exam. History: RUE pain that radiates C-Spine:The cranial-cervical junction is normal. There multilevel degenerative changes including disc dessication.The C7 vertebral body shows loss of normal bone marrow signal intensity indicating possible metastatic lesion which do not show any significant interval change since prior scan.C2 and C4 vertebral body show focal enhancement which again can represent focal metastatic lesion, no change since prior scan.There is no evidence of spinal cord signal abnormality.At the level of C34, there is broad based disc protrusion central to left which abuts thecal sac with minimal spinal canal stenosis.At the level of C45, broad based central disc bulging with ligamentum flavum thickening especially on the left side create mild to moderate spinal canal stenosis.At the level of C56, diffuse bulging of disc with ligamentum flavum thickening create mild to moderate spinal canal stenosis. In addition, there is moderate to severe neuroforaminal stenosis on the left side and mild neuroforaminal stenosis on the right.At the level of C67, there is broad based disc protrusion toward right side lateral recess creating right side lateral recess narrowing with possible compression of the right side nerve root. There is left side neuroforaminal narrowing due to uncovertebral joint hypertrophy.Thoracic spine:The pattern of metastatic lesions on thoracic vertebral bodies appear to be changed significantly.In particular, previously seen diffuse vertebral body involving lesions are now more likely confined appearance. There also interval development of compression fractures on T4 (about 10%), T6 (about 10%), T9 (about 15%) and T11 (about 5%). The large extruded disc at the level of T67 which abuts thecal sac and spinal cord do not show any significant interval change since piror scan. There is left side ligamentum flavum thickening at the level of T9-T10 which creates minimal spinal canal narrowing. Except the level of T67 and T9-T10, there is no evidence of spinal canal narrowing.There is no evidence of abnormal signal intensity of the spinal cord.Lumbar spine Again multiple vertebral body metastatic lesions were seen which demonstrate interval change.The patterns of interval changes are similar to those of thoracic spine. Specifically, those seen as diffuse vertebral body involvement is now showing more confined lesion with development of interval compression fracture of L2 (about 30%) as well as L3 and L4 endplate fractures.However, the S1 vertebral body shows a bit more progressed vertebral body involvement comparing to prior study.Disc dessication was seen in all lumbar spine with ligamentum flavum thickening indicating degenerative changes. In particular, at the level of L34 and L45, there is mild to minimal spinal canal narrowing. Diffuse involvement of bilateral ilium and remained sacrum.Spinal cord signal intensity appears to be normal without evidence of abnormal enhancement.The conus medullaris terminates at the L1 level.

Output: 1. Interval change of pattern of vertebral body metastasis on both thoracic and lumbar spine, specifically the lesions appear to be more confined and developed various degree of compression fractures as described above.2. Multi-level various degree degenerative changes especially cervical spine including spinal canal stenosis and neuroforaminal stenosis.3. No change of T67 intervertebral disc extrusion since prior scan.4. Interval progression of S1 vertebral metastatic lesion comparing to prior scan.


Instruction: Generate impression based on medical findings.

Input: C5-C6 radiculopathy. At C5-6, there is a large eccentric left posterior disc-osteophyte complex that indents the spinal cord and substantially narrows the bilateral neural foramina. There is no discernible signal abnormality in the spinal cord. At C3-4 and C4-5, there is minimal posterior disc-osteophyte complex formation, without significant spinal canal or neural foraminal stenosis. At C2-3, C6-7 and C7-T1, there is also no significant spinal canal or neural foraminal stenosis. There is lack of the usual cervical lordosis, but there is no spondylolisthesis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: At C5-6, there is a large eccentric left posterior disc-osteophyte complex that indents the spinal cord and substantially narrows the bilateral neural foramina. There is no significant spinal canal or neural foraminal stenosis at the other cervical spine levels.


Instruction: Generate impression based on medical findings.

Input: Shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: An os acromiale is noted but without abnormal marrow signal.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the left shoulder.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old, with newly diagnosed base of tongue cancer, compare to outside. A bulky enhancing mass is evident involving the tongue base bilaterally measuring up to 40 mm when assessed in the transverse plane (image 31 series 12). This lesion extends into the floor of mouth bilaterally as well as into the left oral tongue and perhaps a small portion of the right oral tongue as well. The exact boundaries of this infiltrative spread are difficult to assess though the lesion potentially occupies a majority of the tongue. Ulceration of the left oral tongue is demonstrated. The lesion effaces the vallecula and is inseparable from the free edge of the epiglottis. No definite involvement of the supraglottic larynx is seen.Two left level Ib lymph nodes are subjectively prominent but they do not meet imaging criteria for pathologic enlargement. No additional pathologic adenopathy is detected. The salivary glands and thyroid are unremarkable. Bone marrow signal characteristics are unremarkable.

Output: 1.A large mass is evident centered on the tongue base but with extensive infiltration of the floor of mouth and oral tongue.2.No pathologic adenopathy is identified by size criteria.


Instruction: Generate impression based on medical findings.

Input: 16 year-old female with systemic lupus and nephritis. History of elevated cardiac enzymes and chest pain.Referred for CMR to rule out myocardits Left VentricleThe left ventricle is mild-moderately dilated with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 108 ml/m2 (normal range: 65+/-11), the LVEDV is 202 ml (normal range 109+/-23), the LV end systolic volume index is 45 ml/m2 (normal range 18+/-5), the LVESV is 84 ml (normal range 31+/-10), the LV mass index is 67 g/m2 (normal range 67+/-11), and the LV mass is 126 g (normal range 114+/-24). There are no regional wall motion abnormalities present. T2 Stir images show evidence of edema/inflammation in the region of e lateral/antero-lateral wall which is suggestive of an acute inflammatory process such as myocarditis There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Myocardial T1 time ~1150 ms which is abnormal and could be consistent with diffuse fibrosis.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 107 ml/m2 (normal range 69+/-14), the RVEDV is 200 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is 89 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumSmall pericardial effusion. Bright pericardium noted on T2-stir images suggestive of pericarditis.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mild-moderately dilated with normal systolic function. The overall LV ejection fraction is 59%. There are no regional wall motion abnormalities present. T2 Stir images show evidence of edema/inflammation in the region of e lateral/antero-lateral wall which is suggestive of an acute inflammatory process such as myocarditis There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Myocardial T1 time ~1150 ms which is abnormal and could be consistent with diffuse fibrosis.2. The right ventricle is mildly dilated. The overall RV ejection fraction is 56%3. Small pericardial effusion. Hyperenhancement on T2-stir images suggestive of pericardits4. At least mild aortic regurgitation and mid-moderate tricuspid regurgitation. 5. This constellation of findings is consistent with myo-pericarditis.


Instruction: Generate impression based on medical findings.

Input: Status post hypertensive stroke on xarelto. Examination is motion degraded. There is restricted diffusion involving the right posterior corona radiata extending into the posterior aspect of the right caudate body. There is corresponding hypodensity on CT from 1/24/2015 and minimal in this location on CT from 1/20/2015.Again seen is intraparenchymal hemorrhage involving the right caudate tail, adjacent periventricular white matter, and with intraventricular extension. Unchanged caliber of the ventricular system with right lateral ventricles larger than the left without evidence of hydrocephalus.Tiny focus of susceptibility is seen in the dorsal pons suspected to represent a chronic microhemorrhage, less likely vessel. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Acute infarct involving the right posterior caudate and corona radiata/periventricular white matter. Serial CT demonstrates developing hypodensity in this location between CT 1/20 and 1/24/2015.2. Unchanged adjacent intraparenchymal hemorrhage with intraventricular extension.3. Examination is motion degraded. There is a probable chronic microhemorrhage focus in the pons. No other foci of chronic hemorrhage or intracranial masses are appreciated. 4. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old, with history of traumatic brain injury five years ago, cervicothoracic syrinx with increased ICP, presenting with worsening muscle spasms following spinal tap on 7/6. A very extensive T2 hyperintense epidural collection is seen within the spinal canal beginning at the C3 level and continuing caudally to at least the mid lumbar region. The fluid follows CSF signal characteristics and is predominantly located posteriorly. The collection effaces the thecal sac through most of the spine. Apart from crowding due to the epidural collection, the spinal cord itself appears relatively unremarkable. No clear evidence of any focal signal abnormality or syrinx is seen.The spinal alignment is anatomic allowing for some positional straightening of the cervical lordosis. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is detected. The intervertebral discs are preserved with no areas of degenerative spinal canal encroachment or foraminal narrowing.

Output: A very extensive epidural CSF collection is seen beginning at C3 and continuing down to at least the mid lumbar region. This collection effaces the thecal sac and may exert a mild compressive force on the spinal cord. No evidence of any cord edema or focal cord lesion is seen. In particular, no clear evidence of the reported syrinx is demonstrated.These findings were discussed with Dr. Satzer at 10:10 AM on 07/08/16.


Instruction: Generate impression based on medical findings.

Input: Memory loss. ? Late-onset Alzheimer dementia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate T2-hyperintense lesions in the cerebral white-matter. The brain parenchyma appear unremarkable otherwise. There is unchanged mild expansion of the sylvian fissures and the sulci, reflecting age-appropriate brain volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The expanded, empty sella remains unchanged. There is also a small CSF-filled invagination into the floor of the left middle cranial fossa anterior to the left foramen ovale which is unchanged since the previous examination. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Age-appropriate global brain volume loss without specific distribution, not significantly changed since October 2014. 2.Relatively mild white-matter lesions that are nonspecific but most likely vascular related


Instruction: Generate impression based on medical findings.

Input: 35-year-old female. Pain occurring after slipping on ice and ankle. TENDONS: The Achilles tendon and other tendons of the ankle are normal in signal intensity and morphology. LIGAMENTS: The anterior talofibular and posterior talofibular ligaments as well as deltoid ligamentous complex are grossly intact. The distal tibiofibular syndesmotic complex appears intact. ARTICULAR SURFACES AND BONE: Mild patchy edema in the talus and distal fibular tip are suggestive of contusions. No osteochondral defect is seen in the talar dome. Mild edema at the calcaneocuboid articulation, likely degenerative in etiology. ADDITIONAL

Output: 1. Mild edema in the talus and fibular tip suggestive of contusions given patient history of trauma.2. No evidence of ligamentous or tendon injury.3. Small ankle joint effusion.


Instruction: Generate impression based on medical findings.

Input: Evaluate progress of left subdural hemorrhage, assess left quadrigeminal cistern plate lipoma, calcifications: left subdural hemorrhage, lipoma, calcifications. There is a low T2 and high T1 signal subdural hematoma along the left posterior falx cerebri that measures up to 5 mm in thickness, which is not significantly changed. There is also perhaps a trace subdural hematoma along the right aspect of the posterior falx cerebri. There is lipoma within the left quadrigeminal plate cistern, which measures up to 8 mm. There is a low T2 and high T1 signal right scalp hematoma that measures up to 10 mm in thickness and a similarly low T2 and high T1 signal right scalp hematoma that measures up to 10 mm in thickness, both of which are confined by the sutures. There is no evidence of intracranial mass or acute infarct. There is no discernible abnormal intraparenchymal susceptibility effect. The degree of sulcation and myelination is likely related to prematurity. The ventricles are unchanged, accounting for differences in technique. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Unchanged small subdural hematoma along the left posterior falx cerebri and perhaps trace subdural hemorrhage along the right falx cerebri.2. Unchanged bilateral cephalohematomas, right larger than left, and superimposed caput succedaneum. 3. Small left quadrigeminal plate cistern lipoma.4. No discernible brain parenchymal calcification or hemorrhage.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: 22 year old with Ehlers Danlos Syndrome and shortness of breath. Patient referred to evaluate aorta and LV size/ function. Left VentricleThe left ventricle is normal in size and systolic function (LVEF 60-65% qualitatively). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic functionRight 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. No evidence of thoracic or abdominal (up to infra-renal aorta) aortic aneurysm or dissection. Aortic dimensions are:Sinus of Valsalva: 27x27x27mmSinotubular Junction: 22x24mmAscending Aorta: 22x23mmMid Aortic Arch: 21x22mmDescending Aorta: 17x17mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No evidence of aortic aneurysm or dissection.2. Normal left ventricular size and systolic function (LVEF 60-65% qualitatively) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.3. Normal right ventricular size and systolic function.Quantification software unavailable. Report to follow with addendum that includes quantitative measurements of left and right ventricle.


Instruction: Generate impression based on medical findings.

Input: 35 year old female with pain and weakness with a sense of instability of the left knee for 2 weeks. Due to the patient's body habitus, the dedicated knee coil was not able to be used. A cardiac coil was utilized for this examination.MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal signal heterogeneity along the medial facet of the patella indicating near full-thickness to full-thickness articular cartilage degeneration. The articular cartilage of the medial and lateral tibiofemoral compartments is within normal limits.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Mild focal degeneration of the articular cartilage of the medial facet of the patella. Otherwise, no specific findings to account for the patient's knee pain.


Instruction: Generate impression based on medical findings.

Input: 44 years Female (DOB:10/15/1971)Reason: eval positioning of carotid arteries, pt feels air suffocation History: as abovePROVIDER/ATTENDING NAME: MAUREEN CROWLEY MAUREEN CROWLEY MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. The right common carotid artery and the proximal right vertebral artery are not well imaged at the level of the thyroid gland. To a large degree this is related to breathing artifact. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. At the C3 and C2 vertebral body levels there is medial deviation of the internal carotid arteries bilaterally above the level of the hyoid bone and at the level of the hypopharynx.MRI neck:Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.There is medial deviation of the internal carotid arteries bilaterally above the level of the hyoid bone at the C2-3 vertebral body levels.The cervical vertebral bodies in general are intact. There are multilevel degenerative changes present in the cervical spine which appear worse at C3-4 where there is a disc protrusion present which narrows the spinal canal and is suspected to be associated with spinal stenosis.

Output: 1.The right common carotid artery and the right vertebral artery not adequately imaged proximally. Perhaps additional imaging with ultrasound may be of benefit in evaluating this. The possibility of a stenosis of the proximal right vertebral artery or the right common carotid artery cannot be excluded on the basis of this exam.2.There is medial deviation of the internal carotid arteries bilaterally above the level of the hyoid bone at the C2-3 vertebral body levels.3.Findings raise the question of spinal stenosis at C3-4. Please correlate with clinical symptoms. If clinically appropriate dedicated cervical spine imaging may be helpful.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with recurrent left paresthesias. Rule out thrombosis which was possibly seen on MRI/MRA.IMAGE ACQUISITIONS: Brain CTA with contrast, neck CTA with contrast. 120 cc nonionic Omnipaque 350 at 4.5 cc/sec. Left carotid artery: Mild noncalcified stenosis at the origin of the internal carotid artery. There is calcifications of the cavernous portion of the internal carotid artery.Right carotid artery: Calcifications of the cavernous portion of the internal carotid artery. No significant stenosis or septations elsewhere.Left are two artery:Left vertebral artery: Severe narrowing of the left vertebral artery from its origin to the basilar artery with only faint wisps of contrast seen. This is either due to marked hypoplasia or intrinsic disease.Right vertebral artery: No significant stenosis or calcification.BRAIN

Output: 1. Left vertebral artery is severely narrowed, either due to hypoplasia or intrinsic disease.2. P1 segments of the PCAs are not well visualized, either due to absence or hypoplasia3. Mild stenosis of the origin of the left internal carotid artery4. Noncontrast brain CT shows small vessel ischemic disease of indeterminate age and multiple bilateral lacunar infarcts


Instruction: Generate impression based on medical findings.

Input: 73 year old female who is status post left lumpectomy for ILC, resulting in positive surgical margins. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a post-surgical seroma cavity in the left lateral breast, measuring 68 x 64 x 42 mm (AP x LR x CC). At the anterior-inferior margin of the seroma, there is an irregularly shaped enhancing mass, measuring 11 x 13 x 11 mm, which is suspicious for residual lesion.No abnormal enhancement is seen in right breast. Mild post-surgical changes are seen in the left axilla.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Status post lumpectomy in the left breast. A residual tumor is suspected at anterior-inferior margin of the seroma.2. No MRI evidence of malignancy in the right breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.