Instruction: Generate impression based on medical findings.

Input: Left popliteal mass A complex predominantly cystic mass is noted within the posterolateral compartment of the leg lying below the fascial plane of the medial head of the gastrocnemius. There is mass effect upon the muscle itself but no direct invasion. The mass measures approximately 18 cm in the craniocaudal dimension and is heterogeneous in signal on both T1 and T2 sequences. The more superior aspect of the mass is heterogeneous in nature but contains a large T1 hyperintense component likely reflecting hemorrhagic contents. There is soft tissue enhancement both proximal and distal to the mass although there is no discrete nodular enhancement of the mass itself. The marrow signal of the tibia and fibula there is normal. The remaining muscles are normal in caliber and signal as well.

Output: Large complex hemorrhagic mass within the posterior lateral component of the leg. This could represent an old hematoma with other differentials including complex Baker's cyst and or discrete soft tissue mass are also possible but thought to be less likely.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Lung cancer abnormality on the right skull on bone scan. Needs further evaluation. Signs and symptoms: Right skull abnormality. Pre-and post infused head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal.There is no evidence of any abnormal enhancement or brain parenchymal or the leptomeninges.Visualized paranasal sinuses and mastoid air cells are unremarkable.Evaluation of the skull reveals a very faintly identified area all low density of calvarium in the right frontal bone on extreme windowing of images. This finding is best appreciated on axial images 10 through 18 and on coronal images 6 through 15. There is suggestion of multiple linear defects within the lesion in the diploic space which may represent vascular channels. This lesion is not associated with any destructive changes of bone, inner or outer tables of the skull. There is also no detectable associated epidural or subgaleal abnormal soft tissue densities or enhancement. The finding is unlikely to represent a metastatic disease. I believe the lesion represents a hemangioma. Recommend an MRI examination for better assessment of the lesion. This lesion measures approximately 24 x 4 in its trans-axial dimensions and 34-mm in cranial -- cephalad axis. A

Output: 1.This pre-and post infused CT examination of brain demonstrates no evidence of intracranial abnormality.2.Very faintly identified low attenuation of the marrow space of the right frontal bone containing multiple serpiginous defects to represent vascular channels. There is no evidence of any erosive changes of diploic space, outer or inner table of the skull. There is also no evidence of any associated subgaleal or epidural soft tissue component. This finding is not consistent with a metastatic disease and likely represent benign lesion like a hemangioma. Recommend follow-up with an MRI examination.


Instruction: Generate impression based on medical findings.

Input: Evaluate common bile duct and causes for elevated bilirubin. Status post TIPS in 1999. Distal CBD stricture secondary to fibrosis from chronic pancreatitis. Alcoholic cirrhosis. Evaluation is markedly limited due to lack of intravenous contrast and motion artifact.ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is increased intra- and extra- hepatic biliary ductal dilatation, with transition points at the hila and at the pancreatic ampulla, probably strictures. The gallbladder is hydropic, new from prior. There is cholelithiasis, with no definite obstructing stone identified. There is new mild gallbladder wall thickening. Patient is status post TIPS, with metallic artifact present. The common bile duct measures up to 9 mm.SPLEEN: No significant abnormality noted.PANCREAS: There is focal pancreatic ductal dilatation within the pancreatic head. Within the pancreatic head, a T2 hyperintense lesion is similar to prior (series 301, image 18), though evaluation is limited due to motion artifact, probable IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Increased anasarca. No suspicious osseous abnormality identified.OTHER: No significant abnormality noted.

Output: 1.Evaluation is markedly limited due to lack of intravenous contrast, early termination of study and motion artifact.2.Increased intra- and extra- hepatic biliary ductal dilatation, cholelithiasis, newly hydropic gall bladder and probable strictures at the level of the ampula and at the hepatic hila. Findings compatible with mild acute cholecystitis. ERCP recommended.Findings discussed with Dr. Dong at11:11 AM on January 19, 2016.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with history of bilateral lumpectomies in 2003 for infiltrating ductal carcinoma and received radiation and chemotherapy, presents for breast MRI to evaluate newly diagnosed left breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A scar from prior surgery is present at upper inner aspect in the right breast and lower outer aspect in the left breast.In the left at 12 o'clock position, there is a regional non mass enhancement, measuring 20 x 17 x 24 mm (AP x LR x CC), which is a biopsy proven malignancy. A marker clip is present at the central aspect of this lesion.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.Probable liver cyst in the right lobe.

Output: 1. Biopsy proven left breast cancer.2. No MR evidence for malignancy in the right breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 18 years old male patient with a L5-S1 left lateral recess soft tissue mass please evaluated for biopsy and perform CT guided biopsy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the mass within the left lateral recess of the spinal canal. Following needle removal images obtained that demonstrate no complications .

Output: L5-S1 level biopsy of mass within the spinal canal at the left lateral recess. Seven samples were obtained and delivered to pathology.


Instruction: Generate impression based on medical findings.

Input: There is a 2 x 7 x 3 mm mildly T2 hyperintense, T1 hypointense, slightly heterogenous lesion within the posterior aspect of the pituitary gland. The posterior pituitary bright spot is absent. The infundibulum is slightly deviated to the left. The pituitary and sella are small for age with the pituitary measuring only 3 mm in height. There is no evidence for a suprasellar mass. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate global volume loss. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is fluid and mucosal thickening throughout the paranasal sinuses and mastoid air cells.

Output: 1.Posterior pituitary lesion that may represent a congenital cyst or a microadenoma and could be further characterized with a contrast exam when able to tolerate.2.Small pituitary gland and sella as well as global cerebral volume loss.3.Absent posterior pituitary bright spot.4.Paranasal sinus opacification and non-specific mastoid air cell fluid. Please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: MRI thoracic spine: There is no evidence of abnormal enhancement in the spinal cord. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.MRI lumbar spine: The spinal cord displays normal signal signal and morphology, without abnormal enhancement. However, there are partially imaged fusiform enhancing lesions involving multiple sacral nerve roots, the largest of which measures 15 mm in diameter in the left S2-3 neural foramen. There is mild anterolisthesis of L4 on L5, where a disc bulge in conjunction with posterior element hypertrophy results in marked spinal canal stenosis and bilateral neural foraminal stenosis. There is also a central disc extrusion at L1-2 and a small disc bulge at L5-S1, which results in mild spinal canal and mild right and moderate left neural foraminal stenosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable.

Output: 1. No evidence of enhancing lesions in the thoracic and lumbar spinal cord.2. Multiple partially imaged fusiform enhancing lesions involving multiple sacral nerve roots may represent inflammatory demyelinating polyneuropathy or peripheral nerve sheath tumors.3. Multilevel degenerative spondylosis of the lumbar spine, which is most pronounced at L4-5.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate etiology of headache History: daily frontal headaches for 7 weeks The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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: MRI of the brain is within normal limits.


Instruction: Generate impression based on medical findings.

Input: Left hemiparesis.. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are few punctate T2/FLAIR-hyperintense foci in the frontal white-matter without associated diffusion restriction or susceptibility effect. The brain parenchyma and pituitary gland appear unremarkable, otherwise. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is very minimal mucosal thickening in the maxillary and ethmoid sinuses without fluid. The other paranasal sinuses are clear. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Few punctate frontal white-matter lesions are very nonspecific but may reflect minimal microvascular ischemia.


Instruction: Generate impression based on medical findings.

Input: There are a few scattered subcortical T2/FLAIR hyperintense foci in the left frontal lobe and in bilateral parietal lobes. These are nonspecific, as they are not linear or perpendicular to the lateral ventricles. No definite callosal lesions are identified. There is no abnormal enhancement. Ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no extraaxial fluid collection. Midline structures are unremarkable.

Output: A few nonspecific nonenhancing T2/FLAIR hyperintense punctate foci in the subcortical white matter as described above. No definite MR evidence of demyelinating disease at this time.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old, with sciatic neuropathy. Orthopedic screws are partially visualized traversing the left iliac bone and sacrum. Artifact originating from these screws distorts and somewhat obscures visualization of the left sided sacral foramina.Alignment is anatomic. Vertebral body height and morphology are within normal limits. No worrisome marrow replacement or marrow edema is detected.The visualized spinal cord and conus are unremarkable. At the L4-5 level, it appears that the left lateral recess is more cystic than on the right and the dura is displaced medially (see image 18 of series 9). The nerve roots of the cauda equina at this level are also relatively shifted to the middle and right aspects of the thecal sac. The left L4 nerve root is, however, visualized and appears normal as it approaches and traverses the neural foramen.At the L5-S1 level, the left lateral recess remains slightly more cystic than the right. In addition, no clear evidence of the left L5 nerve root is seen approaching or entering the neural foramina, and the left L5 dorsal root ganglion is not visualized within the neural foramen.At the S1 level, again, the neural foramen is more cystic than on the right. There does appear to be a thin linear structure traversing the neural foramen (see image 36 of series 6), though it is unclear if this reflects the nerve or a vessel.There is mild disc bulging at L5-S1. The remaining intervertebral discs are unremarkable. No significant disc herniations are seen. No significant spinal canal or neuroforaminal stenosis is evident at any level. Mild to moderate facet hypertrophy affects L4-5 and L5-S1.

Output: 1. The left lateral recess at L4-5 is more cystic than the right, and it appears that the dura is displaced medially by this process. Findings are suggestive of a posttraumatic pseudomeningocele, less likely a dilated perineural root sleeve cyst. Of note, the left L4 nerve root is visualized traversing and exiting the neural foramen.2. At the L5-S1 level, again the lateral recess on the left is more cystic than the right and there is a general displacement of nerve roots towards the middle and right aspect of the thecal sac. At this level, however, no definite evidence of an L5 nerve root is seen either approaching or within the neural foramen. This may reflect atrophy or retraction of an injured L5 nerve root.3. The left S1 neural foramen is more cystic than the right. A thin linear structure does traverse this foramen, though it is unclear if this represents an atrophied S1 nerve root or perhaps just a vascular structure. In either event, posttraumatic injury to the nerve with a possible pseudomeningocele is again suspected.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated are post-surgical changes related to posterior spinal fusion with bipedicle screws at L3 and L4 as well as intervertebral disc spacer. There straightening of the usual lumbar lordosis. The vertebral body heights are preserved. The vertebral bone marrow signal is mildly heterogeneous. The spinal cord displays normal signal and morphology. However, there is mild enhancement of the cauda equina nerve roots. The tip of the conus medullaris terminates at the level of L1. There is lumbosacral epidural lipomatosis. There is a 2.5 cm cyst in the lower pole of the right kidney with fluid-fluid level, likely representing a hemorrhagic cyst. There is also a 1.4 cm right renal cystic lesion. There is diffuse paraspinal muscle atrophy.T12-L1: No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Mild bilateral facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis.L2-L3: Disc bulge and bilateral facet arthropathy, contributing to mild left greater than right foraminal stenosis. No significant spinal canal stenosis.  L3-L4: Status post laminectomies at L3 and L4. Evaluation is somewhat limited by susceptibility artifact, but no significant spinal canal or foraminal stenosis. L4-L5: Mild disc bulge and bilateral facet arthropathy, contributing to mild bilateral foraminal stenosis. No significant spinal canal stenosis. L5-S1: Mild disc bulge and bilateral facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1. Post-surgical changes related to posterior spinal fusion and intervertebral disc spacer at L3-L4. 2. Lumbosacral epidural lipomatosis and degenerative lumbar spondylosis with mild foraminal stenosis at L2-L3 and L4-L5, without significant spinal canal stenosis. Evaluation at L3-L4 is somewhat limited by susceptibility artifact.3. Apparent mild enhancement of the cauda equina nerve roots without associated thickening, which may be infectious or inflammatory in etiology. 4. Bilateral renal cystic lesions. Renal ultrasonography may be useful for further characterization. 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: 54-year-old woman with history of IPMN, evaluate for stability. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: An 8 mm cystic focus in the pancreatic body/tail (series 11, image 55) is unchanged and appears to communicate with the pancreatic duct. The pancreas duct is nondilated.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable sidebranch IPMN.


Instruction: Generate impression based on medical findings.

Input: Female 60 years old Reason: left hip mass History: pain There is flattening of the left femoral head with low T1, serpiginous signal and corresponding T2 hyperintense subchondral cysts and edema. Osteophyte formation and near-complete degeneration of articular cartilage indicating severe osteoarthritis. No appreciable joint effusion. There is diffuse fatty atrophy of the musculature about the left hip. There is a 5 x 3 cm mass in the subcutaneous fat overlying the gluteus maximus corresponding to calcified lesion seen on prior radiograph, which demonstrates homogeneous low signal on all sequences with no enhancement on postcontrast images.

Output: Severe left hip osteoarthritis with avascular necrosis. Benign-appearing subcutaneous mass corresponding to calcified lesion on radiograph.


Instruction: Generate impression based on medical findings.

Input: History of arterial enhancing hepatic lesion. History of carcinoid symptoms with no clear primary. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement. Several subcentimeter hepatic cysts. No focal suspicious lesion is identified. No biliary ductal dilatation. The portal vein, hepatic veins and hepatic artery are patent. Normally distended gallbladder without gallstones.SPLEEN: The spleen is normal morphology size and signal intensity. There are 2 splenules along the inferior anterior aspect of the spleen.PANCREAS: The pancreas is moderately atrophic without pancreatic ductal dilatation or focal lesion. This is out of proportion to what would be expected for the patient's age.ADRENAL GLANDS: Normal in size and morphology.KIDNEYS, URETERS: Several subcentimeter renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No suspicious liver lesion or other finding to account for the patient's carcinoid symptoms.2. The pancreas is diffusely moderately atrophic without pancreatic ductal dilatation or a focal lesion.


Instruction: Generate impression based on medical findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The cerebellar tonsils are in normal position. The spinal cord displays normal signal and morphology. There are small multilevel disk protrusions at C2/3 through C5/6 and mild disc bulges at C6/7 and C7/8, causing minimal effacement of the ventral thecal sac, but no significant canal stenosis at any level. There is moderate multilevel facet hypertrophy, which in combination with disk disease, causes multilevel neural foraminal stenosis, mild on the right C3/4, moderate on the right C6/7, and severe on the left C6/7.The paravertebral soft tissues are unremarkable.

Output: Moderate degenerative changes with multilevel neural foraminal narrowing, most severe on the left at C6/7.


Instruction: Generate impression based on medical findings.

Input: 22-year-old male with history of primary sclerosing cholangitis ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Liver is normal in size. No evidence of steatosis. Gallbladder appears normal. Common bile duct is normal in size measuring 3 mm. There are a few areas of intrahepatic ductal narrowing with a beaded appearance. It is unclear whether this is progressed since prior exam due to differences in technique. No significant intrahepatic biliary ductal dilatation. No extrahepatic stricturing is evident.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right upper quadrant and ileostomy. No evidence of obstruction. Prominent jejunal loops measuring up to 2.9 cm may represent ileus related to recent surgery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Beaded appearance of the proximal intrahepatic biliary ducts with areas of mild narrowing are suspicious for early primary sclerosing cholangitis. 2.No suspicious hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with radicular upper extremity pain bilateral right worse than left. Evaluate for cervical disc disease. At C4-5, there is a disc osteophyte complex eccentric to the left, which causes mild spinal canal stenosis and minimal left neural foraminal narrowing. At C5-6 there is a small disc osteophyte complex, without significant neural foraminal narrowing. However, there is no significant spinal canal or neural foramen stenosis at this level. There is no significant disc disease involving the remainder of the cervical spine, but there are multiple cystic structures in the lateral aspect of the neural foramina of C6-7, C7-T1, and T1-T2, the largest of which measures up to 12 mm. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. 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: 1.Mild spondylotic changes involving the cervical spine involving the C4-5 and C5-6 levels, with up to mild spinal canal narrowing at C4-5.2.Multiple bilateral neural foraminal perineural cysts at the C6-7, C7-T1, and T1-T2 levels.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: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are small scattered foci of T2 hyperintensity within the subcortical white matter bilaterally. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Small foci of T2 hyperintensity in the subcortical white matter are nonspecific, but are likely related to chronic small vessel ischemic disease.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: Male, 5 years old, with history of tectal plate juvenile pilocytic astrocytoma, status post biopsy and subtotal resection with third ventriculocisternostomy at an outside hospital, status post laser ablation in 5/15, with progressive growth of the lesion, status post repeat ablation. T1 postcontrast imaging was acquired before and after laser ablation of the tectal plate lesion. Preablation images demonstrate positioning of the right frontal approach laser probe within the heterogeneously enhancing tumor. Post ablation images demonstrate increased confluent enhancement which appears to completely encompass the original lesion. A right frontal approach Ommaya catheter is in place with its tip terminating in the region of the right caudate. The lateral and third ventricles remain dilated similar to prior.

Output: Expected findings status post laser ablation of the tectal plate tumor.


Instruction: Generate impression based on medical findings.

Input: 59 year-old with biopsy-proven invasive carcinoma in the left upper outer breast. Additionally a stereotactic biopsy of the left breast at a central site showed ADH. On review of the prior studies, MRI 11/4/2015 and prior mammograms the small mass and area of previous calcifications/displaced clip are noted. Target ill defined mass is located in the left breast in the upper outer quadrant region located posteriorly at 2 o’clock. Also, target area of previous calcifications are located in the left breast in the central region located 5 cm lateral to the biopsy clip. The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach for both lesions. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, two 9 cm Kopans needle was placed at both targets, one at a time. On orthogonal mammography, adequate positioning of the needles were confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. Spring wires were sequentially deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in good position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. It was understood that the biopsy clip is 5 cm medial to the site of previous calcifications for the more anterior inferior wire. Dr. Schacht performed the procedure.Two sets of orthogonal digital specimen radiographs revealed the mass and spring wire to be within one specimen (IDC) and a spring wire to be in the 2nd specimen (ADH). The mass was relatively close to one margin on the IDC specimen and a small additional tissue sample was obtained.

Output: Successful needle localization of the left breast mass and site of prior calcifications.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. 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: Reason: evaluate bilateral hamstring origins History: pain with sitting at ischial tuberosity BONE MARROW: No bone marrow signal abnormality is identified.SOFT TISSUES: There is diffuse fatty infiltration of the imaged musculature of the pelvis including the paraspinal musculature. There is a partial thickness tear of the right hamstring tendon at the level of its origin off the right ischial tuberosity. There is partial thickness tearing of the left hamstring, involving both the conjoined and semimembranosus tendons, with approximately 2 cm retraction of the proximal tendon fragment. Additionally, there is a 1.5 cm round focus of fluid signal intensity within the left quadratus femoris muscle at the level of the myotendinous junction which may represent an interstitial tear. There is an additional smaller rounded focus of fluid signal intensity is identified within the distal fibers of the quadratus femoris muscle proximal to its insertion on the femur which may also represent an additional interstitial tear.JOINTS: Mild osteoarthritis affects the hips bilaterally. There is a small amount of fluid within both hips which is not necessarily of any clinical significance. There is a subcentimeter focus of fluid signal intensity within the superior acetabulum which may represent subchondral cyst formation. Severe degenerative disc disease affects the imaged lower lumbar spine.ADDITIONAL

Output: 1. Partial thickness tearing of both of the hamstring tendons at the level of their origin on the ischial tuberosity, left greater than right, with slight retraction on the left as described above. Interstitial tearing of the quadratus femoris muscle on the left. 2. Nonspecific signal abnormality within the posterior aspect of the right apex of the peripheral zone of the prostate gland. Correlation with PSA is recommended. Other findings as described.


Instruction: Generate impression based on medical findings.

Input: Personal history of LCIS and ALH, family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the right central 3:00 position, there is a new 1.1 cm area of linear non-mass enhancement. This does not meet threshold for kinetic analysis, however based on the appearance and change compared to prior studies, further evaluation with MR guided biopsy is recommended. Second look/MRI directed ultrasound would be highly unlikely to find a correlate for this small subtle finding.No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.

Output: New linear non-mass enhancement in the right breast. Further evaluation with MR guided biopsy is recommended. If the patient is on blood thinning medications, these should be held prior to biopsy. The finding and need for biopsy were emailed to Dr. Romero.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 14 years old, with lumboperitoneal shunt for pseudotumor with syrinx, presenting with new onset weakness and sensory changes in the lower extremities. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Robust biphasic CSF flow is seen through the foramen magnum.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.Spine:A spinal cord syrinx is redemonstrated beginning at approximately the C7 level and continuing down to the T3 level. While the craniocaudal extent of the syrinx has not significantly changed, the maximal caliber has increased. The syrinx now measures up to 6 x 6 mm, previously 5 x 4 mm.Apparent mass effect upon the mid thoracic spinal cord is again seen displacing the cord anteriorly without significant interval change. The etiology for this finding is uncertain but may represent the presence of an intradural arachnoid cyst or some other CSF loculation.Cord morphology and signal characteristics are otherwise unremarkable. The conus tip terminates at T12 which is normal. The nerve roots of the cauda equina disperse evenly through the thecal sac. A lumbar peritoneal drain is visualized entering the thecal sac posteriorly at approximately the L3 level.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement or marrow edema is detected.No significant degenerative disk disease is identified. The spinal canal and neural foramina are patent.

Output: 1. Unremarkable evaluation of the brain.2. Mild interval increase in the caliber of the low cervical/upper thoracic cord syrinx. The craniocaudal extent of the syrinx is unchanged.3. Stable apparent mass effect upon the mid thoracic cord which displaces the cord anteriorly.


Instruction: Generate impression based on medical findings.

Input: Female 20 years old; Reason: Stress fracture distal tibia History: spontaneous pain and swelling. There is edema within the distal tibial metaphysis. There is also periosteal reaction along the posterior tibial metaphysis. While we see no discrete fracture line there is a poorly defined band-like focus of relatively low signal positioned within the edema that may represent early findings of a stress fracture. There is mild edema in the adjacent soft tissues and also posteriorly within Kager's fat pad. There is also mild edema within the distal fibula, calcaneus, and cuboid, which may reflect additional sites of relatively mild stress reaction/altered biomechanics. There are small tibiotalar and subtalar joint effusions. We see no osteochondral defects. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex is intact. The visualized component of the deltoid ligament appear intact. The spring ligament components appear intact. The Achilles tendon appears normal. There is a small amount of fluid within the sheaths of the medial tendons, which otherwise appear intact. The peroneal tendons appear intact. The anterior tendons are intact.

Output: 1. Edema within the distal tibial metaphysis is nonspecific but compatible with a stress reaction/early stress fracture. Additional milder edema is noted in the distal fibula, calcaneus, and cuboid, perhaps representing additional sites of relatively mild stress reaction/altered biomechanics.2. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Reason: ? Worsening of listening upon standing History: back and bilateral leg pain Please note that exam could not be performed with patient standing due to inability to stand. Service notified at the time of the exam.Again seen is grade 1 anterolisthesis of L3 and L4. Exaggerated lordosis appears similar to the prior MRI. Moderate degenerative disc disease at L3-L4 with vacuum phenomenon and mild degenerative disc disease at L4-L5 is present. Vertebral body heights are intact. Small anterior osteophytes and severe facet arthropathy of the lower lumbar levels is present. There are large calcified fibroids in the pelvis.

Output: Degenerative changes of the lumbar spine with anterolisthesis appearing similar to the prior MRI. Please note that patient was unable to perform exam while standing as requested by service.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with highly suspicious left breast mass and enlarged left axillary lymph node with indeterminate right breast lesion on research MRI. Preliminary targeted right breast ultrasound was performed for the MRI area of concern. At the 3 o'clock position of the right breast, 3 cm from the nipple there is a 0.6 x 0.3 x 0.5 cm hypoechoic partially circumscribed mass with mild surrounding vascularity. This is located approximately 1.4 cm inferior to a complicated cyst, and corresponds to the enhancing lesion within the right breast on MRI. Ultrasound-guided biopsy of this lesion was recommended and subsequently performed. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 0.6 cm at the 3 o’clock position with mild surrounding increased vascularity, 3 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. No specimens were fragmented. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location at the biopsy site. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Happ. Dr. Kulkarni was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Reevaluate cyst. Signs and symptoms: Headache. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination redemonstrates a small left frontal periventricular cyst without appreciable interval change since prior exam.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Postcontrast images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges and no enhancement of the above detailed cyst. This is a similar observation as prior study.The signal void of all major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.Calvarium, scalp, orbits, paranasal sinuses and mastoid air cells are unremarkable.

Output: Stable small left periventricular frontal cyst since prior exam and unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Word finding difficulty. Evaluate for acute ischemia. There is a punctate focus of restricted diffusion within the left superior parietal lobule. There is no mass effect, midline shift or herniation. There are multiple punctate foci of susceptibility abnormality predominantly involving the basal ganglia, claustrum, thalami, and inferior cerebellum bilaterally, as well as the right centrum semiovale, right occipital lobe and left medial frontal lobe compatible with blood product from microhemorrhage. There is encephalomalacia likely in the right frontal lobe including the centrum semiovale, corona radiata, insula, and subinsular white matter with ex vacuo dilatation of the right lateral ventricle. There is also encephalomalacia in the right cerebellar hemisphere. There are additional scattered areas of T2 hyperintensity in the periventricular and subcortical white matter. There is diffuse cerebral volume loss with superimposed Wallerian degenerative of the right brainstem. There is minimal mucosal thickening involving the right anterior ethmoid air cells. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a punctate focus of T1 and T2 hyperintensity in the right parietal calvarium, which likely represents a hemangioma.

Output: 1.Punctate acute infarct in the left parietal lobe without hemorrhagic transformation.2.Multiple punctate foci of susceptibility likely represent chronic microhemorrhages related to hypertensive.3.Chronic infarcts involving the right frontal lobe, insula, and right cerebellar hemisphere.4.Chronic patchy periventricular and subcortical small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: 40F with twisting injury during exercise, now with persistent left medial knee pain not relieve with rest/NSAIDs/PT, ?meniscal injury, ?ligamentous injury History: 40F with twisting injury during exercise, now with persistent left medial knee pain not relieve with rest/NSAIDs/PT, ?meniscal injury, ?ligamentous injury MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defects. Bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Normal-appearing knee without findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: evaluation for pelvic pain in this renal transplant patient with history of nephrectomy, transplant and recurrent infections History: pain in the pelvic area radiating down her legs PELVIS:UTERUS, ADNEXA: Uterus appears atrophic.BLADDER: Bladder is suboptimally distendedLYMPH NODES: No pelvic lymphadenopathyBOWEL, MESENTERY: Distended cecum with a fluid/fluid levelBONES, SOFT TISSUES: Right lower quadrant renal allograft without perinephric collections. No hydronephrosis. There are small parenchymal cysts.Pelvic laxity.OTHER: Linear T2 hyperintense tract seen on the axial T2-weighted images extends from the anus at the 6:00 position suspicious for a small perianal fistula.

Output: 1.Findings suspicious for a small perianal fistula at the 6 o clock position which is only partially imaged.


Instruction: Generate impression based on medical findings.

Input: 46 years, Female, Reason: 46F with HCV and abnormal ultrasound. Cross sectional imaging to better evaluate History: HCV. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Large gallstone. Smaller subcentimeter left hepatic cyst.There is a lesion in segment 4a/b which measures 1.3 x 1.7 cm (11/260) and likely corresponds to lesion seen on ultrasound. This lesion is T2 isointense, does not enhance and washes out on delayed images. No loss of signal on out of phase images is evident to suggest focal steatosis. Overall these are indeterminate features.There is an additional lesion in segment 3 which is only seen on portal venous and delayed phase images where it is hypointense to the background liver and measures 1.4 x 1.2 cm (11/266), also with indeterminate features.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Two lesions are identified in the left hepatic lobe, one of which corresponds to lesion seen at ultrasound. Both of these lesions have indeterminate features as above and MRI follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Sphenoid wing meningioma status post resection. There are postoperative findings related to left pterional craniotomy. There is no measurable tumor in the region of the left sphenoid wing. There is no evidence of acute intracranial hemorrhage or infarct. There is minimal unchanged encephalomalacia along the anterior left temporal pole. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Stable postoperative findings without evidence of intracranial tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: History of metastatic melanoma with brain metastasis status post resection for SRS treatment planning. This is a limited stealth MRI of the brain for treatment planning. There are post-operative findings related to a right frontal craniotomy for tumor resection with more conspicuous rim enhancement of the surgical cavity. There remains dural thickening and enhancement with interval decrease in size of a fluid collection subjacent to the craniotomy flap. There is decreased mass effect on the right frontal horn without significant midline shift. There is evidence of a remote left frontal craniotomy with redemonstration of a resection cavity at the left frontal lobe convexity, which appears unchanged. Redemonstrated is a 9 mm lesion in the right precuneus with associated susceptibility artifact, which is unchanged in size. There is interval progression in size of a punctate 4 mm enhancing lesion in the left precuneus, which in retrospect was present on prior MRI's but more punctate. There is ill-defined, patchy enhancement in the right temporal lobe, which is likely artifactual. Again seen are multiple areas of susceptibility artifact throughout the bilateral cerebral hemispheres, consistent with hemosiderin deposition.

Output: 1. Limited stealth MRI of the brain for treatment planning.2. Expected post-operative findings related to a right frontal craniotomy for tumor resection with increased conspicuity of rim enhancement surrounding the resection cavity margin, which is compatible withe evolution of post-surgical change. Attention on follow-up is suggested.3. Punctate 4 mm enhancing lesion in the left precuneus, which is slightly increased in size compared to prior exams. Ill-defined patchy enhancement in the right temporal lobe is likely artifactual. 4. No significant interval change in the appearance of the right parietal precuneus hemorrhagic lesion as well as left posterior frontal resection cavity.


Instruction: Generate impression based on medical findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. 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 cervical spine. THORACIC SPINE

Output: 1. Mild distention of the left optic nerve sheath and mild flattening of the globes. This finding can be seen with intracranial hypertension and can be correlated with CSF opening pressure, as clinically indicated.2. There is a 4 mm pineal cyst which is incidentally seen. Brain MRI is otherwise unremarkable. No suspicious intracranial mass or evidence of mass effect. Preserved CSF spaces and biphasic CSF flow at the foramen magnum, without evidence of Chiari I information.3. Spine MRI appears within normal limits.


Instruction: Generate impression based on medical findings.

Input: Evaluate cyst at the level of the nasopharynx and oropharynx. There is a non-enhancing T2 hyperintense lesion that measures up to approximately 20 mm in the midline of the posterior oropharynx with associated obliteration of the airway. The lesion communicates with the spinal canal via a narrow channel through the dysmorphic basiclivus, which may represent a form of canalis basilaris medianus. In addition, the upper spinal cord, brainstem, and cerebellum are markedly dysmorphic. There are also extensive segmentation anomalies of the upper cervical spine with associated scoliosis. There is no evidence of solid mass lesion or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is fluid within the bilateral mastoid air cells and middle ears. A tracheostomy is in position.

Output: 1. A midline posterior pharyngeal cystic lesion measuring up to 20 mm that communicates with the intracranial compartment via a narrow defect in the clivus likely represents a developmental meningocele or neurenteric cyst, perhaps as a manifestation of split notochordal syndrome associated with the cervical spine segmentation anomalies and hindbrain malformation. A cervical spine CT may be useful for further delineation of the abnormal bony anatomy.2. Nonspecific fluid within the bilateral mastoid air cells and middle ears.Findings discussed with Dr. Baroody on 3/2/2015 at 2:30pm by Dr. Wu.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with severe rest pain near greater trochanter of unexplained etiology. ACETABULAR LABRUM: Components of a total right hip arthroplasty situated near anatomic alignment. On the large field-of-view images, the left hip joint demonstrates mild degenerative changes, otherwise alignment is anatomic.ARTICULAR CARTILAGE AND BONE: Components of a total right hip arthroplasty situated in anatomic alignment. There is asymmetric increased STIR signal within the right proximal femur centered at the greater trochanter and surrounding bursa most compatible with greater trochanteric bursitis. No acute fracture is evident.SOFT TISSUES: The subcutaneous tissues and musculature appear normal. The mature heterotopic ossification seen on prior pelvis radiograph is not well visualized on the current study.ADDITIONAL

Output: Findings compatible with right greater trochanteric bursitis.


Instruction: Generate impression based on medical findings.

Input: Evaluate perianal fistula. History of Crohn's disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Several subcentimeter pelvic lymph nodes measuring less than 1 cm in short axis are noted and are likely reactive.BOWEL, MESENTERY: The pelvis is partially imaged. There is mild circumferential wall thickening of the imaged sigmoid colon which demonstrates restricted diffusion, hyperenhancement and perinephric stranding.BONES, SOFT TISSUES: At approximately the 2:00 position of the anal canal there is a fistula tract extending inferiorly in the intersphincteric space terminating at the left gluteal fold. There is no discrete fluid collection.OTHER: No significant abnormality noted.

Output: Intersphincteric fistula extending to the left gluteal fold without an associated fluid collection. It appears to originate at approximately the 2:00 position of the anal canal.Mild active sigmoid colitis.


Instruction: Generate impression based on medical findings.

Input: Pain. Evaluate for internal derangement, possible slap tear. ROTATOR CUFF: The rotator cuff tendons and muscles are intact. No evidence of muscle atrophy.SUPRASPINATUS OUTLET: There are small osteophytes at the acromioclavicular joint compatible with mild osteoarthritis. No fluid is seen in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is intact. There are small subchondral cysts along the posterior humeral head which are likely degenerative in etiology.There is a linear area of high signal intensity along the superior labrum at the 12 o'clock position which does not fill with contrast and likely represents a normal variant sulcus. No definite evidence of a labral tear. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Intact labrum.2. Mild AC joint osteoarthritis and posterior humeral head degenerative cysts.


Instruction: Generate impression based on medical findings.

Input: Acute expressive aphasia. There is scattered cerebral white mater T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are prominent extra-axial CSF spaces, particularly in the left parietal convexity with mild flattening of the underlying parenchyma. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses are grossly unremarkable. There are bilateral lens implants. There is a right frontal calvarium osteoma.

Output: 1. Mild to moderate chronic small vessel ischemic disease, but no evidence of acute infaraction.2. Prominent extra-axial CSF spaces, particularly in the left parietal convexity may represent hygroma, but no evidence of acute intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Primary biliary cirrhosis. Evaluate changes in cysts/hemangiomas. ABDOMEN:LIVER, BILIARY TRACT: No new hepatic lesion is identified. Unchanged segment 6, T2 hyperintense lesion measuring 1.2 x 1.0 cm (series 7, image 23), with progressive enhancement, consistent with a hemangioma. Unchanged subcapsular anterior T2 hyperintense lesion, retains contrast on delayed imaging and measures 0.9 x 0.6 cm (series 7, image 7), compatible with a hemangioma. An additional T2 hyperintense focus measuring 0.5 x 0.4 cm in segment 8/7 (series 7, image 10) demonstrates no definite enhancement, most likely a hepatic cyst, unchanged from prior. There is no biliary ductal dilatation. The liver is smooth in contour and normal in morphology.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Right anterior cardiophrenic lymph node measures 1.8 x 1.0 cm (series 3, image 9), unchanged. A right paracardiac lymph node near the hepatic dome measures 1.2 x 0.7 cm (series 3, image 5), unchanged. Stable prominent gastrohepatic, periportal and peripancreatic lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged hepatic lesions, probably hemangiomas and a subcentimeter cyst. 2.Unchanged lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: No. New onset of aphasia. Rule out bleed or mass. Examination demonstrates a mass within the posterior fossa with minimal amount of hemorrhage or calcification. There is surrounding vasogenic edema and mass effect on the fourth ventricle and minimally on the quadrigeminal plate. No evidence of hydrocephalus is detected. Further follow-up with an MRI examination is recommended. The mass measures approximately 26.2 mm x 41.This examination is otherwise unremarkable.

Output: Mass within the left cerebellum with minimal possible hemorrhage or calcification. Further follow-up with an MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: 2-year-old female patient with complex febrile seizure. Evaluate for anatomic abnormality. The brain parenchyma appears unremarkable. There are no findings to suggest cortical dysplasia, heterotopia, or other abnormality to suggest a seizure focus. There is no evidence of intracranial hemorrhage or mass. Myelination is within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Normal examination of the brain without abnormality to suggest a seizure focus.


Instruction: Generate impression based on medical findings.

Input: Markedly elevated alkaline phosphatase. Hepatic MRI inconclusive. History of known ulcerative colitis with new onset pruritis and elevated alkaline phosphatase. Evaluate for PSC versus extrinsic biliary compression. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No focal suspicious lesion.The common hepatic duct measures up to 7 mm. There is irregular dilatation and narrowing of the intrahepatic and extrahepatic bile ducts most noticeably of the left hepatic duct (series 5 image 1).No filling defect in the common bile duct is identified. The common bile duct tapers gradually towards the ampulla without a discrete mass lesion.. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Irregular narrowing and dilatation of the intrahepatic and extrahepatic bile ducts compatible with PSC without a discrete mass lesion.


Instruction: Generate impression based on medical findings.

Input: 86 years Female (DOB:7/10/1929)Reason: eval for evolution of microhemorrhages History: hemorrhagic strokePROVIDER/ATTENDING NAME: FERNANDO D GOLDENBERG FERNANDO D GOLDENBERG No diffusion weighted abnormalities are appreciated.There is a small hemorrhagic focus in the right thalamus associated with surrounding signal hyperintensity of FLAIR. There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the available B0 images and available FLAIR images. This was also present on the prior exam.The exam is limited due to patient motion.

Output: 1.There is a small subacute right thalamic hemorrhage.2.Periventricular and subcortical white matter lesions as well as signal changes in the internal capsules, basal ganglia, brainstem and thalami are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. This was also present on the prior exam.3.No evidence for acute ischemic cerebral infarction. 4.Exam is limited due to the patient's inability to cooperate to complete the exam and due to motion artifact. As a result the evaluation is not as complete as most MRI exams and abnormalities may not be identified.


Instruction: Generate impression based on medical findings.

Input: Osteomyelitis, unspecified [M86.9], Reason for Study: ^Reason: evaluation of back pain and weakness in the setting of osteo History: pain and weakness of LE For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1.  There is new enhancing lesions on the right side of L45 transverse process which extends toward right side paraspinal muscle. The lesion extends around the level of the right side posterior SI joint level. Comparing to prior scan especially CT guided biopsy, the lesions is matching with the needle path. Thus, this new lesion is likely an extension of discitis infection through the biopsy needle path. A simple bit exaggerated inflammatory reaction through the needle track is another possibility but less likely.Enhancing lesions on both L45 and L5S1 as well as L4 and L5 vertebral bodies with bone marrow edema indicating discitis and osteomyelitis are again seen, unchanged since prior scan.Mild to moderate spinal canal stenosis with bilateral mild to moderate neuroforaminal stenosis at the level of L34, and L45, unchanged since prior scan.Spinal cord signal intensity is normal.Lumbar spine alignment is normal.The vertebral body height is preserved. The conus medullaris terminates at the T12-L1 level.

Output: 1. Interval development of right paraspinal muscle enhancing lesion at the level of L45 which likely represent infection extension through prior post CT guided disc biopsy needle track. 2. Otherwise unchanged MR findings of L45 and L5S1 discitis and osteomyelitis.3. Unchanged multilevel spinal stenosis and neuroforaminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Reason: New brain mets, MRI for SRS treatment planning History: None There is redemonstration of punctate enhancing lesions at the grey-white matter junctions in the superior right postcentral gyrus x2 and the left superior frontal gyrus that measure up to 4 mm with minimal associated vasogenic edema. There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Punctate metastases in the superior right postcentral gyrus and left superior frontal gyrus. 2. Confluent periventricular white matter signal change is probably treatment related


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with syncope and fall. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. Extensive periventricular and subcortical white matter areas of hypoattenuation appear unchanged and are consistent with chronic small vessel ischemic disease. Prominent sulci are consistent with parenchymal volume loss, appropriate for age.The ventricles and basal cisterns are normal in size and configuration.Mild irregularity of right orbital roof appears unchanged, and is possibly result of prior trauma. Otherwise, calvaria and skull base are radiographically normal. Right mastoid air cells are opacified, unchanged. Otherwise, the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No acute intracranial abnormality or interval change.2.Stable chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 49-year-old man with history of hepatitis C and NASH. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged and cirrhotic in morphology with nodular contour and widened fissures. No evidence of steatosis on in and out of phase imaging. No enhancing focal hepatic lesion identified. Please note that the inferior pole of the liver was imaged only in delayed phase.The gallbladder is distended with sludge but normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly without signal abnormality or focal lesion.PANCREAS: Small area of interdigitating fat within the body of the pancreas (1700/70), the pancreas is otherwise unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple renal cysts noted, otherwise no significant abnormality.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: Cirrhotic liver and splenomegaly without focal hepatic lesion.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Nontraumatic intracerebral hemorrhage, unspecifiedClinical question: evaluate for hydrocephalus s/p IPH w/ intraventricular extensionSigns and Symptoms: headaches, 6m s/p basal ganglial hemorrhage w/ IVH The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is susceptibility effect present within an irregular shaped focus in the right basal ganglia and internal capsule .There are a couple punctate foci of susceptibility effect present at the right temporal lobe subcortical white matter and the left external capsule. No abnormal enhancing mass lesions are appreciated intracranially. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Chronic stage hemorrhage in the right basal ganglia and adjacent internal capsule. (This was acute stage on a 4/24/15 CT of the head).3.No intracranial mass is identified.4.The ventricles are non-dilated.


Instruction: Generate impression based on medical findings.

Input: Status post OLT with increasing LFTs and dilatation of common bile duct seen on sonography ABDOMEN:LIVER, BILIARY TRACT: Marked extrahepatic and moderate intrahepatic biliary duct dilatation. Common bile duct measures up to 1.5 cm, at midportion, at this level also somewhat kinked in appearance and beyond this point tapers to 0.9 cm, however duct remains widely patent. No intraluminal signal void seen to suggest choledocholithiasis. Patent portal veins, splenic vein and SMV. Visualized hepatic arteries patent.SPLEEN: No significant abnormality noted.PANCREAS: Mildly prominent pancreatic duct but within normal limits.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal T2 hyperintense foci, most likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES, OTHER: Small right pleural effusion. Mild cardiomegaly.

Output: 1. Moderate to marked biliary ductal dilatation as above, with common bile duct measuring 1.5 cm at midportion and tapering to 0.9 cm til level of ampulla, no obstructing lesion delineated, findings may be related to a benign distal stricture, correlation with patient's history/laboratory values and further evaluation with ERCP recommended. No evidence of choledocholithiasis. 2. Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with left elbow decreased range of motion. Evaluate for tendon tear. LIGAMENTS: No significant abnormality noted.TENDONS: The triceps tendon appears normal. The biceps tendon appears normal. The flexor and extensor compartment tendons at the elbow appear normal.ARTICULAR SURFACES AND BONE: Articular cartilage appears normal. Bone marrow signal intensity appears normal.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Small joint effusion about the elbow. Otherwise unremarkable MRI study of the left elbow.


Instruction: Generate impression based on medical findings.

Input: Multinodular goiter RIGHT LOBE MEASUREMENTS: 6 x 2.7 x 2.9 cmLEFT LOBE MEASUREMENTS: 5.7 x 1.8 x 1.9 cmISTHMUS MEASUREMENTS: 4-mmRIGHT LOBE: Previous described right lower lobe solid nodule is grossly unchanged measuring 2.7 x 2.1 x 1.9 cm.LEFT LOBE: Previous described left lower lobe solid nodule is also grossly unchanged measuring 0.9 x 1 x 1.4 cm.ISTHMUS: A new solid nodule measuring 1.1 x 0.8 cm in the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral multiple lymph nodes are again noted. Largest lymph node on the right measures 2.1 x 1 cm inferiorly and largest lymph node on the left measures 1 x 1.2 cm superiorly. The etiology of the lymph nodes is unknown.OTHER: No significant abnormality noted.

Output: Multinodular goiter with no significant change in the right and left lobe nodules and a new isthmic nodule. Bilateral multiple lymph nodes in the neck are again noted and are nonspecific.


Instruction: Generate impression based on medical findings.

Input: Deep brain stimulation planning for Parkinson disease. There is a developmental venous anomaly in the left frontal lobe. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Pre-treatment planning MRI demonstrates diffuse cerebral volume loss and a developmental venous anomaly in the left frontal lobe.


Instruction: Generate impression based on medical findings.

Input: 40 year-old male status post flap for rhabdomyosarcoma on back with syncope x 2. History of neurofibromatosis. Please evaluate if neurofibroma intracranially are present to explain the syncope. Syncope is not believed to be cardiac in etiology. HEAD CT:Multiple superficial neurofibromas are identified within the scalp. (image 25/32). No evidence of abnormal intracranial enhancement.The cerebral hemispheres, cerebellum and brainstem are normal in structure and attenuation. No intracranial hemorrhage, infarctions, edema or areas of mass effect are identified. No abnormal extra-axial fluid collections are identified. The ventricles are normal in volume and are midline.The visualized paranasal sinuses and mastoid air cells are normally aerated.There is a bony dehiscence between the right jugular fossa and the middle ear with an enlarged right jugular fossa. This can result in pulsatile tinnitus. Differential considerations for this finding include a normal large dominant right jugular vein secondary to a large right lateral and sigmoid sinuses, a high riding jugular fossa most likely due to the increased size of the sigmoid sinus, and a paraganglioma resulting from the pars nervosa in this location. An MRI is recommended to exclude tumor given the patient history of neurofibromatosis.

Output: 1. The right jugular fossa appears enlarged as described. An MRI of the internal auditory canal with contrast is recommended to exclude the presence of a nerve sheath tumor given the history of neurofibromatosis. Findings were discussed with Dr. Hofer following interpretation.2. No evidence of abnormal intracranial enhancing masses. 3. Superficial neurofibromas in the scalp.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male. Left lateral knee pain. Evaluation of lateral fluctuant mass previously evaluated by ultrasound without conclusive characterization. MENISCI: The body and posterior horn of the medial meniscus are torn and flipped into the intercondylar notch in front of the PCL, consistent with a bucket handle tear. Complex branching signal abnormality in the body and lateral aspect of the posterior horn of the medial meniscus consistent with a complex tear; the medial aspect of the posterior horn is not visualized towards its insertion consistent with a component of complete radial tearing.LIGAMENTS: The ACL is not visualized consistent with a complete tear. The PCL, MCL, and LCL are intact.ARTICULAR CARTILAGE AND BONE: Marked diffuse articular cartilage thinning of the lateral femoral condyle with areas of full-thickness cartilage loss anteriorly. Large areas of full thickness cartilage loss of the weight bearing surfaces of the medial tibiofemoral compartment. Marked diffuse cartilage thinning of the patellofemoral compartment articular cartilage with full thickness cartilage loss of the lateral patellar facet.Underlying subchondral marrow edema and cysts in the tibia and femur are most likely degenerative in etiology. EXTENSOR MECHANISM: Intact.ADDITIONAL

Output: 1. Large bucket handle tear of the medial meniscus. Complex tear of the body and posterior horn of the lateral meniscus.2. Complete tear of the ACL.3. Palpable abnormality at the lateral joint line is likely due to a combination of ganglion cysts and a small hematoma.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for nerve root compression causing hyperreflexia. Signs and symptoms: Hypertension. Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with a straightening of cervical lordosis. There is some a large focus of marrow signal change involving extensively the left aspect of T1 vertebrae and extending into the left pedicle and articulating facet. This finding demonstrates increased T2 signal intensity both on T1 and T2 weighted images and the appearance is highly suggestive of a benign hemangioma. Unremarkable signal intensity of vertebral column otherwise.Foramen magnum is unremarkable.C2 -- C3 demonstrate mild degenerative changes with resultant moderate bilateral neural foraminal compromise.C3 -- C4 demonstrate degenerative changes with resultant significant bilateral neural foraminal compromise and no central spinal stenosis.C4 -- C5 demonstrate degenerative changes with resultant significant (left greater than right) neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate degenerative changes with resultant significant bilateral neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate degenerative changes with resultant significant left and moderate right neural foraminal compromise without central spinal stenosis.C7 -- T1 demonstrate moderate (left greater than right) neuroforaminal compromise and no central spinal stenosis.T1 -- T2 there was a degenerative changes resulting in mild central spinal stenosis and moderate bilateral neuroforaminal compromise (right greater than left).The signal intensity and caliber of cord remains within normal.

Output: 1.Degenerative changes of cervical spine results in bilateral significant neural foraminal compromise at all levels as detailed. There is however no evidence of spinal canal compromise or stenosis at any level. The signal intensity and caliber of cervical and uppermost visualized thoracic cord is normal.2.There is also evidence of neural foraminal compromise at T1 -- T2 level due to degenerative changes and mild central spinal stenosis.


Instruction: Generate impression based on medical findings.

Input: Worsening right knee pain Due to the patient's body habitus the patient's knee could not fit in the dedicated knee coil, and the torso coil was used instead resulting in suboptimal image qualityMENISCI: The posterior horn of the medial meniscus is not visualized likely due to extensive chronic tearing and fragmentation. There is also attenuation and abnormal signal intensity within the body of the medial meniscus indicating additional degeneration and tearing. The anterior horn of the meniscus is also attenuated likely reflecting chronic attritional tearing.There is marked attenuation of the anterior horn and anterior aspect of the body of the lateral meniscus indicating extensive chronic tearing and fragmentation. The posterior horn of the lateral meniscus is relatively preserved.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee, particularly the medial compartment, with areas along the medial femoral condyle and medial tibial plateau devoid of articular cartilage and associated with edema like signal in the underlying marrow.There is also full-thickness degeneration of the articular cartilage along the lateral femoral condyle above the posterior horn of lateral meniscus and moderate degeneration of the articular cartilage along the posterior aspect of the tibial plateau.There is moderate to severe degeneration of the articular cartilage of the patellofemoral joint.Tricompartmental osteophytes are also noted.A lobulated focus of abnormal signal intensity within the distal femoral metaphysis likely reflects a benign enchondroma.LIGAMENTS: The ACL is not visualized, presumably due to a chronic tear. The PCL is intact. The medial collateral ligament is bowed medially by underlying osteophytes but is otherwise intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Severe osteoarthritis of the right knee particularly affecting the medial tibiofemoral compartment with extensive tearing of the menisci.2. Nonvisualization of the ACL indicating a chronic tear.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old, with history of stroke and residual deficits (expressive aphasia, left-sided weakness), now with worsening mental status, unable to respond to questions or simple commands. Concern for new stroke. Image quality is degraded by significant motion artifact. Within this limitation, the following observations are made.Large areas of encephalomalacia are redemonstrated involving the left parietal, occipital and temporal lobes, and the right middle frontal gyrus. These lesions appear similar to the prior MRI. Encephalomalacia in the right occipital lobe is new from the prior MRI but unchanged relative to a CT from 2012. Numerous small, chronic cerebellar infarcts are also unchanged. No evidence of restricted diffusion is seen to suggest acute ischemia.Ill-defined periventricular T2 hyperintensity has progressed from the prior examination. Ventricles and sulci are prominent compatible with volume loss. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: 1.Evidence of extensive bilateral chronic ischemia is seen, largely within the MCA distributions, showing no significant change from prior exams.2.Findings compatible with moderate chronic microvascular ischemic disease have progressed from prior.3.No evidence of acute ischemia or any other definite acute intracranial abnormality. No new findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Hydrocephalus, yearly follow-up. Compared to CT dated 11/15/2012, there is no significant change in ventriculomegaly involving the lateral, third, and fourth ventricles. There is diminished supratentorial white matter volume particularly the left parieto-occipital and frontal lobes. There is thinning of the corpus callosum. No evidence of recent infarct or hemorrhage. Small chronic blood products involving the dependent portion of the left lateral ventricle are decreased in conspicuity compared to prior MRI. Sulcation appears within normal limits. There is normal myelination pattern. No new mass or mass-effect. No extra-axial collections. Major flow-voids are preserved. Partially empty sella. There is mild nonspecific opacification of the paranasal sinuses. There is a cystic lesion involving the right parietal scalp which may represent a scalp lesion such as sebaceous cyst for example.

Output: 1. No significant change in ventriculomegaly involving the lateral, third, and fourth ventricles compared to CT 11/15/2012 compatible with communicating hydrocephalus. 2. Diminished supratentorial white volume and thinning of the corpus callosum.3. Slight decrease in conspicuity of chronic intraventricular blood products.


Instruction: Generate impression based on medical findings.

Input: History: Left parietal intracranial hemorrhage follow-up Bilobed shape left frontal parietal hematoma is again seen. It appears slightly different on the current CT due to technique and angle of acquisition when compared to the recent brain MRI. Left high convexity frontal lobe hematoma, slightly ill defined and relatively hypodense, measuring about 2.2 x 1.9-cm. More inferiorly, the left frontal parietal lobe hematoma measures 2.3 x 2.4-cm. They are associated with large amount of adjacent edema. Trace amount of adjacent subarachnoid blood are also seen, unchanged. There are mild to moderate diffuse cerebral edema overall with paucity of extra axial space and sulci, effacement of basal cisterns, especially in the left. There is probable left-sided uncal herniation. No evidence of midline shift. The lateral ventricles are compressed. No hydrocephalus. Marked mucosal thickening with bubbly material seen in the sphenoid sinuses. Large right maxillary sinus retention cyst or polyp is present. Left inferior mastoid air cells opacification, left more than right. Minimal mucosal thickening seen in the ethmoid sinuses. Small right frontal sinus osteoma.

Output: 1. Left frontoparietal hematoma as described above with large amount of adjacent edema. Diffuse overall brain edema with paucity of extra-axial space and sulci, decrease in visualization of the left suprasellar cistern raising the possibility of left-sided uncal herniation. 2. Within limit of the comparison between current CT and prior MRI, there is no conclusive evidence of new separate intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 92 years old, with altered mental status, aphasia. No evidence of restricted diffusion is seen. Moderate periventricular FLAIR hyperintensity is noted without edema or mass effect. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles and sulci are moderately and proportionately prominent compatible with parenchymal volume loss. Moderate pannus formation is seen at the odontoid without impingement of the brainstem. Mucosal thickening and frothy secretions are evident in the right maxillary sinus.

Output: 1.No evidence of acute ischemia.2.Findings compatible with chronic microvascular ischemic disease.3.Possible right maxillary sinus mucosal inflammation.


Instruction: Generate impression based on medical findings.

Input: Compared to the previous study there is a suprasellar mass that measures 22 mm in the CC diameter (601/14) unchanged since the previous study. In the axial view the mass measures 17 x 15 mm (701/12), not significantly changed since the previous study. The cavernous carotids appear normal. The mass abuts the optic chiasm and displaces of the chiasm and left optic nerve superiorly. The left anterior cerebral artery is slightly displaced superomedially.There is subcortical T1 hypointensity and T2 hyperintensity in the right subcentral lobule extending to the right supramarginal gyrus with volume loss representing encephalomalacia. The area is surrounded by FLAIR hyperintensity representing gliosis.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.

Output: 1.Suprasellar mass is grossly unchanged in size since the previous study. 2.Encephalomalacia of the right subcentral lobule extending to the right supramarginal gyrus.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male patient with medial sided knee pain for six weeks. No trauma. Evaluate for injury to account for pain. MENISCI: There is complex tearing of the posterior horn of the medial meniscus with radial and vertical components. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the weightbearing articular cartilage of the lateral femoral condyle and lateral tibial plateau. There is marked thinning of the articular cartilage of the weightbearing portion of the medial femoral condyle. There is a partial-thickness defect within the lateral facet of the patellar articular cartilage.There is a crescentic region of low signal intensity on T1 and T2-weighted images within the weightbearing portion of the medial femoral condyle with significant surrounding increased T2 signal compatible with bone edema (image 17, series 1101 and image 17, series 1201). These findings are consistent with an osteochondral fracture. No intervening T2 signal intensity is identified to suggest instability. The underlying cartilage is intact though markedly thinned.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Osteochondral fracture of the medial femoral condyle without evidence of instability and surrounding bone edema.2. Complex tearing of the posterior horn of the medial meniscus.3. Chondromalacia.


Instruction: Generate impression based on medical findings.

Input: Neuroblastoma; assess for progression of disease. Neck Soft Tissues: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are intact. The imaged intracranial structures are unremarkable. Cervical and Thoracic Spine: There is no evidence of abnormal enhancement or mass lesions in the spine. There vertebral column alignment is within normal limits. There is no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of recurrent neuroblastoma in the neck or cervical and thoracic spine.


Instruction: Generate impression based on medical findings.

Input: Reason: MS, new coordination issues on Tysabri, concern for MS flare History: fall, worsening coordination MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some of these are perpendicularly oriented relative to the lateral ventricles. There is regression of the size of the T2 and flair signal change in the several of these lesions, for example, several in the centrum semiovale bilaterally as well as one adjacent to the trigone of the right lateral ventricle. Associated contrast enhancement on the prior exam has also regressed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is patchy and discontinuous signal hyperintensity present within the cervical spinal cord from the C2 vertebral level to the C6 vertebral level without spinal cord enlargement. No abnormal enhancing lesions are identified in the cervical spine.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 no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a redemonstration of multiple lesions in the periventricular and subcortical white matter which are consistent with a diagnosis of demyelinating disorder. Compared to the prior exam some of the lesions appear smaller. Finding suggests that these lesions are now in a chronic stage.2.Multiple lesions are present throughout the cervical spinal cord which are suspicious for demyelination. Lack of contrast enhancement in the cervical spinal cord suggests that these are likely in the chronic stage


Instruction: Generate impression based on medical findings.

Input: Thoracic spine compression fracture. There is mild thoracic scoliosis convex to the left. Compression deformities of various degrees are seen in thoracic spine, involving T4, T5, T6, T7, T8, T10, T11 and T12. The compression deformities are worst at T8 and T12 level. At T12 level, there are changes related to previous vertebroplasty. Small amount of vertebroplasty material is seen extravasated into the right paraspinal region, possibly involving a venous structure. At T11 - T12 there is disk bulging without significant compromise to spinal canal. Mild disk bulging is also seen throughtout the rest of the thoracic spine, without significant compromise of the spinal canal, although mild neuroforaminal narrowing is present.Abnormal opacity in the left upper lobe is partially visualized, suspicious for a neoplastic process as reported on prior CT chest of 9/15/2011. This is a lytic lesion involving the left pedicle L1, with no definite corresponding lesion seen on prior MRI study. Metastasis cannot be excluded.

Output: 1. Multi-level compression deformities in thoracic spine. Status post vertebroplasty at T12, with extravasated material in the right paraspinal region, probably through venous structure.2. Suspicious for left upper lobe neoplasm. Please correlate with CT chest.3. New lytic lesion at left L1 pedicle, suspicious for a lytic metastasis. Further correlation with MRI with contrast is recommended.


Instruction: Generate impression based on medical findings.

Input: Post contrast images are somewhat limited by patient motion. There are prominent areas of susceptibility, intrinsic T1 hyperintensity, and central diffusion restriction corresponding to areas of recently identified parenchymal hemorrhage, along the anterolateral aspect of the cranial margin of the left posterior parietal resection cavity. Previous blood products within the resection cavity have resolved, with residual rim of hemosiderin staining. The area of the hemorrhage measures 1.2 x 1.8 cm in greatest axial dimensions, and appears to demonstrate a dependent blood level.Compared to the prior MRI, there are multiple areas of increasingly confluent but slightly heterogeneous enhancement along the margins of the resection cavity. Direct comparison is somewhat limited due to lack of 3-D T1 post contrast images on the current exam. Overall, the cavity itself is expanded and now FLAIR hyperintense concerning for tumor involvement. Overall extent of prominent left cerebral FLAIR hyperintensity appears similar within the white matter, with extension into the left external and internal capsules. There is progressive extension of abnormal signal into the corpus callosum across midline, as well as mild medial expansion of the abnormal signal along the posterior body of the left lateral ventricle. There is increased midline shift to the right now measuring 8 mm and localized mass effect upon the near completely effaced posterior left lateral ventricle.One of the more confluent areas is identified along the medial aspect of the left ventricular atrium, now measuring 2.3 x 1.9 cm on 1101/14, previously 1.8 x 1.5 cm. There is also a new 1.3 x 1.1 cm area of enhancement along the anterior aspect of the left temporal horn which is now near completely effaced. The previously identified intraventricular nodule along the anterior body of the left lateral ventricle has increased in size now measuring 6 x 7 mm, previously 4 x 5 mm. Overall craniocaudal extent of the area of abnormal enhancement now measures 5.7 cm on 1201/10, compared to previous 3.9 cm.There is stable focal prominence of CSF space along the anterior aspect of the left temporal pole which may represent a small arachnoid cyst, as it is present on the baseline exam from 2009. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.Redemonstration of small area of hemorrhage along the superior margin of the previous left parietal resection cavity, with overall progression of tumor within and surrounding the prior resection cavity. Similar degree of associated white matter abnormality to correspond to recent CT, as well as localized mass effect and midline shift with near complete effacement of the posterior left lateral ventricle.2.Further increased size of tumor nodule within the anterior body of the left lateral ventricle.3.New left temporal periventricular tumor involvement.4.Gradual progressive extension of abnormal signal across midline along the corpus callosum increased medial extension of abnormal white matter signal within the adjacent expanded left frontal lobe gyri.


Instruction: Generate impression based on medical findings.

Input: A 74 year old female with history of hear transplant on 5/26/2011, last echocardiography showed normal left ventricular function and a dobutamine stress test showed adequate response and no evidence for inducible ischemia.MEDICATIONS: Baclofen, calcium, vitamin B, D, folic acid, magnesium, levothyroxine, omeprazole, pravastatin, prednisone, tacrolimus. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 53 ml/m2 (normal range: 65+/-11), the LVEDV is 96 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 41 g/m2, and the LV mass is 74 g. There are no regional wall motion abnormalities present. There is mild basal septal hypertrophy measuring up to 14 mm on the 3 chamber view end diastole.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 49 ml/m2 (normal range 69+/-14), the RVEDV is 89 ml (normal range 110+/-24), the RV end systolic volume index is 16 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsSternal wires.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and systolic function (RVEF 67%).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: Clinical question: Intraventricular brain cyst, evaluate for change/size, one year follow up. Signs and symptoms: As above. Nonenhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrate evidence of acute or new finding since prior exam. Mildly expansile trigone of right lateral ventricle at the site of a previously fenestrated intraventricular cyst remains identical in size and extent to prior exams.Right posterior temporal approach for fenestration of the cyst remains stable and with revisualization of a linear encephalomalacia along the surgical approach similar to prior exam.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise and stable since prior study. Normal visualization of signal voids of major intracranial arterial branches. Normal signal intensity of the intracranial venous sinuses.Unremarkable calvarium, orbits, mild chronic sinus disease and unremarkable mastoid air cells and middle ear cavities.

Output: 1.No acute or new finding since prior study.2.No detectable interval expansion of previously fenestrated right intraventricular cyst.3.Stable linear encephalomalacia along the course of surgical approach in the right posterior temporal.4.Stable and unremarkable brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Enhancing liver lesion on CT, follow-up exam ABDOMEN:LIVER, BILIARY TRACT: 5 mm T2 hyperintense enhancing lesion in the right hepatic lobe, which corresponds anatomically to enhancing lesion seen on CT. Additional small T2 hyperintense lesions in the left hepatic lobe. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 8 mm enhancing right adrenal nodule.KIDNEYS, URETERS: 4 cm hemorrhagic poorly enhancing mass in the right superior pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Multiple small T2 hyperintense enhancing lesions in the liver, all of which have similar imaging features suggestive of hemangiomas.2.Indeterminate enhancing right adrenal nodule, which does not meet the criteria for an adenoma and is too small to fully characterize.3.Right superior pole renal mass most consistent with renal cell carcinoma.Discussed with pager x9301 at time of dictation.