Instruction: Generate impression based on medical findings.

Input: 20-year-old with history of von Hippel-Lindau and prior brain/spinal hemangioblastomas. Evaluate for interval change. Motion artifact moderately limits the image interpretation, particularly within the spine Brain:Surgical changes from prior midline suboccipital surgery.Redemonstration of a nodule of enhancement along the midline dorsal medulla at the level of the foramen magnum is not significantly changed from prior measuring 5 mm, previously 5 mm.Redemonstration of 5 small enhancing nodules in the bilateral cerebellar hemispheres which are not significantly changed from prior. There is mild associated edema.Mild edema associated with the lesions is not significantly changed.Dedicated imaging of the temporal bones and internal auditory canal does not show any enhancing or destructive mass to suggest endolymphatic sac tumor. No lesions within the supratentorial brain are appreciated. No evidence of acute ischemia or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine:The vertebral body and intervertebral disc heights are maintained. Straightening of the cervical lordosis is seen, alignment is otherwise maintained. No suspicious bone marrow signal abnormalities. Redemonstration of an intramedullary lesion in the posterior cervical cord at the C4 level which measures 10 mm in maximum dimension. This is previously reported as measuring 6 mm, however repeat measurement on the exam from 1/3/2015 using similar slice as on current measurement yielded a similar measurement of 10 mm. There is stable edema within the cord adjacent to this lesion. No new cervical cord lesion.No disc bulges, neural foraminal stenosis, or spinal canal stenoses in the cervical spine. Thoracic spine:There is stable mild straightening of the thoracic spine. Mild endplate irregularity which was also previously present from T9 through L1 with mild wedging deformities of the T10 and 11 vertebral bodies are unchanged. No evidence of acute fracture.Redemonstrated enhancing lesion in the right posterior cord at the T4 level measures 7 mm, previously 6 mm. Additional lesion in the right posterior cord at the T6 level measures 4 mm, previously 5 mm. These lesions are associated with mild cord edema appearing similar to prior.No significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing. Lumbar Spine:The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities.No enhancing masses are noted in the conus or cauda equina.No significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: Accounting for differences in technique and motion degradation on some sequences, there is no appreciable interval change in multiple enhancing lesions in the bilateral cerebellar hemispheres, dorsal medulla, cervical spinal cord, and thoracic spinal cord which are compatible with hemangioblastomas. Associated edema is also not significantly changed. No new lesions or new edema is identified. There are also no findings to suggest endolymphatic sac tumor


Instruction: Generate impression based on medical findings.

Input: 73 year-old female history of pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: Subsegmental left hepatic lobe nonenhancing cyst. The common bile duct appears normal measuring 5 mm. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is decreased intrinsic T1 signal abnormality with distal fatty atrophy. There is pancreatic ductal dilatation measuring up to 9mm with tortuosity about the neck, body, and tail region and dilated sidebranches. There are three areas of abrupt narrowing without enhancing mass, filling defect or nodularity. The proximal duct appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter nonenhancing left interlobar cyst.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.Dilated and tortuous pancreatic duct with multiple areas of abrupt narrowing as above without abnormal enhancement, filling defect or mass, likely secondary to benign strictures. Decreased intrinsic T1 signal of the pancreas with distal atrophy. Constellation of findings suggests chronic pancreatitis. Continued follow up with Secretin stimulated MRCP is recommended if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Possible pineal mass: headache, dizziness. There is a pineal gland cyst that measures up to 6 mm in diameter. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A pineal gland cyst that measures up to 6 mm in diameter, which likely represents benign cystic degeneration. Otherwise, no evidence of intracranial hemorrhage, ventriculomegaly, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient with altered mental status, confusion, UE weakness, please evaluate for stroke/ ischemic changes The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Images are mildly degraded by patient motion which may obscure more subtle abnormalities.

Output: 1.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction identified.3.Images are mildly degraded by patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: Known right breast cancer with metastatic lymph node on neoadjuvant chemotherapy. A targeted right ultrasound was performed for the known malignancy and metastatic node. The right breast cancer now measures 2.1 x 1.9 x 1.8 cm. Previously, this measured 3.6 x 2.7 x 2.4 cm on the June MRI. The original outside sonographic measurement was up to 2.9 cm. The known metastatic right axillary lymph node is well seen with clip artifact. This measures 2.1 x 1.3 x 2.1 cm. Previously, on MRI from June this measured up to 2.5 x 2.5 x 2.2 cm. The original outside ultrasound measurement of the node was up to 2.7 cm.

Output: Some interval decrease in ultrasound measurements compared to the June MRI and prior outside ultrasound. A current MRI might provide more accurate comparisons for interval change if that is clinically needed.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Neurofibromatosis, type 1 with moyamoya and brainstem mass.. There is an unchanged heterogenously enhancing mass centered within the right midbrain, which measures 22 AP x 20 RL x 18 SI mm. There is no evidence of intracranial hemorrhage or acute infarct.. There is unchanged encephalomalacia with subcentimeter cystic defects in the left frontal deep and periventricular white matter and within the right temporal occipital region. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are postoperative findings related to bilateral pial synangiosis. There is steno-occlusive disease involving the internal carotid arteries with associated collateral vessels. There is a probable right basal ganglia developmental venous anomaly. There is a partially-imaged left cleft palate and associated postoperative findings.

Output: 1. Unchanged right brainstem mass, accounting for differences in technique.2. Unchanged areas of encephalomalacia in the left frontal deep and periventricular white matter and within the right temporal occipital region are compatible with chronic infarcts. No evidence of acute cerebral infarction.3. Postoperative findings related to bilateral pial synangiosis and steno-occlusive disease involving the internal carotid arteries are better depicted on the prior MRA. .


Instruction: Generate impression based on medical findings.

Input: Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There are scattered bihemispheric FLAIR high signal intensities on periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Right ethmoid sinus shows mucosal thickening.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic leison.2. Non specific small vessel ischemic disease, unchanged since 2004.3. Normal brain MRA and neck MRA


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old, history of 4.4 ascending aortic aneurysm The quality of this examination is nondiagnostic. The patient will be called back for repeat examination at no additional cost.

Output: Nondiagnostic exam.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: 67 year old woman with history of LV dysfunction and eosinophilia, with previous cardiac biopsy suggestive of eosinophilic myocarditis. She was referred for cardiac MRI to evaluate for scar and active inflammation in view of recent steroid wean and intermittent symptoms of fatigue. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LVEDV is 152 ml (normal range 109+/-23), the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVESV is 75 ml (normal range 31+/-10), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LV mass is 85 g (normal range 114+/-24), and the LV mass index is 45 g/m2 (normal range 67+/-11). There is global mild hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RVEDV is 137 ml (normal range 110+/-24), the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVESV is 56 ml (normal range 35+/-13), and the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Aortic sinus of valsalva measures 41 x 39 x 38 mm which is similar to the previous study.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is trivial pericardial effusion. On T2 STIR images there is prominence of the pericardial sac that could suggest evidence of pericardial inflammation. This prominence of the pericardial sac was also seen on previous study.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is no longer dilated but still shows mildly reduced systolic function (LV EF 50%). This has improved from previous LVEF 46%2. No late gadolinium enhancement to suggest an infiltrative, inflammatory or fibrotic process. 3. Normal size right ventricle with normal systolic function (EF 59%).4. There is trivial pericardial effusion. On T2 STIR images there is prominence of the pericardial sac that could suggest evidence of pericardial inflammation. This prominence of the pericardial sac was also seen on previous study.5. See aortic measurements above.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: Right shoulder pain. No bony abnormality is seen. Unremarkable examination of the right shoulder.

Output: Normal appearing right shoulder with no findings to account for patient's pain.


Instruction: Generate impression based on medical findings.

Input: Suspected right temporal meningioma. There is no significant interval change in the extra-axial lesion overlying the anterior right temporal lobe, which measures approximately 9 x 13 mm. There is slight mass effect upon the adjacent brain parenchyma. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the extra-axial lesion overlying the anterior right temporal lobe, which may represent a meningioma.


Instruction: Generate impression based on medical findings.

Input: Reason: screening for recurrent BCC compared to previous MRI History: Pervious BCC with family history of NMSC, pt also has history of multiple neurofibromas. Again seen are postoperative findings in the left nasal ala and nasolabial fold region, as well as in the left frontal scalp region. There is deformity of the left nasal ala and predominantly linear low T1 and T2 signal tissue in the surgical bed, which likely represents scar tissue, but no measurable enhancing tumor. There is no evidence of significant lymphadenopathy in the partially imaged neck. Inferior aspect of the neck is not included on the axial sequences. The salivary glands are unremarkable. The orbital contents and imaged intracranial structures are unremarkable.

Output: Postoperative findings related to left nasal skin tumor resection without evidence of locoregional tumor recurrence. No significant cervical lymphadenopathy in the imaged upper neck.


Instruction: Generate impression based on medical findings.

Input: Supervision of high risk pregnancy, unspecified, unspecified trimester [O09.90], Reason for Study: ^Reason: brain mass, please perform seizure 2 protocol History: seizure 29 years Female (DOB:10/25/1987)Reason: brain mass, please perform seizure 2 protocol History: seizurePROVIDER/ATTENDING NAME: MAHMOUD A. ISMAIL Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.FLAIR/T2 high signal intensity tubular structure across the deep white matter of left frontal lobe [series 401, image 22] is representing developmental venous anomaly.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain nonenhanced phase contrast with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. The left transverse sinus is hypoplastic which is normal variation.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Developmental venous anomaly on the left frontal lobe3. Normal brain MRV


Instruction: Generate impression based on medical findings.

Input: Complex multisystem autoimmune disorder with headache and back pain. Brain: There are new subcentimeter enhancing lesions in the left middle and superior frontal gyri. However, there is considerable interval regression of the right cerebellar and left posterior parietal lobe lesions. Otherwise, there is no significant interval change in the non-enhancing patchy white matter T2 hyperintensity in the left perirolandic and adjacent periventricular white matter and in the right superior frontal gyrus. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are postoperative findings related to left frontal biopsy. The orbits are grossly unremarkable. There is persistent diffuse paranasal sinus mucosal thickening and secretions.Spine: Since September 2015, there has been interval increased swelling in the spinal cord at the C6 through T3 levels with associated T2 hyperintensity and marked enhancement. The rest of the spinal cord is unremarkable. The vertebral column alignment is unchanged. 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.

Output: 1. Interval development of enhancing lesions in the left frontal lobe, but regression of the right cerebellar and left posterior parietal lobe lesions, and unchanged lesions in the right superior frontal gyrus and left perirolandic and adjacent periventricular white matter.2. Since September 2015, the inflammatory lesion in the spinal cord at the C6 through T3 levels has worsened. 3. Diffuse inflammatory changes in the paranasal sinuses may represent acute sinusitis, either infectious or perhaps related to the autoimmune disorder.


Instruction: Generate impression based on medical findings.

Input: Susceptibility near the left inferior temporal gyrus represents expected hemosiderin in the surgical cavity. A 7 x 7 mm area of enhancement seen immediately anterior to the surgical site corresponds to an area of diffusion restriction on the immediate postoperative MR from 3/4/15. No additional abnormal foci of enhancement are identified. There is no significant midline shift. The ventricles and basilar cisterns appear normal. There is normal enhancement of the major intracranial vascular structures.

Output: Limited MR performed for treatment planning demonstrates postoperative findings of tumor resection in the left inferior temporal lobe with interval increase in enhancement anterior to the surgical cavity most consistent with evolution of postsurgical change.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for labral tear vs hernia History: progressive pain with ambulation and coughing Moderate to severe osteoarthritis affects the hip with full-thickness degeneration of the articular cartilage along the anterior superior aspect of the joint. There is associated osteophyte formation. There is mild enhancement of the hip joint following contrast administration indicating a mild synovitis. Subchondral foci of signal abnormality also show enhancement following contrast administration and could either represent enhancing degenerative "geodes" or erosions, however, we see no joint effusion. There is deformity and increased signal intensity within the acetabular labrum, particularly superiorly, likely representing a combination of mucoid degeneration and degenerative tearing. There is relatively mild osteoarthritis of the left hip. There is a small cyst adjacent to the left superior labrum that may reflect an underlying labral tear. Mild osteoarthritis affects the pubic symphysis. Mild osteoarthritis affects the sacroiliac joints. Severe degenerative disc disease affects the imaged lower lumbar spine.The skin appears unusually thickened and there is little subcutaneous fat between the skin and underlying gluteus maximus muscle and virtually no fat within many of the imaged muscles. The subcutaneous fat that is present posteriorly shows reticulation and enhancement suggesting mild inflammation extending along the lateral aspect of the hip. Review of the patient's medical records indicates a history of lower extremity sclerosing skin process with atypical fasciitis/lipodystrophy syndrome. There is a large uterine mass presumably representing a fibroid that was present on a prior CT examination from 2008. We see no hernia.

Output: 1. Moderate to severe osteoarthritis of the right hip with mild synovitis and enhancing subchondral foci that could represent degenerative geodes or small erosions. We see no joint effusion.2. Degeneration and tearing of the acetabular labrum.3. Other findings as described above including osteoarthritis, degenerative disc disease, a uterine fibroid, and findings compatible with the patient's history of a lower extremity sclerosing skin process with atypical fasciitis/lipodystrophy syndrome.


Instruction: Generate impression based on medical findings.

Input: 54 years, Female, Reason: history of breast CA, and abdominal adenopathy of ? cause. Followup scan of IPMN. History: IPMN. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Nonenhancing cystic lesion in the pancreatic head without definite communication with the pancreatic duct is unchanged measuring 8 mm (4/76).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Axillary lymph nodes seen previously is not visualized.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Artifact is seen in the mid abdomen.

Output: Cystic lesion in the pancreatic head is unchanged, likely a side branch IPMN.


Instruction: Generate impression based on medical findings.

Input: 75-year-old woman with history of pancreas divisum and recurrent pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. Slight dropout of signal on opposed phase imaging suggests fatty infiltration of the liver. Patient is status post cholecystectomy. There is no intrahepatic pancreatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is pancreas divisum with a santorinicele (401/17). The main pancreatic duct is dilated up to 5 mm. On post secretin images, there is normal exocrine function of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts noted. The right kidney appears normal.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: Pancreas divisum with santorinicele and dilated main pancreatic duct, but no exocrine abnormality on post-secretin images.


Instruction: Generate impression based on medical findings.

Input: For numbering purposes, there are a total of 5 lumbar type vertebral bodies. The conus medullaris is normal in signal and morphology and terminates at L1-L2 level. The filum appears to shift anteriorly on prone imaging. There is no evidence of fibrofatty filum. 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.

Output: No abnormalities of the lumbar spine. 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: Known left breast cancer on neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Biopsy proven cancer in the left 2:00 far posterior depth is again noted with hydromark biopsy clip artifact. Residual faint enhancement near the skin measures 1.2 x 0.7 x 1.5 cm. This is significantly decreased from prior measurements of 2.5 x 2.6 x 3.1 cm. The biopsied left axillary lymph node is also again seen with hydromark artifact. At this point, this node measures about 9 mm, previously up to 1.5 cm. Multiple additional lymph nodes in the left axilla are also decreased in size, including in the subpectoral region, where the largest node now measures only up to 8 mm, previously a subpectoral node measured 2.1 cm.No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: Significant response to therapy with measurements as above.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Status post recent 5/23/2015 liver transplant with elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant. The hepaticojejunostomy is unremarkable without intrahepatic biliary ductal dilatation. No focal lesion. Along the dorsal surface of the liver extending from the porta hepatis and dorsal to the left hepatic lobe is a loculated homogeneous fluid collection measuring 14.8 x 3.1 cm.SPLEEN: Minimal peri-splenic fluid. Borderline splenomegaly. PANCREAS: The pancreas is atrophic and significantly decreased in signal intensity suggestive of iron deposition. 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: Bilateral gynecomastia.OTHER: Small right greater than left pleural effusion with adjacent compressive atelectasis.

Output: This study is limited for evaluation of solid organ and vascular pathology without intravenous contrast. No intrahepatic biliary ductal dilatation. Fluid collection extending from the porta hepatis along the dorsal surface of the left hepatic lobe, persistent and mildly increased since the CT dated 6/16/2015. If there is clinical concern for a biloma a HIDA scan may be obtained.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Dizziness and giddinessClinical question: repeated episodes of vertigo may have been caused by posterior circulation compromise MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are several subcortical and periventricular white matter lesions which are hyperintense on T2 and FLAIR MR imaging. Given their small number there are of little clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The left vertebral artery is smaller than the right vertebral artery. There is extracranial origin of the right posterior inferior cerebellar artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. There likely of little clinical significance given their small number. Several subcortical and periventricular white matter lesions are frequently seen in this age group.4.A small left vertebral artery is present intracranially. This could be variation of normal.


Instruction: Generate impression based on medical findings.

Input: Developmental delay and short stature. History of intrauterine growth restriction. No parenchymal structural abnormality is appreciated. Myelination is appropriate for age. No findings to suggest cortical developmental malformation. Gray-white differentiation is preserved. T2/FLAIR-hyperintense signal in the parietal white-matter likely represents zona terminalis, which is within normal limits. The ventricles and the other CSF-containing spaces are normal in size. Midline structures including the corpus callosum as well as posterior fossa structures appear within normal limits.The mastoid air cells and the middle ear cavities are clear. There is partial opacification of the partially pneumatized sinuses which is nonspecific. Calvarium and extra cranial soft tissues are unremarkable.

Output: No brain parenchymal structural abnormalities are appreciated.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old, history of coccygeal/sacral chordoma status post resection. Surveillance scan. There are postoperative changes involving the lower sacrum with absence of the coccyx. Mild enhancement in the surgical bed likely represents scar tissue. This region is better assessed on the accompanying pelvic MRI.Fatty signal within the S2 and S3 vertebral bodies is again seen similar to prior compatible with focal fat or hemangiomas. No evidence of suspicious T2 hyperintensity or pathologic enhancement is seen at these levels.Elsewhere in the lumbar spine, no pathologic marrow signal alteration or enhancement is seen. Vertebral body height and morphology is normal. The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: No significant disk disease. No spinal canal or neural foramina stenosis.L2-3: No significant disk disease. No spinal canal or neural foramina stenosis.L3-4:Disc protrusion is again seen. No significant spinal canal stenosis. Minimal right foraminal narrowing. No left foramina narrowing.L4-5:Minimal disk bulge. Left dorsal annular fissure. No significant spinal canal stenosis.Minimal bilateral foraminal narrowing.L5-S1: New left paracentral disc protrusion with increased effacement of the left lateral recess and contact of the descending left S1 nerve root. No significant central canal stenosis or neural foraminal stenosis.Mild facet arthropathy in the lumbar spine. Paraspinous soft tissues are unremarkable.

Output: 1. Postsurgical changes in the sacrococcygeal region are only partly visualized on this examination. No evidence of residual or recurrent tumor is seen. Please see separate report from accompanying pelvic MRI.2. Mild degenerative changes in the lumbar spine as described above with interval increase in left paracentral disc protrusion at L5-S1.


Instruction: Generate impression based on medical findings.

Input: Clinical question: SC abnormality? Signs and symptoms coronal previous neck surgery right upper extremity radicular pain. Pre-and post-enhanced cervical MRI:Examination demonstrates a stable post operative changes Chiari decompression with resultant expansion of subarachnoid space at the surgical site similar to prior exam.Examination redemonstrates a mildly expansile syrinx of cervical cord extending from C1 to the uppermost visualized thoracic cord.The syrinx at C2 level measures 4.4-mm in transverse axis which is smaller compare to prior study measurements of 6.1-mm at the same level. There is however suggestion of mild interval increased size of syrinx more inferiorly compared to prior exam at C4 and C5 levels. At C5 it measures 3.5 mm in transverse axis compared to prior study measurements of 2.5-mm.post-enhanced images demonstrate no abnormal enhancement of the cord, leptomeninges or the vertebral column.Degenerative changes of cervical spine results in mild central spinal stenosis at C3 -- C4 and C4 -- C5 levels.Mild bilateral neural foraminal compromise at C3 -- C4, moderate to severe bilateral neural foraminal compromise at C4 -- C5, severe right and mild left neural foraminal C5 -- C6, mild bilateral neural foramina compromise at C6 -- C7 and significant right neural foramina compromise at C7 -- T1 is also noted.

Output: 1.Stable postoperative changes of Chiari decompression since prior exam.2.Stable extent of mildly dilated syrinx of cervical cord extending from T1 through the entire cervical cord and into the upper thoracic.3.Minimal interval decrease transverse caliber of syrinx at C1 -- C2 level and sulcal interval increased at C4 and C5 levels.4.No abnormal enhancement of the cord, leptomeninges or the spinal column on post infused images.5.Degenerative changes of cervical spine results in a central spinal stenosis at C3 -- C4 and C4 -- C5 levels. Multi-level neural foraminal compromise is also present as detailed per level above.


Instruction: Generate impression based on medical findings.

Input: History of nasopharyngeal carcinoma with new liver lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. Within segment 2 there is a focal lesion measuring 2.3 x 1.8 cm which has increased T2 signal as well as prominent diffusion restriction. The lesion is hypoenhancing relative to the background liver.No additional focal lesions. The hepatic vasculature is patent. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelvises. No hydronephrosis. No focal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a focal lesion the left aspect of the T12 vertebral body that has increased T2 signal, mildly increased T1 signal, and postcontrast enhancement compatible with an intraosseous hemangioma.OTHER: Partial visualization of multiple sacral cystic structure seen only on the large field-of-view coronal T2 images; possibly representing Tarlov cysts.

Output: 1.Focal lesion in segment 2 of the liver as described above most compatible with a hypovascular metastasis.


Instruction: Generate impression based on medical findings.

Input: Reason: episodes of bilateral visual loss, h/o stroke History: bilat visual loss MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is volume loss present in the posterior fossa with subdural effusions.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.Findings suggest a 4-mm sized right posterior communicating artery aneurysm which is directed laterally and inferiorlyFindings suggest a small infundibulum measuring 1.5 mm at the left posterior communicating artery origin.There is no evidence for cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is a little bit larger than the left A1 segment. The posterior communicating arteries are not readily identified. The vertebral arteries are asymmetric in size- left larger than right.There is extracranial origin of the left posterior inferior cerebellar artery.

Output: 1.Findings suggest a 4 millimeter aneurysm at the communicating segment of the LICA. This can be confirmed with CTA. 2.Findings suggest 1.5mm Infundibulum at the origin of the left posterior communicating artery. This can be confirmed with CTA. 3.No evidence for cerebrovascular occlusive disease.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p acl with anterior knee pain History: pain, cyclops lesion? MENISCI: The lateral meniscus appears intact. The medial meniscus appears.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the lateral aspect of the lateral femoral condyle adjacent to the previously described lateral notch sign/impaction fracture. There is full-thickness articular cartilage degeneration along the medial facet of the patella with articular cartilage blistering and a focal full-thickness articular cartilage cleft.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. The graft appears intact. Note is made foci of decreased signal abnormality along the anterior aspect of the graft consistent with anterior arthrofibrosis. There is also prominent osteophyte formation along the medial aspect of the medial femoral condyle. The PCL appears intact. The LCL and MCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Postsurgical changes of ACL graft reconstruction with findings consistent with anterior arthrofibrosis as described above. The graft appears intact.2. Articular cartilage degeneration with full-thickness articular cartilage clefts as described above. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: History of NK/T-cell lymphoma and bone marrow transplant as well as CNS involvement by post transplant lymphoproliferative disorder. Again seen are evolving chronic blood products, with evidence of retraction, and associated encephalomalacia in the right parieto-occipital region underlying the burr hole. Similarly, superficially located multifocal susceptibility effect from previous hemorrhages also remains. Confluent cerebral white-matter T2-hyperintensity, which is more pronounced on the right, also remains unchanged. There is no mass-effect, midline shift or brain herniation. Ex vacuo dilatation of the lateral and third ventricles have slightly increased and remains most pronounced in the posterior right lateral ventricle. No clear evidence of hydrocephalus.There is subtle contrast enhancement in the medial right occipital lobe, medial to the hemorrhage at the site of the previous lesion, as before, which is nonspecific in the setting of treatment changes in this region. Otherwise, there is no abnormal enhancement. Focal contrast enhancement involving the posterior aspect of the left insular cortex is resolved compatible with evolution of injury. Major intracranial vascular flow voids are preserved.The orbits are grossly unremarkable. There is moderate mucosal thickening in the paranasal sinuses associated with secretions in the maxillary sinuses. In the proper clinical setting, this may reflect acute or acute on chronic sinusitis.

Output: 1.No new mass or new enhancement to suggest disease progression. Subtle contrast enhancement in the right occipital lobe, medial to the evolving chronic blood products, is nonspecific in the setting of treatment changes in this region. 2.Evolving chronic blood products in the right parieto-occipital region with evidence of retraction. The other areas of signal abnormality indicative of previous multifocal hemorrhage remain unchanged. 3.Confluent cerebral white-matter T2-hyperintensity, which is more pronounced on the right, also remains unchanged and compatible with treatment change.4.Dilatation of the lateral and third ventricles is slightly increased and remains most pronounced in the posterior right lateral ventricle and likely reflective of volume loss. No clear evidence of hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: There is slight reversal of upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Right facet hypertrophy causes mild right neural foraminal stenosis.C3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy cause mild bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and mild bilateral neural foraminal stenosis.C5/6: Osteophyte disc complex, ligamentum flavum thickening, and uncinate hypertrophy. There is mild bilateral neural foraminal stenosis.C6/7: Osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C2/3: Mild right neural foraminal stenosis.2.C3/4: Mild bilateral neural foraminal stenosis.3.C4/5: Mild central and mild bilateral neural foraminal stenosis.4.C5/6: Mild bilateral neural foraminal stenosis.5.C6/7: Mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old, with multiple sclerosis and gait problems, follow-up progression. Numerous T2 hyperintense lesions are evident involving the corpus callosum, the periventricular and juxtacortical white matter of the cerebral hemispheres, brainstem and cerebellum. Since the prior examination, numerous lesions have increased in size or have newly developed. The largest progressive lesion is evident in the right frontal juxtacortical white matter and shows marked corresponding T1 hypointensity. The remaining lesions demonstrate mild to moderate T1 hypointensity. No evidence of significant generalized mass effect is seen. Brain parenchymal volume is relatively preserved. No abnormal extra-axial fluid collections are seen. The ventricles remain normal in size and morphology. A mucous retention cyst seen in left maxillary sinus.

Output: Progression of demyelinating disease in the brain.


Instruction: Generate impression based on medical findings.

Input: Please evaluate response to neoadjuvant chemotherapy for breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Interval decrease in the size and enhancement characteristics of the previously mentioned 3 enhancing masses in the central lateral right breast. The largest mass is seen as a curvilinear area of enhancement along the lateral aspect, and measures 2.9 x 0.8 x 1.2 cm, previously measured 3.8 x 4.1 x 3.4 cm. The postero- lateral mass demonstrates thick rim enhancement with central area of necrosis, and now measures 1.8 x 1 x 1.6 cm, previously measured 2.2 x 2.6 x 3.0 cm. The third anteromedial mass demonstrates thin rim enhancement and now measures 0.6 x 0.8 x 0.8 cm, previously measured 1.0 x 0.9 x 1.0 cm. The most anterior mass resides approximately 1 cm posterior to the nipple. Total area of enhancement in the right breast measures 1.3 x 5.3 x 1.4 cm, previously measured 3.8 x 6.9 x 4.5 cm and extends to the lateral cutaneous surface, mid depth, and to the lateral margin of the nipple. The retraction and the lateral deviation of the nipple has improved. Enhancement of the lateral aspect of the skin where the largest mass is in close proximity still persists.Interval decrease in size of right axillary lymph nodes. The largest lymph node with susceptibility artifact from a biopsy clip now measures 2.1 cm, previously measured 2.6 cm. The previously mentioned retropectoral lymph node now measures 1.6 cm, previously measured 1.9 cm. No abnormal enhancement is seen in the left breast. Multiple normal appearing lymph nodes are present in the left axilla.Chemotherapy port projected over the left medial chest wall.

Output: Interval decrease in size of 3 masses in the right central breast and right axillary lymph nodes.No MRI evidence for malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Worst headache of life, posterior headaches, left-sided weakness, slurred speech. Signs and symptoms: Worst headache of her life, posterior headache, left-sided weakness, slurred speech. Nonenhanced CT of brain:Images through posterior fossa are unremarkable.Edema in the right anterior temporal tip with a small amount of hemorrhage is noted. Combination of these findings measures approximately 46 mm x 25 minute periodsmall area of parenchymal edema in the right frontal pole measuring 19 mm times 19-mm. No hemorrhage associated with this finding.Minimal subarachnoid hemorrhage localized to the right anterior parietal region.Suspect a small CSF density extra-axial collection in the left frontal and temporal region. This finding measures approximately 4.5 Mm in size. The gray -- white matter differentiation is preserved. Ventricular system is within normal size and no midline shift.No -attenuation of the white matter of bilateral occipital lobes and is believed to be artifactual.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells demonstrate minimal findings of acute sinusitis in the right maxillary sinus no detectable fracture on this exam. No definitive abnormality of the scalp. For further evaluation MRI examination of brain is recommended.

Output: 1.Foci of edema in the right anterior temporal tip with minimal hemorrhage and right anterior -- inferior frontal lobe without hemorrhage and minimal localized right parietal subarachnoid hemorrhage. Findings are suspected for posttraumatic changes. Follow-up with an MRI is recommended to exclude extent of injury or additional cause for these findings.2.Normal size of ventricular system and no midline shift.3.Negative calvarium.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with dyspnea on exertion, obstructive and restrictive pattern on pulmonary function testing, normal ejection fraction. Referred for cardiac MRI to rule out cardiac sarcoidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%. The LVEDV is 131 ml (normal range 109+/-23), LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), LVESV is 52 ml (normal range 31+/-10), and LV end systolic volume index is 31 ml/m2 (normal range 18+/-5). The LV mass is 70 g (normal range 114+/-24) and the LV mass index is 41 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is <1050 which is within normal limits..There is no myocardial iron overload. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RVEDV is 158 ml (normal range 110+/-24), the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVESV is 67 ml (normal range 35+/-13), and the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Normal sized left ventricle with normal systolic function (LVEF 60%)2.Normal sized right ventricle with normal systolic function (RVEF 58%)3.No late gadolinium enhancement. No evidence of inflammatory or infiltrative disease of the myocardium.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: History of Crohn's disease status post multiple surgeries at outside hospital with ileostomy and mucous fistula complicated by multiple obstructive episodes. Stricture at anal canal and ileostomy. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is relatively well distended with oral contrast. There is a paucity of small bowel compatible with history of multiple small bowel resections. Note is made of a right lower quadrant ileostomy and mucous fistula.In the left hemiabdomen there is an approximately 8 cm (series 401/11) long segment of proximal small bowel which demonstrates mild distention with moderate circumferential wall thickening, mild T2-weighted weighted hyperintensity, restricted diffusion and enhancement compatible with active inflammation. Distally it is associated with a clover-leaf appearance of adjacent small bowel loops which are tethered together suspicious for a complex fistulous network (series 401/12). This also involves the adjacent mucous fistula which demonstrates similar diffuse signal intensity compatible with active inflammation.There is mild circumferential T2-weighted mildly hyperintense wall thickening of the ileostomy loop compatible with active inflammation involving approximately 5 cm.No fixed luminal narrowing or associated upstream/prestenotic dilatation is identified to suggest a flow-limiting stricture. No significant free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: T2-weighted hyperintense peri-anal fistulous tract extending cranially and dorsally towards the coccyx and anteroinferiorly towards the scrotum with probable seton catheter in place. No associated fluid collection. Additionally, there is T2 weighted mildly hyperintense tract extending along the left perianal region in the ischioanal fossa towards the left gluteal cleft without a discrete fluid collection.OTHER: No significant abnormality noted.

Output: Active inflammation of the mucous fistula, an approximately 8 cm proximal small bowel loop in the left hemi-abdomen and approximately 5 cm of the ileostomy loop. No flow-limiting stricture is identified. Complex fistulous network involving the proximal small bowel loop, adjacent small bowel loops and mucous fistula in the left hemi-abdomen.Peri-anal fistulous disease as described above is incompletely evaluated. No associated abscess is seen.


Instruction: Generate impression based on medical findings.

Input: Nausea with vomiting [787.01], Reason for Study: ^Reason: headaches, history of cervical cancer History: headaches No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: 70 yo male with multiple myeloma with worsening back pain History: worsening back pain BONE MARROW: Nonspecific scattered T1 hypointense foci in the osseous structures of the pelvis. Prior needle tract noted in the left ilium.SOFT TISSUES: Presacral soft tissue mass has decreased in size with a residual component of the presacral mass on the right of the rectum measuring 4.8 x 2.7 cm (image 20/series 1401) previously, 9.7 x 7.0 cm. The mass partially encircles the rectum.The reference left subcutaneous abdominal wall mass measures 6.0 x 3.7 cm (image 35/series 1501) previously, 4.6 x 3.3 cm.There are several lesions adjacent to the right psoas muscle with an infiltrative mass that extends into the right iliac fossa. The right psoas muscle is edematous. The mass partially encases the exiting nerve roots on the right.There are additional lesions in the bilateral gluteal muscles. The right pre-sacral lesion partially impresses upon the exiting right sciatic nerve.JOINTS: Mild degenerative changes affect the hips bilaterally. Moderate to severe degenerative changes affects the lower lumbar spine at L5-S1.ADDITIONAL

Output: 1.Decrease in the size of the presacral mass.2.Increase in the size of the left body wall mass.3.New areas of signal abnormality involving the gluteal, and right psoas muscle with new small enhancing lesions.


Instruction: Generate impression based on medical findings.

Input: The patient is a 9-week-old male with history of apnea for two minutes. Rule out bleed or mass. There is no evidence of intracranial hemorrhage, mass or edema. The parenchyma of the cerebrum, cerebellum and brainstem is normal in attenuation and morphology.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on medical findings.

Input: 75 year-old female with abnormal spells daily, abnormal EEG consistent with seizures, evaluate temporal lobes versus atrophy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Ventricular sizes and sulci are within acceptable limits for a patient of age 75 years. There are mild scattered foci of high T2 signal within periventricular and subcortical white matter, consistent with sequela of chronic small vessel ischemic disease, unchanged in extent. The ventricles and basal cisterns are normal in size and configuration. The skull and extracranial soft tissues are unremarkable. There are no abnormal enhancing foci.Dedicated coronal FLAIR imaging demonstrates a suggestion of increased T2 hyperintensity within bilateral hippocampi, however internal hippocampal architecture is preserved and hippocampal size is within normal limits. There is no preferential mesial temporal lobe atrophy.

Output: 1.Stable chronic small vessel ischemic disease.2.Dedicated coronal FLAIR imaging demonstrates a suggestion of increased T2 hyperintensity within bilateral hippocampi, however internal hippocampal architecture is preserved and hippocampal size is within normal limits. Given this nonspecific appearance, it is of uncertain clinical significance.


Instruction: Generate impression based on medical findings.

Input: Ms. Wesley is a 47-year-old female with known right breast IDC with lobular features/DCIS and a metastatic right axillary lymph node. She presents today for I-SPY research MRI (#4). There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST: There has been slight interval decrease in size of biopsy-proven malignancy in the right retroareolar region now measuring 3.2 x 1.4 x 3.0 cm, previously measuring 3.2 x 2.7 x 3.3 cm (AP x ML x SI). The biopsy-proven malignancy demonstrates less avid enhancement on postcontrast sequences when compared to the prior study. Again seen is a biopsy marker clip located centrally within this malignancy. There continues to be minimal persistent periareolar skin thickening. Multiple benign enhancing masses in the right breast are unchanged. Biopsy-proven metastatic right axillary lymph node now measures 1.5 x 0.9 cm, previously 1.8 x 1.1 cm. Biopsy marker clip is located centrally within this lymph node. No new abnormal enhancement is identified in the right breast. LEFT BREAST:No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region. Vascular port again present in the left medial chest wall.

Output: (1) Slight interval decrease in size and marked decrease in enhancement pattern of patient's known right breast malignancy. Slight interval decrease in size of known metastatic right axillary lymph node.(2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Headache. Pituitary abnormality on CT scan. BRAIN MRI:There is extensive mucosal thickening involving the paranasal sinuses. In addition, there is fluid in the maxillary sinuses. In the appropriate clinical setting, this may reflect sinusitis, which may account for patient's symptoms.Brain demonstrates normal structure and signal. There is no mass. The ventricles and the other CSF-containing spaces are normal in size. There is no abnormal diffusion restriction or susceptibility effect to indicate recent infarct or intracranial hemorrhage. Focal flow void abutting the left internal carotid terminus and indenting the under surface of the anterior aspect of the left putamen, where there is minimal apparent surrounding T2-hyperintense signal, is probably a saccular aneurysm arising from the carotid terminus. The left carotid terminus itself is also mildly dilated compared to the right carotid terminus. While the neck seems to be small, the maximum width of this presumed aneurysm is 4 mm. It is likely 7 mm apex to base. Otherwise, the major intracranial vascular flow voids are preserved, reflecting gross patency.There is no destructive skull lesion. The orbits are normal.PITUITARY MRI:The pituitary gland shows homogeneous contrast enhancement without focal lesion. It is not enlarged. The pituitary infundibulum is of normal thickness and is midline. The cavernous sinuses are also normal.

Output: 1.While this study is not optimal for vascular assessment, there is suggestion of a complex appearing 7 mm saccular aneurysm arising from a mildly dilated left internal carotid artery terminus. There is no intracranial hemorrhage. Dedicated cranial MR angiography without contrast is recommended.2.There is extensive mucosal thickening and fluid in the paranasal sinuses. In the proper clinical setting, this may reflect sinusitis, which may account for or contribute to patient's symptoms.3.There is no brain abnormality.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Rita M Rossi-Foulkes over the phone on December 31, 2015 at 1643 hours.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with metastatic lung cancer, follow-up brain METs. Well demarcated T2 hyperintense lesions in the left inferior cerebellar hemisphere, gray white matter junction of the left frontal lobe, right parietal lobe, and right posterior occipital lobe are not significantly changed in size or signal characteristics. The reference left inferior cerebellar hemisphere lesion measures 7 x 9 mm and previously measured 7 x 9 mm (image 7, series 701). There is some intrinsic T1 hyperintensity at the site of these lesions but no significant enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No significant interval change in the size and signal characteristics of the cerebellar and hemispheric lesions compared with the prior exam. No new lesions identified.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female patient with Crohn's disease and fistula in 6/2015. Evaluate for perianal Crohn's disease. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered small mesenteric lymph nodes.BOWEL, MESENTERY: There is an 8 cm segment of rectum and distal sigmoid colon with mild wall thickening and increased edema signal that extends to the anal verge with enhancement. The ischiorectal fat is indurated and there is an enhancing left anterior transsphincteric perianal fistula that extends from the 2:00 position to the left perineum (series 9 image 76). There is also a blind ending tract extending from the anterior anus, 12:00 position (series 9 image 74).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left anterior transsphincteric perianal fistula extending to the left perineum.2.Blind ending tract from the anterior anus.3.Active inflammatory changes of the rectosigmoid colon compatible with history of Crohn's disease.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with a history of metastatic thyroid cancer, please compare to previous CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules demonstrate diffuse increase in the size.Reference left costophrenic nodule (image 240, series 6) measures 8 mm x 6 mm, previously, measuring 6 mm x 4 mm..Focal opacity with branching appearance in the superior segment of the left lower lobe (image 61, series 7) may represent inspissated mucus within a dilated bronchus.MEDIASTINUM AND HILA: Partially visualized heterogeneous thyroid mass is again noted.Prominent prevascular, precarinal, and subcarinal lymph nodes are stable.Moderate coronary artery calcifications with a stent identified in the LAD.CHEST WALL: Sclerotic focus within the manubrium is stable compared to prior exam dated 11/20/10ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The hypodense lesion in the inferior pole. The right kidney is unchanged and may represent a complex cyst however neoplasia cannot be excluded. Dedicated renal CT and/or MRI is recommended.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Multiple pulmonary nodules demonstrating diffuse increase in size compatible with progression of disease. No new sites of disease can be identified.


Instruction: Generate impression based on medical findings.

Input: 77 year old male with a history of lymphoma, cardiomyopathy, hypertension, hyperlipidemia, diabetes, and chronic kidney disease. Etiology of cardiomyopathy unclear.MEDICATIONS: Alendronate, Iron, Finasteride, Folic Acid, Glipizide, Insulin, Lisinopril, Metformin, Potassium, Sitagliptin. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is a small non-transmural myocardial infarction involving the apical inferior wall and a very small focal transmural myocardial infarction involving the apical anterior wall, based on late gadolinium enhancement. The remainder of the myocardial is free of myocardial infarction, fibrosis, inflammation, or infiltration. The majority of the myocardium is viable.Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 126 ml (normal range 47+/-19), the LV mass index is 68 g/m2, and the LV mass is 140 g. There is hypokinesis of the apical inferior wall. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 96 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The proximal portion of the descending thoracic aorta is mildly dilated (34mm). Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity may be limited in individuals with reduced ejection fraction.2. There is a small non-transmural myocardial infarction involving the apical inferior wall and a very small focal transmural myocardial infarction involving the apical anterior wall. The remainder of the myocardial is free of myocardial infarction, fibrosis, inflammation, or infiltration. The majority of the myocardium is viable.3. Mild left ventricular dilation with mildly reduced systolic function (LVEF 45%). There is hypokinesis of the apical inferior wall.4. Normal RV size with mildly reduced systolic function (RVEF 49%).5. Proximal portion of the descending thoracic aorta is mildly dilated.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: History of meningioma status post resection. Signs and symptoms: Surveillance. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates chronic postoperative changes upper left parietal craniotomy. There is a focus of encephalomalacia and gliosis under the craniotomy flap.Post enhanced images demonstrate minimal enhancing epidural thickening at the craniotomy site however without convincing evidence of residual or recurrence of tumor. Further follow-up however these needed.Multiple periventricular and subcortical foci of flair hyperintensity without interval change since prior exam are identified. The findings are nonspecific however possibilities of demyelinating disease and small vessel ischemic strokes should be considered. Some of the lesions have a perpendicular course to the ventricular system which could represent demyelinating plaques. Correlate with history and risk factors.

Output: 1.Chronic changes of left parietal craniotomy without evidence of residual or recurrent soft tumor. Further follow-up is recommended.2.Negative diffusion weighted series.3.Stable multiple foci of flair hyperintensity in the periventricular and subcortical white matter without enhancement. Some of the lesions appear perpendicular to the ventricular wall and could represent demyelinating disease. Small vessel ischemic strokes cannot be entirely excluded


Instruction: Generate impression based on medical findings.

Input: 73 year-old female status post left lumpectomy and radiation therapy in 2006. Left breast reconstruction. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 8.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A linear opaque marker overlies a scar on the left breast at the 6 o'clock position. Stable postsurgical architectural distortion of the left breast present. Benign dystrophic calcifications in the left breast again noted. ATEC clip within the central left breast from 2006 MRI guided biopsy unchanged. No dominant mass, suspicious microcalcifications or new areas of architectural distortion in either breast. Surgical clips project over left axillary region

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 53 year old male with recent diagnosis of pulmonary sarcoidosis, and biventricular dysfunction. Referred for cardiovascular MRI to evaluate for cardiac sarcoid. Left VentricleThe left ventricle is mildly dilated with severely depressed systolic function. There is severe global hypokinesis with systolic and diastolic septal flattening. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 226 ml (normal range 142+/-34), the LV end systolic volume index is 88 ml/m2 (normal range 25+/-9), the LVESV is 187 ml (normal range 47+/-19), the LV mass index is 79 g/m2 (normal range 85+/-15), and the LV mass is 171 g (normal range 164+/-36). There is late gadolinium enhancement of the inferior RV insertion point. The pattern is well described in patients with pulmonary hypertension. There is also a mid-wall/epicardial stripe of late gadolinium enhancement involving the basal to mid septal wall. The finding is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding supports the diagnosis of cardiac sarcoidosis but it is unclear whether it represents sarcoid in the inflammatory stage or in the fibrotic stage. Cardiac FDG-PET may be helpful to differentiate these possibilities. No LV apical thrombus is noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 11%, the RV end diastolic volume index is 179 ml/m2 (normal range 82+/-16), the RVEDV is 384 ml (normal range 142+/-31), the RV end systolic volume index is 159 ml/m2 (normal range 31+/-9), and the RVESV is 341 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation. AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (34mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLymph nodes and lung changes consistent with sarcoid noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild LV dilation with severely reduced systolic function (LVEF 17%).2. Severe RV dilation with severely reduced systolic function (RVEF 11%). Systolic flattening of the interventricular septum suggesting increased RV systolic pressure.3. There is late gadolinium enhancement of the inferior RV insertion point. The pattern is well described in patients with pulmonary hypertension. There is also a mid-wall/epicardial stripe of late gadolinium enhancement involving the basal to mid septal wall. The finding is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The finding supports the diagnosis of cardiac sarcoidosis but it is unclear whether it represents sarcoid in the inflammatory stage or in the fibrotic stage. Cardiac FDG-PET may be helpful to differentiate these possibilities. 4. Severe right atrial dilation.5. At least moderate tricuspid regurgitation. Findings discussed with Dr. Estrada.


Instruction: Generate impression based on medical findings.

Input: CHF admitted with ADHF requiring inotropes, reported recent stroke at OSH. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There are a few scattered, punctate foci of susceptibility effect in the cerebral white matter, which may represent chronic microhemorrhages. There is mild diffuse, primarily periventricular white matter T2 hyperintensity. There are small areas of encephalomalacia in the right inferior cerebellar hemisphere and right paracentral lobule. There is no abnormal intracranial enhancement. 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. There is degenerative spondylosis in the imaged upper cervical spine, which is otherwise incompletely characterized.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2. Probable chronic small vessel ischemic white matter disease and small chronic right cerebellar hemisphere and right paracentral lobule infarcts.3. Mild diffuse cerebral volume loss.4. Degenerative spondylosis in the imaged upper cervical spine, which is otherwise incompletely characterized.


Instruction: Generate impression based on medical findings.

Input: Adenoid cystic carcinoma of the left floor of mouth. There is an enhancing mass centered the left floor of mouth that measures up to approximately 50 mm. The tumor has eroded into the lingula aspect of the left mandible and extends into the left submandibular space with mass effect upon the glossotonsillar sulcus. The tumor does not extend across the midline. There are denervation changes in the left tongue, but there is no evidence of perineural tumor in the region of the skull base. There is an enlarged left level 1B lymph node that measures 12 x 19 mm in axial section. The right submandibular gland and bilateral parotid glands are unremarkable. There is a right palatine tonsillary crypt retention cyst. The thyroid gland is unremarkable. The imaged orbits and intracranial structures are unremarkable. There is mucosal thickening in the bilateral ethmoid and maxillary sinuses. There is multilevel degenerative cervical spondylosis.

Output: 1. The adenoid cystic carcinoma of the left floor of mouth measures up to approximately 50 mm and has eroded into the lingula aspect of the left mandible and extends into the left submandibular space. 2. An enlarged left level 1B lymph node may represent metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of bronchus and lung, unspecified site [162.9], Reason for Study: ^Reason: Evaluate for abnormality; Hx. SCLC History: None There is about 10.5 mm sized ring-enhancing lesion on the right frontal lobe with significant surrounding edema indicating metastatic nodule.No other enhancing lesion is found.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Right maxillary sinus opacification.

Output: About 10 mm sized metastatic nodule on the right frontal lobe with significant surrounding edema consistent with metastatic lesion.


Instruction: Generate impression based on medical findings.

Input: Male 30 years old status post OLT in 1987 for biliary atresia admitted with conjugated hyperbilirubinemia and diarrhea. Evaluate for biliary dilation. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of liver transplant. Nodular, cirrhotic liver morphology. Atrophic right hepatic lobe with reticular T2 hyperintensity is consistent with fibrosis. There is compensatory hypertrophy of the left lobe.Again seen is multifocal intrahepatic biliary ductal stricturing and dilatation. The common duct is not well seen which may be related to technique particularly as there is no upstream biliary ductal dilatation. The overall appearance is concerning for multifocal strictures.There is a new subcentimeter intrinsically T1 hyperintense, mildly enhancing lesion in hepatic segment 2 (series 18, image 24) with no washout is nonspecific, attention on follow-up imaging is recommended. The hepatic vasculature is patent.SPLEEN: Mild splenomegaly measuring 16 cm in craniocaudal dimension.PANCREAS: Unchanged mild narrowing of mid-body main pancreatic duct with stable upstream ductal prominence. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst. Stable mild prominence of the left collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small bilateral pleural effusions and associated atelectasis.

Output: 1. Cirrhotic liver morphology with right hepatic lobe fibrosis.2. Accounting for differences in technique stable multifocal intrahepatic biliary stricturing. The common duct is not well seen which may be related to technique as there is no upstream biliary ductal dilatation.3. Small bilateral pleural effusions.4. Mild splenomegaly.5. Additional findings as above.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of brain, unspecified site [191.9], Reason for Study: ^Reason: history of cervical astrocytoma s/p resection History: off therapy evaluation Redemonstration of ill-defined diffuse high signal intensity lesion on FLAIR and T2-weighted imaging on the mandibular and cervicomedullary junction intra-axial lesion, maximum diameter on sagittal scan was measured around 29.4 mm x 14 mm. The lesion does not show any gadolinium enhancement, nor does not show any evidence of hemorrhagic foci within the lesion. Approximate size of the mass and MR characteristics do not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Previously seen right maxillary sinus opacification has been cleared.C-spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.There is no evidence of degenerative changes of cervical spine.

Output: 1. Stable and no change in terms of size and MR characteristics of medullar and cervicomedullary junctional mass lesion since prior scan.2. Unremarkable C spine MRI.


Instruction: Generate impression based on medical findings.

Input: Medial joint pain MENISCI: There is attenuation of the posterior horn of the medial meniscus which may reflect changes of prior partial meniscectomy versus chronic attritional tearing. There is branching intermediate signal of the posterior horn of the medial meniscus which extends to both the tibial and femoral articular surfaces compatible with tear although this could also represent residual intrasubstance degenerative signal following meniscectomy. We suspect there is at least undersurface tearing of the posterior horn, however. There is mild medial extrusion of the body of the medial meniscus which also appears attenuated. The anterior horn of the medial meniscus is intact.There is attenuation of the posterior horn of the lateral meniscus which again may reflect changes of prior partial meniscectomy or chronic attritional tearing. There is obliquely and vertically oriented intermediate signal within the posterior horn which extends to the tibial articular surface which we suspect represents undersurface tearing although could represent residual intrasubstance degenerative signal following partial meniscectomy.ARTICULAR CARTILAGE AND BONE: There is moderate to severe degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle posteriorly with areas of full-thickness cartilage loss. A small focus of degenerative subchondral signal intensity is seen within the medial tibial plateau with mild degeneration of the overlying articular cartilage. There is moderate degeneration of the articular cartilage of the lateral compartment with full-thickness cartilage loss along the lateral femoral condyle and lateral tibial plateau adjacent to the posterior horn of the lateral meniscus. There is moderate degeneration of the articular cartilage of the patellofemoral joint. There are tricompartmental osteophytes.LIGAMENTS: The patient has undergone ACL reconstruction. Graft fibers can be traced from the femoral interference screw to the tibial interference screw and the graft itself is slightly ill-defined with intermediate signal intensity representing degeneration. Additional adjacent intermediate-low signal intensity is thought to represent scarring. Degenerative signal intensity is also seen within the lateral collateral ligament proximally with the remaining major ligaments intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial and lateral meniscus abnormalities as described above likely represent a combination of postmeniscectomy changes and degenerative tearing.2. Surgical changes of ACL reconstruction with intact graft showing features of degeneration and adjacent scarring.3. Osteoarthritis further detailed above; loose body noted within a Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: 59 years Male (DOB: 6/25/1957)Reason: evaluate for inflammatory lesions or tumors History: new onset facial palsy and other focal deficitsPROVIDER NAME: JAMES R. BRORSON JAMES R. BRORSON 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.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There appears to be a 6 mm in the distal right vertebral artery just proximal to the origin of the right posterior inferior cerebellar artery.The visualized portions of the paranasal sinuses demonstrate partial opacification of the posterior ethmoid air cells and mucosal thickening in the right frontal sinus as well as a mucous retention cysts in the maxillary sinuses. 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. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is a 2mm T2 hyperintense focus in the right hemicord at the C6 vertebral level.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. There is left-sided facet hypertrophy present at this level associated with mild narrowing of the left-sided neural foramen.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. There are endplate and uncovertebral osteophytes at this level associated with narrowing of neural foramina. There are some mild endplate reactive changes present.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics. At the T5-6 level of the spinal cord is displaced anteriorly and mildly narrowed in its AP dimension, however no distinct lesion is identified associated with this. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: 1.There is mild displacement of the thoracic spinal cord anteriorly raising the question of a possible adhesion to the dura and herniation.2.Findings suggest a 6-7mm right vertebral artery aneurysm. A CT angiogram may help further evaluate this.3.A 2 mm lesion within the right hemicord at the C6 level is present. There is nonspecific and may relate to prior injury.


Instruction: Generate impression based on medical findings.

Input: Reason: 81 y/o male with met disease in liver (RCC), evaluate for progression on current chemotherapy regimen. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are approximately 6 hepatic lesions distributed through both lobes. Reference measurements are provided below. Lesions demonstrate a residual thin rim of enhancement with central necrosis in the majority of the lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Complex cystic lesion with dense calcification (correlate with prior CT imaging) in the left upper pole is unchanged. There are several other simple cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 8/30/2016 13:00:00)SEGMENT 8 LESION: 3.7 x 3.0 cm (Image 28, Series 1200); 4.3 x 3.2 cm on prior (6/7/2016) (Image 208, Series 9).SEGMENT 2 LESION: 2.2 x 2.0 cm (Image 28, Series 1200); 2.7 x 2.9 cm on prior (6/7/2016) (Image 209, Series 9).SEGMENT 6 LESION: 2.7 x 3.2 cm (Image 46, Series 1200); 3.4 x 2.5 cm on prior (6/7/2016) (Image 225, Series 9).

Output: Continued decrease in the size of the reference hepatic metastases.


Instruction: Generate impression based on medical findings.

Input: 40-year-old female with metastatic non-small cell lung carcinoma. Note is made of heterogeneous bone marrow signal which likely represents residual islands of red marrow. The foci of decreased bone marrow signal abnormality on T1 weighted images are hyperintense to skeletal muscle. No enhancing mass lesions are identified. The imaged musculature of the pelvis appears normal. Linear focus of signal void within the vagina consistent with a tampon. 4.3 cm right adnexal cystic lesion is likely physiologic in a menstruating patient of this age. Facet joint osteoarthritis affects the lower lumbar spine. Mild degenerative disc disease affects the imaged portion of the lower lumbar spine.

Output: No evidence of osseous metastatic disease affecting the sacrum, as clinically questioned. The patient was called back for this additional imaging and will not be billed for this examination.


Instruction: Generate impression based on medical findings.

Input: Other disturbances of skin sensation [R20.8] / Malignant neoplasm of unspecified site of left female breast [C50.912], Reason for Study: ^Reason: concern for leptomeningeal disease on lumbar MRI, assess for in brain, cervical, and thoracic spine Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIThere are multiple low signal intensity vertebral bodies indicating possible sclerotic metastatic lesions involving C4, T2, T3 and T5 vertebral bodies. There is no evidence of cortical disruption or compression fracture.There is no evidence of spinal cord signal abnormality.There is a diffuse bulging of disc at the level of C45 and C6-7 which abuts thecal sac without evidence of spinal canal stenosis.No abnormal enhancement.Thoracic spine MRILow signal intensity lesions replacing normal bone marrow signal at T5, T7, T10T12, L1 and L2 vertebral bodies indicating possible sclerotic metastasis.Similar sclerotic lesions are also seen on bilateral ribs.In particular, the T7 vertebral body shows about 40% compression fracture without evidence retropulsion.There is no MR evidence of bone marrow edema.Spinal cord signal intensity is normal.There is no evidence of spinal canal stenosis.There is no evidence of abnormal enhancement.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Multiple vertebral body lesions involving both cervical and thoracic vertebrae indicating multifocal sclerotic bony metastasis.3. No evidence of abnormal enhancement on both cervical and thoracic region.4. Normal spinal cord signal intensity.5. About 40% compression fracture of T5 vertebral body.


Instruction: Generate impression based on medical findings.

Input: There is a rotatory subluxation at L1-L2 with 10 mm of rightward subluxation of the L1 vertebral body with respect to the L2 vertebral body. There is also loss of the normal lumbar lordosis. There are multilevel prominent anterior disc-osteophyte complexes. At the T11 level, there is an extradural rounded 9 mm diameter structure with low T2 and low T1 signal adjacent to the left facet joint with an effusion, which causes minimal mass effect upon the spinal cord. There is increased T2 signal intensity within the left-sided facet joint at this level. At T12-L1, there is a left paracentral disc herniation, which causes mild narrowing of the spinal canal, as well as moderate to severe left neural foraminal narrowing, but no significant right neural foraminal narrowing. At L1-L2, there is a disc bulge with considerable narrowing of the central spinal canal with impingement upon the nerve roots. The neural foramina are mildly narrowed bilaterally. At L2-L3, there is a disc bulge and facet hypertrophy with moderate to severe narrowing of the spinal canal. There is also mild left and moderate right neural foraminal narrowing. At L3-L4, there is a disc bulge and facet hypertrophy with severe narrowing of the spinal canal and the neural foramina are moderately narrowed bilaterally. At L4-L5, there is moderate disc bulge without narrowing of the central spinal canal and mild right and moderate left neural foraminal narrowing. At L5-S1, there is facet hypertrophy and a disc bulge with a superimposed left neural foraminal extrusion that results in severe left neural foraminal narrowing, but no significant spinal canal or right neural foraminal narrowing. The vertebral body heights are preserved. The bone marrow signal is unremarkable. There is atrophy of the paraspinal muscles.

Output: 1. A subcentimeter lesion in the spinal canal at the T11 level, adjacent to the left facet joint with an effusion may represent a synovial cyst or less likely a disc sequestration and causes minimal mass effect upon the spinal cord. 2. Lumbar scoliosis and 10 mm left lateral listhesis at L1-L2. 3. Multilevel degenerative spondylosis affecting the lumbar spine with considerable spinal canal and neural foraminal narrowing at certain levels.


Instruction: Generate impression based on medical findings.

Input: Reason: research History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.8 x 2.4 x 3.8 cm.Peripheral Zone: There is a 4 x 7 mm right apical posterior lesion with restricted diffusion on image #24, series #1303 consistent with prostate cancer. In addition in the mid prostate there are small foci on the right and left side of the peripheral zone close to the midline best seen on image #124, series #1303 consistent with prostate cancer.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: Unremarkable.Extracapsular Extension: Not present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right apical and bilateral mid peripheral zone cancer without evidence of extracapsular extension or seminal vesicle invasion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.