Instruction: Generate impression based on medical findings.

Input: Cervicalgia, paresthesias. Chronic low back pain, leg weakness, history of trauma. Cervical spine: The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis with minimal retrolisthesis of C4 on C5 and C5 on C6. Alignment is otherwise maintained. There is irregularity involving the left lateral mass of C1 with suggestion of loss of height on the left and may be on a degenerative basis; CT can better assess this finding if clinically warranted although there is no significant edema in this region to suggest acute inflammation in this region. There is moderate degree of bone marrow edema associated with facet arthropathy at the left C2-C3 facet joint. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal. There is moderate left and mild right neural foraminal stenosis with prominent facet arthropathy on the left as above.C3-4: There is no spinal canal stenosis. There is moderate to severe right neural foraminal stenosis related to severe right-sided facet arthropathy. There is mild facet arthropathy on the left and mild to moderate left neural foraminal stenosisC4-5: No significant compromise to the spinal canal. Bilateral uncovertebral hypertrophy and bilateral facet arthropathy, which is worse on the left. There is associated moderate to severe left and moderate right neural foraminal stenosis.C5-6: Severe loss of disc height with mild associated edema in the adjacent vertebral bodies. There is a disc osteophyte complex, bilateral uncovertebral hypertrophy, and bilateral facet arthropathy with moderate spinal canal stenosis. There is severe bilateral neural foraminal stenosis.C6-7: Small disc defect complex and bilateral uncovertebral hypertrophy. Mild spinal canal narrowing and moderate to severe bilateral neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal. There is mild to moderate left and mild right neural foraminal stenosis. There is bilateral facet arthropathy with mild distention of the facet joint on the left.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits aside from straightening of the normal lordotic curvature. There is severe loss of disc height at the L5-S1 level with suggestion of vacuum phenomena. There is also disc desiccation at L4-L5 with minimal overall height loss. There is suggestion of a pars defect or cleft involving the left L5 posterior neural arch (not well evaluated with MRI) but without associated edema.Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: Mild disc bulge with dorsal annular fissure and moderate facet arthropathy, worse on the left. There is no significant spinal canal stenosis. There is mild left and minimal right neural foraminal narrowing.L5-S1: There is a disc bulge without significant spinal canal stenosis. There is moderate right neural foraminal stenosis and mild left neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. Degenerative changes throughout the cervical spine, worst at the C5-C6 level where there is moderate spinal canal stenosis and severe bilateral neural foraminal stenosis. There is also multilevel cervical facet arthropathy including edema associated with the left C2-C3 facet arthropathy. Additional levels in the cervical spine as detailed above. 2. Degenerative changes in the lumbar spine, particularly at the L5-S1 level. There is no significant spinal canal stenosis at any level in the lumbar spine. There is moderate right and mild left L5-S1 neural foraminal stenosis. There is also facet arthropathy in the lumbar spine, worst at the left L4-L5 level.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of cholangiocarcinoma, possibly metastatic. History of NSTEMI. Septic shock, concern for abscess. Hypotensive. LUNGS AND PLEURA: Intubated. Predominantly upper lobe emphysema. Mild reticular opacities in the lung bases. Linear opacity in the left lung base likely represents atelectasis or scarring. No pleural effusions. Several scattered micronodules are present, several of which are calcified and likely related to prior granulomatous disease. The largest noncalcified lung nodule measures 3 mm in the right upper lobe. There is new bilateral lower lobe consolidation and volume loss. MEDIASTINUM AND HILA: Calcified right hilar and mediastinal lymph nodes are likely due to prior granulomatous disease. Other small mediastinal and hilar lymph nodes are present, but no significantly enlarged mediastinal or hilar node. Aortic and coronary atherosclerotic calcifications are present. Cardiomegaly. The orientation of the heart within the thorax is abnormal with posterior displacement of the ventricles. The pericardium is seen at the level of the right AV groove, but elsewhere, pericardium is not clearly apparent. This raises the possibility of partial absence of the pericardium, which could explain the abnormal orientation of the heart. CHEST WALL: Degenerative changes affect the thoracic spine.ABDOMEN: LIVER, BILIARY TRACT: There is a poorly defined hepatic mass with intrahepatic biliary dilatation in the left lobe. Multiple new hypodensities have appeared throughout the liver since the prior MRI exam. The dominant left lobe mass in hepatic segment 2/3 is larger and now measures 7 x 7 cm, associated with intrahepatic biliary dilation in left lobe; findings most consistent with cholangiocarcinoma (series 4, image 79). The fat layer between this exophytic mass and the pancreas appears preserved. The mass occludes the left bile duct approximately 1 cm from confluence, however, the confluence itself appears unaffected. Left hepatic and portal veins are obliterated by mass. The middle hepatic vein passes immediately lateral to mass but appears unaffected. No extrahepatic biliary ductal dilation. New metastasis in the posterior inferior right hepatic lobe measures more than 4 cm in diameter (image 93 of series 4). The metastases have indistinct margins. The new smaller hepatic hypodensities have better defined borders and may represent metastases vs. septic emboli, although metastases are more likely. There is an accessory left hepatic artery arising from the left gastric artery. The left gastric artery arises directly from the aorta adjacent to the celiac trunk (series 17, image 57). SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic calcification, probably from prior pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is diffuse retroperitlymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New moderate ascites. IVC filter is in place. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Foley catheter in a decompressed urinary bladder. There is an reservoir for the patient's penile prosthesis in the expected position adjacent to the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A rectal tube is in expected position.BONES, SOFT TISSUES: Degenerative changes of the lumbosacral spine and pelvis.OTHER: Moderate ascites. Probable carcinomatosis of the mesentery.

Output: Findings consistent with left liver lobe cholangiocarcinoma. Dominant left lobe mass is larger since 10/12/2011, and multiple new hepatic hypodensities have appeared. New hepatic metastases. New moderate ascites. New bilateral lower lobe consolidation / volume loss.New diffuse omental density suggests carcinomatosis.


Instruction: Generate impression based on medical findings.

Input: A 16 year old female with syncope and echocardiographic findings of suspected interatrial shunt. Also noted to have right ventricle enlargement with mildly reduced systolic function. Referred for cardiac MRI to further evaluate these findings Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 148 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 36 g/m2 (normal range 67+/-11), and the LV mass is 62 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The LA volume is 54 ml. There is a small PFO or ASD noted with predominantly left-to-right shunting with saturation band technique. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 91 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 83 ml (normal range 35+/-13). No RV wall motion abnormalities or sacculations/aneurysms noted. Indexed RVEDV meets pat of the minor criteria for ARVC.Right AtriumThe right atrium is normal in size. The RA volume is 76 ml.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 trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Coronary arteriesThe coronary arteries have normal origin.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. The left ventricle is normal in size and systolic function, the LVEF is 56%. 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.2. The right ventricle is normal in size with low systolic function, the RVEF is 47%. No wall motion abnormalities noted of the RV wall in this study. Indexed RVEDV was 91 mL/m2 meeting part of the one of the minor criteria for ARVC. 3. Small PFO/ASD noted. Qp:Qs not calculated.4. Normal origins of the coronary arteries.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: 21-year-old female with Crohn's disease with abdominal pain and loose stools. Evaluate for active terminal ileitis. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. 8 mm hemangioma in the right hepatic lobe noted (series 5/11).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is narrowing of the terminal ileum over a length of approximately 4 cm with mild-to-moderate bowel wall thickening and increased enhancement, most compatible with active inflammatory bowel disease. There is mild upstream dilation of ileum proximal to the terminal ileum. Superior to the terminal ileum, there is mild enhancing phlegmonous change within the mesenteric fat without evidence of abscess or obvious fistula. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings most compatible with active inflammatory bowel disease involving the terminal ileum with adjacent phlegmonous change without abscess or obvious fistula.


Instruction: Generate impression based on medical findings.

Input: history of possible testicular mass on CT. RIGHT TESTIS: The testicular echotexture is homogenous. Blood flow is normal. Right testicle measures 3.4 x 2.6 x 4.2 cm.LEFT TESTIS: The testicular echotexture is homogeneous. Blood flow is normal. The left testicle measures 3.2 x 2.0 x 4.7 cmRIGHT EPIDIDYMIS: The right epididymis measures 0.9 x 0.6 cm.LEFT EPIDIDYMIS: The left epididymis measures 0.6 x 1.2 cm. A left epididymal cyst measuring 0.3 x 0.5 cm is visualized.OTHER: Bilateral small varicoceles.

Output: Bilateral small varicoceles are present. Left-sided epididymal cyst.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: 60-year-old male with effusion, left ankle neurofibromatosis, unspecified. Evaluate cause of swelling, patient with neurofibromatosis and multiple invasive neurofibromas. There is a joint effusion within the subtalar joint and sinus tarsus which demonstrates low T1 signal, intermediate T2 signal with enhancement compatible with synovitis. There is fluid and thickened synovium within the tendon sheath of the posterior tibialis tendon compatible with tenosynovitis. There is thickening and stranding of the adjacent medial subcutaneous tissues compatible with inflammatory changes. The posterior tibialis muscle appears normal. The remaining tendons and muscles of the ankle appear normal. Within the anterior calcaneus there is an area which demonstrates low T1 signal and intermediate T2 signal with mild enhancement in a tubular configuration compatible with a vascular remnant, which is a normal variant and of no clinical significance. Otherwise the bone marrow signal appears normal.The ligaments of the ankle appear normal.

Output: 1. No findings to suggest neurofibromatosis in the left ankle.2. Synovitis of the subtalar joint and sinus tarsus.3. Tenosynovitis of the posterior tibialis tendon with adjacent inflammatory changes in the medial subcutaneous soft tissues.4. Normal variant vascular remnant within the calcaneus, of no clinical significance.


Instruction: Generate impression based on medical findings.

Input: 68-year-old man with history of elevated PSA of 3.7 in August 2016, 2.5 last year. PELVIS:PROSTATE:Prostate Size: 55 x 45 mmPeripheral Zone: There is a very small focus of decreased T2 signal and abnormal ADC signal in the left apex (801/6 and 508/104) which measures less than 5 mm.Central Gland: Multiple BPH nodules are noted.Seminal Vesicles: There is nonspecific low T2 signal within the seminal vesicles, however there is no mass or lesion.Extracapsular Extension: No extracapsular tumor.BLADDER: The enlarged central gland impresses upon and distorts the bladder.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Very small suspicious focus of signal abnormality in the left apical peripheral zone.2.Markedly enlarged central gland with BPH nodules.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with history of left buttock abscess status post I&D 2 weeks ago now with increased drainage in the setting of chronic immunosuppression on steroids and a history of total hip replacement with revision (2002, 2012). Assess extent of abscess cavity and possible joint involvement. Evaluation of the hip and surrounding soft tissues is limited due to metallic susceptibility artifact resulting from the patient's total arthroplasty and acetabular reconstruction. There is a nonenhancing collection of heterogeneous signal intensity on T2-weighted images along the medial margin of the left gluteus maximus muscle that extends through the skin best seen on image 33 of series 1102 which presumably represents residua of the patient's known draining buttock abscess perhaps containing packing material. The collection is approximately 4 cm x 1 cm in transverse dimension and 6-7 cm in oblique craniocaudal dimension tracking from the skin towards the ischial tuberosity; however we see no signal abnormality within the ischium to indicate osteomyelitis. There is surrounding soft tissue inflammation involving the skin, subcutaneous fat and the gluteus maximus muscle. This inflammation also extends anteriorly and laterally to involve the quadratus femoris and adductor muscles of the hip but we see no direct communication with the hip joint itself.The conjoined tendon of the hamstrings is avulsed from its origin on the ischial tuberosity and there is a tear of the proximal semimembranosus tendon such that only a few strands are seen extending to the ischium. Edema extends inferiorly along the hamstrings however this may reflect a chronic tear rather than an acute tear.There is bandlike signal abnormality tracking through the subcutaneous fat of the lateral hip region which likely represents a scar related to the patient's prior surgery. There is edema in the adjacent subcutaneous fat. Small collection of near-fluid signal intensity with thin enhancing margins and septa in the soft tissues along the cranial extent of the hardware measuring 2 cm x 1 cm x 3 cm which we suspect likely represents a small seroma, with a small abscess considered less likely. There is atrophy of the left gluteus minimus and medius muscles as well as fatty atrophy of the left iliopsoas muscle.There is a collection of heterogeneous high signal intensity on T2-weighted images along the medial aspect of the proximal femur extending inferiorly off the field of view of the study. It is surrounded by a rim of low signal intensity which corresponds to ossification seen on recent radiographs. We suspect that this finding represents a prior subperiosteal hemorrhage with subsequent bone formation rather than representing an infectious process as it does not appear to communicate with the aforementioned abscess cavity.A few mildly enlarged inguinal lymph nodes are noted on the left. Evaluation of the right hip on the large field-of-view images is limited by metallic susceptibility artifact resulting from the patient's total hip arthroplasty. Note is made of heterotopic ossification along the gluteal tendons. Degenerative arthritis affects the visualized lower lumbar spine.

Output: 1.Postoperative changes as described above.2.Draining buttock abscess cavity and surrounding inflammation as described above. We see no evidence to suggest joint involvement.3.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Reason: patient with b/l knee ulcerations and zygomycetes infection. Eval for extension of infection History: above There are ulcerations affecting the soft tissues of the knee. The largest is situated just below the patella with nonenhancing near-fluid-signal-intensity extending to the inferior pole of the patella disrupting the attachment of the patellar tendon indicating a complete or near complete tear. The patella itself is slightly high riding and there is undulation of the distal quadriceps tendon. There also may be a small erosion along the inferior margin of the patella with edema within the adjacent bone, concerning for osteomyelitis. There is a thin elongated rim-enhancing collection superficial to the medial retinacular structures measuring 3.3 x 0.7 x 3.1 cm, which could represent a small abscess. This may communicate with the aforementioned large anterior ulceration, but this is equivocal. There is extensive edema within the subcutaneous fat, some of which becomes confluent. There is a moderate-sized joint effusion with thickened and enhancing synovium. This may also communicate with the aforementioned large anterior ulceration, but this is equivocal. Nonetheless, this is concerning for septic arthritis. We see no erosions within the femur or tibia. While this study was not protocoled for detailed evaluation of the articular cartilage, we see no definite articular cartilage defects. The cruciate and collateral ligaments appear intact.

Output: 1. Large anterior soft tissue ulceration associated with disruption of the proximal patellar tendon and joint effusion as well as a thin elongated rim-enhancing fluid collection along the medial retinacular structures which may communicate with this ulceration but this is equivocal.2. Edema within the patella with possible focal erosion of the inferior pole of the patella which is concerning for osteomyelitis.These findings were discussed with Dr. Bacaloa, by phone at 1:15 PM on 2/17/2016.


Instruction: Generate impression based on medical findings.

Input: 54 year old with a history of left nipple-sparing mastectomy and sentinel node biopsy for DCIS/ADH with reconstruction in 09/2011. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast. The patient is status post left mastectomy and reconstruction.No abnormal enhancement is seen in either the right breast or left reconstruction. A few scattered cysts are present in the right breast. A few scattered enhancing foci are similar to the prior study. No abnormal lymph nodes are identified in either axillary region.A few tiny high T2 signal hepatic lesions are probably benign such as cysts.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 61 year old female referred for cardiovascular MRI to evaluate etiology of heart failure. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. Mild concentric left ventricular hypertrophy. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 155 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 80 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 132 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a borderline region of increased signal on the late gadolinium enhancement images along the basal anterolateral wall of unclear significance which could represent a small amount of mild underlying fibrosing, infiltrative, or inflammatory process; however, I suspect it is more likely an imaging artifact.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 136 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trivial pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trace pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is normal in size with mild left ventricular hypertrophy and mildly reduced systolic function (LVEF 49%). There is probably no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Right ventricle is normal in size with normal systolic function RVEF 55%)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: Again seen is an arachnoid cyst in the right posterior fossa extending into the right cerebellopontine angle cistern that currently measures 5.1 x 2.8 cm, previously 5.2 x 3.2 cm. There is a stable mass effect on the right cerebellar hemisphere and right cerebellar peduncle. There are no areas of abnormal signal in the parenchyma. Evidence of prior small right lateral suboccipital craniotomy for cyst fenestration. No evidence of acute infarct or hemorrhage. No other mass or mass effect. No hydrocephalus. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: No significant interval change in arachnoid cyst in the right posterior fossa.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old. Reason: Thyroid Cancer. Please assess lymph nodes in the lateral and central neck. RIGHT LOBE MEASUREMENTS: 2.2 x 2.4 x 6.9 cmLEFT LOBE MEASUREMENTS: 2.2 x 2.9 x 6.9 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Heterogeneous echotexture. A right lower pole nodule measures 1.5 x 0.7 x 1.1 cm, ovoid, hypoechoic, noncalcified, without significant internal vascularity.LEFT LOBE: Heterogeneous echotexture. A left lower pole nodule measures 1.8 x 0.8 x 1.5 cm, heterogeneous, with internal echogenicity which may reflect calcification.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 2 lymph node measures 0.9 x 0.5 x 2.5 cm, with a fatty hilum. A left level 2 lymph node measures 1.0 x 0.4 x 1 .2 cm, with heterogeneous echotexture and suggestion of a fatty hilum. A left level 3 lymph node measures 1.0 x 0.2 x 1.1 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: 1. Enlarged, heterogeneous thyroid with bilateral nodules as detailed above. The nodule on the left corresponds with the patient's known thyroid cancer.2. A left level 2 nonenlarged heterogeneous lymph node is nonspecific, but presence of a fatty hilum favors benignity. No other suspicious lymph nodes are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old, with relapsed multiple myeloma. Evaluate for bony lesions. Cervical:Ill-defined nonspecific STIR hyperintensity is seen within the C6 vertebral body. Elsewhere within the cervical spine, marrow signal characteristics are somewhat heterogeneous which is felt to be degenerative in nature. No definite additional concerning marrow replacement is seen. The visualized spinal cord demonstrates normal signal characteristics. No epidural abnormalities are suspected.C2-3: Right facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Right facet hypertrophy. Mild posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac with a mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation resulting in effacement of the ventral thecal sac and slight flattening of the ventral cord. Mild to moderate generalized spinal canal stenosis. Severe bilateral foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation resulting in slight effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. Moderate left and severe right foraminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. C7-T1: Facet hypertrophy. Mild posterior disc-osteophyte complex formation. Mild bilateral foraminal narrowing. Thoracic:Hyperintensity and subtle T1 hypointensity is seen within the T2 and T4 vertebral bodies suspicious or pathologic marrow replacement. There may be scattered additional very small foci of T1 hypointensity within the vertebral bodies, but image resolution does not permit definitive diagnosis in this regard. Left lateral fusion instruments and strut grafts are noted spanning from T9 through L1, and artifact from these devices does obscure osseous evaluation to some degree. Despite this, it does appear that the left transverse process of T10 is expanded which probably reflects marrow space disease.Alignment is anatomic. Vertebral body heights are preserved. The visualized thoracic spinal cord shows no abnormal signal. No epidural abnormalities are suspected. Minimal scattered degenerative disc disease is seen without significant spinal canal or foraminal stenosis, though assessment of the foramina is somewhat limited in the instrumented region due to artifact.Lumbar:There are five lumbar type vertebral bodies with a transitional S1. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are somewhat heterogeneous. Superimposed upon this, there are numerous very small foci of T1 hypointensity involving every lumbar level. Larger foci of marrow replacement on the order of 1 cm are seen within the left sacrum and the iliac wings.The distal spinal cord, conus and cauda equina demonstrate normal morphology. No epidural abnormalities are seen.Facet hypertrophy and ligamentum flavum thickening become progressively worse at lower lumbar levels. However, there is no significant disc bulging or disc herniation. The spinal canal remains patent throughout. Mild left neuroforaminal narrowing is seen at L5-S1.

Output: 1.Pathologic marrow signal is seen within the C6 vertebral body, the T2 and T4 vertebral bodies, the left T10 transverse process, and the sacrum and iliac bones highly suspicious for metastatic disease. There may be additional scattered very small foci of marrow replacement within the lumbar spine and elsewhere which could also indicate metastatic disease.2.Postoperative findings compatible with lateral instrumented fusion and partial corpectomy are seen spanning from T9 through L1. Elsewhere, vertebral body height and morphology are within normal limits. No compression deformities are identified. No epidural tumor is seen, and no tumor related spinal canal encroachment is detected.3.Degenerative disease is seen in the cervical spine with scattered spinal canal stenosis ranging from mild to moderate and scattered foraminal narrowing.


Instruction: Generate impression based on medical findings.

Input: Unilateral asymmetric enlargement of the atrium of the right lateral ventricle is seen likely representing an intraventricular cystic lesion measuring 16 x 12 mm in the axial plane. There are no findings to suggest acute or chronic blood product within this lesion. No brain parenchymal abnormalities are identified otherwise. There is no significant mass effect or midline shift. The remainder of the ventricular system is normal in size and morphology.

Output: Findings suggesting the presence of a choroid plexus cyst within the right ventricular atrium without evidence of hemorrhage.This exam was discussed with Dr. Sarosh Rana from Obstetrics/Maternal Fetal Medicine at 3:10 p.m. today.


Instruction: Generate impression based on medical findings.

Input: Mental status change. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged punctate foci of T2 hyperintensity in the right frontal lobe white matter. The ventricles and extra-axial cerebrospinal fluid spaces 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: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Unchanged nonspecific punctate foci of T2 hyperintensity in the right frontal lobe white matter.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for sacroiliitis, inflammatory back pain There is no evidence of fracture or malalignment. Tiny osteophyte along the right SI joint but no fluid or enhancement within the SI joint to indicate sacroiliitis. There is benign-appearing cortically based lesion in the proximal right femur, which is incompletely imaged on this study, but of doubtful clinical significance and likely correlates with lucent lesion seen on CT from 7/20/2010. Otherwise bone marrow signal intensity is normal.There is small amount of fluid in the bilateral hip joints, which is normal. We see no synovitis. The muscles are within normal limits.Enlarged prostate is noted.

Output: Minimal osteoarthritis of the right SI joint, but no evidence of sacroiliitis. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Concern for CSF leak, infection. Recent resection of L1-L2 tumor. Five lumbar type vertebral bodies are presumed to be present. There is normal lumbar lordosis. Postsurgical changes of a left L1 hemi-laminectomy for tumor resection and posterior left L1-L2 fixation with pedicle screws and unilateral paraspinous rod are redemonstrated. Additionally, there appears to have been partial resection of the inferior aspect of the L1 vertebral body.There is a fluid collection extending along either side of the spinous processes from T12 to L3. The collection on the left measures 11 mm in thickness and 8 cm in its craniocaudal dimension and appears to communicate with the skin surface. While the fluid collection on the left has a relatively simple fluid appearance, the fluid collection on the right which measures approximately 9 cm in the craniocaudal dimension and 2 cm in thickness demonstrates significant heterogeneous signal, which likely reflects internal debris or blood products. There is peripheral enhancement associated with both collections. Increased enhancement of the paraspinal musculature, left greater than right, may reflect myositis. There is no evidence of epidural abscess or discitis/osteomyelitis. No residual tumor is definitively appreciated The vertebral body and disk heights are well-maintained. Disc desiccation and disc bulge with mild to moderate narrowing of the neuroforamina affects L5-S1. There is no significant spinal canal stenosis. No focal marrow signal abnormality is appreciated. The conus medullaris and cauda equina nerve roots are unremarkable.

Output: 1. Posterior paraspinous fluid collection from T11 to the L3 levels with peripheral enhancement and inflammatory changes in the adjacent musculature. Given recent surgery, differentials include seroma and pseudomeningocele with superimposed infection/abscess not excluded. The fluid collection component on the right demonstrates heterogeneous signal likely reflecting internal debris/blood products while the fluid collection on the left demonstrates signal features more compatible with simple fluid. The collection on the left appears to extend to the skin surface along the surgical tract. Fluid sampling is suggested for further evaluation.2. There is no epidural abscess or spinal canal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Evaluate right wrist fractureIMAGE ACQUISITIONS: CT of the right wrist was performed without contrast using the ultra high resolution protocol. There is a transverse fracture of the ulnar styloid. The bones appear in near anatomic alignment. There is a comminuted fracture of the radial aspect of the trapezium with it least two separate fragments adjacent to the main trapezium bone. There is mild displacement of the fracture fragments. There is a 2-mm ossific fragments in the just posterior and on the radial side of the lunate which which is likely a fragment from the trapezial fracture. Another 2-mm ossific fragment located just superior to the trapezium in between the trapezium and first metacarpal also is likely a fracture fragement given its proximity to the fracture trapezium comment this could be an acute fracture fragment.There is a 4-mm well corticated ossific density anterior to the lunate which does not appear to be an acute fracture fragment.There is slight widening of the scapholunate interval however this does appear stable. The patient had a previous MRI which shows a tear the scapholunate ligament which appear chronic.Small to moderate sized joint effusion is present.The remainder of the carpal bones, distal radius, and proximal metacarpal bones which are visualized on this study appear intact. No other fractures are identified.Cast material is seen surrounding the wrist.

Output: Fractures of the ulnar styloid and trapezium as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: 75F hx of chronic pancreatitis on prior EGD/EUS and family history of pancreatic cancer, evaluate pancreas for any changes. ABDOMEN:LIVER, BILIARY TRACT: There is normal signal intensity and homogeneous enhancement of the liver without focal lesion. No intra or extra hepatic biliary ductal dilatation is identified. There is a large stone in the gallbladder fundus. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No discrete pancreatic lesion is identified. There is mild atrophy of the pancreatic tail. There is slight irregularity of the main pancreatic duct but no focal stricture is identified. There is a slightly blunted response to secretin.ADRENAL GLANDS: Enhancing right adrenal nodule is again seen, measuring 1.7 x 0.9 cm, unchanged.KIDNEYS, URETERS: Status post right nephrectomy. The left kidney appears normal.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Normal bowel caliber without obstruction.BONES, SOFT TISSUES: No focal osseous lesion is identified.OTHER: No significant abnormality noted.

Output: 1.No focal pancreatic lesion is identified to suggest pancreatic malignancy.2.There is improved but mild residual peripancreatic inflammation with irregularity of the pancreatic duct and mild atrophy of the pancreatic tail. 3.There is a a slightly blunted response to secretin.4.Enhancing right adrenal nodule, which does not meet criteria for an adenoma. The differential diagnosis includes metastatic disease (given history of previous renal cell carcinoma) or a small pheochromocytoma.5.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Female, 15 years old. Knee pain, sports and swelling after dance injury MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is normal. No focal cartilage defects.LIGAMENTS: The cruciate and collateral ligaments are normal. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on medical findings.

Input: 50 year old female with hypertension, new LBBB, ?syncope, and family history of early coronary disease. She is referred to evaluate for ischemia and scar.MEDICATIONS: HCTZ First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 151 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 61 ml (normal range 31+/-10), the LV mass index is 52 g/m2, and the LV mass is 103 g. Abnormal septal motion consistent with LBBB.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 149 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 57 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac 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.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 60%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 62%).


Instruction: Generate impression based on medical findings.

Input: 68 year old man with significant burden of ventricular ectopy, referred for cardiac MRI for evaluation of possible underlying myocardial scar prior to EP study/ablation. 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 115 ml/m2 (normal range: 74+/-15), the LVEDV is 280 ml (normal range 142+/-34), the LV end systolic volume index is 63 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 151 g (normal range 164+/-36). LV dysfunction is global. There are 2 distinct regions of late gadolinium enhancement in a pattern that is atypical for prior myocardial infarction suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is mid-wall late gadolinium enhancement and involves the basal inferolateral wall and the basal anteroseptum. This pattern has frequently been described in old myocarditis, but can represent other non-ischemic etiologies as well. 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 47%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 265 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 140 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 no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.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. The left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%.2. There are 2 distinct regions of late gadolinium enhancement in a pattern that is atypical for prior myocardial infarction suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is mid-wall and involves the basal inferolateral wall and the basal anteroseptum and has frequently been described in old myocarditis, but can represent other non-ischemic etiologies as well. 3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%.4. Mild dilation of the main pulmonary artery.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: 74-year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.9 x 4.7 x 4.6 cm.Peripheral Zone: High T1 signal in the peripheral zone bilaterally due to hemorrhage, which limits sensitivity for cancer detection. Within this limitation, there is a single small focus of low T2 signal and restricted diffusion measuring up to 5 mm in the left base, most compatible with prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pathologic lymph nodes by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small focus in the left base peripheral zone, most compatible with prostate cancer. No evidence of extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: T4N2, WHO type III, nonkeratinizing EBV+ nasopharyngeal cancer, status post treatment. Orbits: The globes, ocular adnexa, optic nerves, and orbital fat are unremarkable, without evidence of intraorbital mass lesions. There are post-treatment findings in the nasopharyngeal region, where there is mild soft tissue swelling and associated persistent enhancement of the central skull base, but no measurable residual tumor in the soft tissues. Neck: There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter. The major cervical flow voids are grossly intact. There are secretions and mucosal thickening in the bilateral maxillary and ethmoid sinuses. There is bilateral tympanomastoid opacification. There is fluid within the bilateral mastoid air cells.

Output: 1. Post-treatment findings in the nasopharyngeal region without evidence of measurable tumor progression in this area and no evidence of intraorbital lesions. 2. Persistent enhancement of the central skull base is likely related to treatment-effects at the site of previous tumor infiltration.3. No evidence of significant cervical lymphadenopathy.4. Persistent bilateral otomastoid effusions, which may be attributable to Eustachian tube dysfunction and/or mastoiditis.5. Persistent evidence of acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: 74Yrs-old male with a history of CAD s/p failed PCI of PDA In 2004, admitted with dyspnea and new LV dysfunction, referred for ischemic evaluation.MEDICATIONS: ASA, losartan, nifedipine, coreg, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is present. Viability/ Myocardial ScarThere is a mid myocardial stripe of late gadolinium enhancement in the basal to mid septum. This pattern is not typical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The "mid wall stripe" pattern can be seen in non-ischemic dilated cardiomyopathies.Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 211 ml (normal range 142+/-34), the LV end systolic volume index is 86 ml/m2 (normal range 25+/-9), the LVESV is 157 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 137 g. LV dysfunction is global.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 111 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is apically displaced due to bi-leaflet tethering. There is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSee recent CT for lung findings. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction.3. Mildly dilated LV with severely reduced systolic function (LVEF 26%). There is a pronounced mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum. The pattern is atypical for prior myocardial infarction and most likely represents myocardial fibrosis. It has been commonly described in dilated cardiomyopathy.4. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male 49 years old; Reason: Left achilles tendon avulsion, tx'd w/o surgery, evaluate pain along Achilles insertion Three views of the left ankle again show marked thickening of the Achilles tendon compatible with tendinosis and tearing, as seen on prior MRI.Small foci of ossification posterior to the calcaneus appear similar to those seen in the prior study, and may represent avulsed fragments. A small focus of heterotopic ossification is again seen along the anterior margin of the Achilles tendon.

Output: Findings compatible with Achilles tendinosis and tearing, appearing similar to the prior study.


Instruction: Generate impression based on medical findings.

Input: Syncope. The study was initially protocoled along with MRA of the neck with contrast. However, the patient was unable to hold still for the examination despite premedication. Therefore, no contrast was given and the contrast-enhanced neck MRA was not performed. The study remains at least moderately limited by patient motion.Brain MRI: There is wedge shaped diffusion restriction involving the anterior-superior aspect of the left cerebellar hemisphere, associated with T2-hyperintense/T1-hypointense signal and mild swelling but no significant mass-effect on the fourth ventricle or other posterior fossa structures. This is compatible with an acute/early subacute infarct. There is T2-hyperintensity with volume loss in the left pons, compatible with encephalomalacia, most probably from previous infarct. There is moderate patchy T2-hyperintense signal in the cerebral white-matter as well, which probably represents chronic microvascular ischemia. There are multiple foci of susceptibility effect involving the right basal ganglia, compatible with punctate hemorrhages. There is no definite associated edema or T1 shortening. In fact, these are associated with mild but focal ex vacuo enlargement of the posterior body on the right lateral ventricle. Otherwise, there is moderate global brain volume loss resulting in expansion of the ventricles and other CSF-containing spaces. There is no midline shift or brain herniation. The sella is expanded and largely fluid-filled.The mastoid air cells are clear. There is trace mucosal thickening in the paranasal sinuses. There is no gross orbital abnormality. A small forehead lesion that is T1-hyperintense may represent a small sebaceous cyst.SusceptibilityCranial MRA:There is moderate irregularity and attenuation of flow-related signal in the right V4 segment, which probably reflects moderate atherosclerosis. The left vertebral artery and the basilar artery are patent but slightly irregular. Similarly, the other major intracranial vessels show irregularity likely related to atherosclerotic disease without large vessel occlusion. Note motion degradation limits assessment.

Output: 1.Examination moderately limited by motion.2.Acute/early subacute left cerebellar infarct, in the territory of the superior cerebellar artery.3.Chronic left pontine infarct and moderate cerebral chronic microvascular ischemia. Moderate brain volume loss.4.Punctate hemorrhages in the right cerebral hemisphere are likely chronic and may relate to hypertension.5.Diffuse moderate atherosclerosis of the intradural segment of the right vertebral artery. There is also atherosclerotic involvement of the other major intracranial vessels but no large vessel occlusion.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is a mixed signal T1 and T2 intensity lesion within the medial rolandic brain involving both sensory and motor cortices, measuring 17 mm AP by 13 mm transverse dimensions (as measured on axial T2 technique), unchanged in size or morphology. This is associated with susceptibility hypointense abnormality, however without perilesional edema. Postcontrast images demonstrate an associated developmental venous anomaly which drains posteriorly, superiorly, and medially. There are no other foci of susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no other masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Stable cerebral cavernous malformation involving left medial rolandic brain involving both sensory and motor cortices with an associated developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Brain MRI:There are numerous T2 hyperintense foci within the supratentorial and infratentorial brain. Several of the periventricular lesions are oriented in parallel fashion to the callosomarginal junction. Infratentorial lesions include lesions within the pons, cerebellar peduncles, cerebellum, and medulla. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes and there are no stenoses.Abnormal T2 hyperintense foci are found within the spinal cord in the following levels: C2, C3 (which is slightly expansile), C3/4, questionable C5 right posterolateral cord, C6, and questionable C7 right lateral cord.

Output: Numerous T2 hyperintense lesions within the supratentorial brain, infratentorial brain, and cervical spinal cord consistent with the provided history of multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: Motor vehicle accident. Possible re-tear of rotator cuff ROTATOR CUFF: There appears to be a partial articular sided tear of the supraspinatus near its insertion.. No evidence of retraction. No evidence of communication with the subdeltoid or subacromial bursa. The infraspinatus is normal. The subscapularis is normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: There is been a surgical tenodesis of the long head of the biceps tendon.

Output: Small articular sided partial tear of the supraspinatus.


Instruction: Generate impression based on medical findings.

Input: Meningoma in pituitary area: surveillance. There is no significant change in size of the lobulated homogeneously enhancing mass along the right planum sphenoidale, measuring up to 14 mm. There is associated mass effect upon the adjacent brain parenchyma optic apparatus, and anterior cerebral arteries. The pituitary gland and infundibulum are intact, with trace probable par intermedia cyst.

Output: No significant change in size of the right planum sphenoidale meningioma.


Instruction: Generate impression based on medical findings.

Input: History of liver mass. ABDOMEN:LIVER, BILIARY TRACT: There is a dominant 14.2 x 9.5 cm T2-weighted heterogeneously hyperintense mass infiltrating the right hepatic lobe with numerous adjacent smaller lesions in the right and caudate lobe. The mass extends into a branch of the right hepatic vein to the level of the IVC, compatible with tumor thrombus. The mass demonstrates restricted diffusion and thick peripheral enhancement with central nonenhancement suggesting central necrosis. On delayed imaging there is no significant washout.Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Free pelvic fluid is noted on the sagittal images. Moderate size hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Neoplastic tumor infiltration of the right hepatic lobe with right hepatic vein tumor thrombus extending to the level of the intrahepatic IVC.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Syringomyelia and syringobulbia Arnold-Chiari syndrome without spina bifida or hydrocephalusClinical question: Syrinx, yearly eval for changes/sizeSigns and Symptoms: yearly eval of syrinx Cervical spine:There is redemonstration of an 8 mm x 6 mm axial dimensions syrinx extending from the C5-6 disc space level down to the upper thoracic spine and centered at C7 which previously measured approximately 7 x 5 mm axial dimensions and extended from the C5-6 disc level. On the 2013 exam it measured 4.5 x 6 mm axial dimensions.The patient is status post Chiari decompression.The cervical vertebral bodies are appropriate in overall alignment and height. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The syrinx extends down to the C6-7 disc space level on the current exam and previously extended down to approximately the same level.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: Compared to prior exams over the past 2 years the patient's syrinx is currently larger in axial dimensions at the C7 vertebral level. The superior and inferior extent of the syrinx appears approximately the same.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Suspected NMO, vs necrotizing paraneoplastic myelitis. Please evaluate brain for involvement.Signs and Symptoms: severe transverse myelitis, abnormal VEP The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with prostate cancer. Planning confirmatory biopsy for active surveillance.Additional history per EMR:PSA 5.7 (March 2015)TRUS-guided prostate biopsy (May 2015) 1 of 12 cores positive for prostatic adenocarcinoma, left lateral apex, Gleason 3+3=6, <1mm (5% of submitted tissue) PELVIS:PROSTATE:Prostate Size: 4.5 x 4.2 cm.Peripheral Zone: No suspicious lesion is identified within the peripheral zone.Central Gland: The transitional zone is enlarged containing several nodules demonstrating benign morphology without suspicious characteristics.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No candidate lesion identified on imaging for patient's known prostatic adenocarcinoma.


Instruction: Generate impression based on medical findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9], Reason for Study: ^Reason: stroke History: dysarthria, left hypoesthesia Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear. Right eye globe shows dystrophic shape with the internal low signal intensities indicating phthisis bulbi.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 lesion.2. No evidence of flow-limiting arterial luminal stenosis on brain MRA and neck MRA.


Instruction: Generate impression based on medical findings.

Input: Unspecified cerebral artery occlusion with cerebral infarctionDiagnosis: Other malaise and fatigueClinical question: r/o acute processSigns and Symptoms: weakness MRI of the brainThere is diffusion restriction along the right MCA territory predominantly involving patchy areas along the right inferior and middle frontal gyri as well as the insular cortex. There are small foci of diffusion restriction along the right temporal lobe.There is subtle FLAIR signal hyperintensity in these areas of diffusion restriction.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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, left middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The right MCA flow voids are not readily recognized.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, left middle and posterior cerebral arteries. There is a high grade stenosis at the distal right m1 segment involving superior and inferior divisions.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the PCA bilaterally with a tiny right p1 segment and a small left p1 segment. The LVA is larger than the RVA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The origins of the vertebral arteries are tortuous.

Output: 1.Near complete occlusion of the right m1 segment of the MCA at the bifurcation and distal m1 segment with evidence for slow antegrade flow "outline sign" at the proximal right superior and inferior divisions.2.Acute cerebral infarction involving predominantly the right middle and inferior frontal gyri as well as the right insular cortex with associated smaller foci of infarction in the right temporal lobe.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for stenosis at the carotid bifurcation.


Instruction: Generate impression based on medical findings.

Input: 87-year-old woman with history of pancreatic mass on CT. ABDOMEN:LIVER, BILIARY TRACT: Scattered foci of calcification are seen in the liver, otherwise the liver is normal in signal and morphology. The gallbladder appears and there is no intra or extra hepatic biliary ductal dilatation.SPLEEN: The spleen appears normal.PANCREAS: Within the tail of the pancreas (series 3, image 11) there is a lobulated 39 x 32 mm, T2 hyperintense lesion with thin, mildly enhancing septae. The majority of these fluid locules are homogenous in signal intensity on both T2 and T1 sequences and similar in signal intensity to one another on T1 and T2 sequences. There is a similar lesion seen in the neck of the pancreas (series 3, image 8) measuring 14 x 14 mm. Finally, there is a subcentimeter area of T2 hyperintense signal in the body of the pancreas (series 3, image 12). The latter lesions appear to communicate with the pancreatic duct which is nondilated. The larger size of the lesion located in the pancreatic tail makes assessment for a definitive connection to the pancreatic duct difficult. The distal pancreatic parenchyma is normal without atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are noted, the largest of which is a right midpole cyst measuring 47 x 46 mm (series 9, image 9).RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Corresponding to lesion seen on earlier CT is 39 mm lobulated pancreatic tail lesion containing enhancing septations. Additional smaller pancreatic head and body lesions seen that appear to communicate with the pancreatic duct are seen, consistent with sidebranch IPMNs. The larger size of the pancreatic tail lesion makes definitive identification of a pancreatic ductal connection difficult. However, given the lobulated and multicystic appearance of the dominant lesion and the presence of sidebranch IPMNs elsewhere, another sidebranch IPMN is favored. Although the location is atypical, a serous cystic neoplasm is another differential consideration.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for rotator cuff tear History: left shoulder pain. ROTATOR CUFF: The supraspinatus tendon and muscle appear normal. The infraspinatus tendon and muscle appear normal. The teres minor tendon and muscle appear normal. There is mild increased signal intensity within the distal fibers of the subscapularis tendon, which may reflect insertional tendinosis, but the muscle appears normal.SUPRASPINATUS OUTLET: There is minimal inferior spurring of the acromion process and perhaps minimal impression upon the superior fibers of the supraspinatus tendon of questionable significance. No fluid is present within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No joint effusion. There is attenuation of the anterior superior labrum, but this may not be of any clinical significance. Otherwise, given the limitations of a non-arthrographic study, the glenoid labrum is unremarkable. Glenohumeral joint alignment is normal. The articular cartilage is within normal limits.BICEPS TENDON: Given the limitations of a non-arthrographic study, the tendon of the long head of the biceps appears normal.ADDITIONAL

Output: 1.Possible mild insertional tendinosis of the subscapularis tendon, but we see no discrete rotator cuff tear.2.Subjectively, the anterior inferior capsular structures appear slightly thickened, but clinical significance of this is uncertain.3.Minimal spurring of the inferior aspect of the acromion process and perhaps minimal impression upon the superior fibers of the supraspinatus tendon of questionable significance.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female. Plantar fasciitis. Evaluate for a plantar tear. Evaluation of the fibula and surrounding soft tissues is limited due to metallic susceptibility artifact resulting from a distal fibular plate and screw device.TENDONS: Small amount of fluid within the medial tendons is unlikely to be of clinical significance. There is increased signal intensity within the peroneus brevis tendon as it courses posterior and beneath the fibular tip suggesting a longitudinal tear. There is a small amount of fluid within the peroneal tendon sheath at the level of the fibular tip, of questionable significance. The anterior tendons are normal.LIGAMENTS: The anterior talofibular ligament is not well visualized perhaps due to a chronic tear. The calcaneofibular ligament appears intact. The posterior talofibular ligament is slightly heterogeneous but we suspect is intact. The anterior and posterior tibiofibular ligaments are grossly intact. There is loss of the normal fatty striations of the deep fibers of the deltoid ligament along with small ossicles distal to the medial malleolus suggesting old trauma.ARTICULAR SURFACES AND BONE: There is thickening and increased signal intensity of the plantar fascia at its calcaneal attachment compatible with plantar fasciitis. We see no fluid signal intensity disrupting the fascia to indicate a tear. A small plantar calcaneal spur at the fascial attachment is seen with mild marrow edema, likely reactive. An os trigonum representing normal variant anatomy is noted with normal signal intensity. Tiny ankle and midfoot osteophytes compatible with mild osteoarthritis. Small amount of fluid in the tibiotalar and subtalar joints, of doubtful clinical significance. We see no osteochondral defect.

Output: 1. Plantar fasciitis with reactive mild edema in an adjacent calcaneal spur. We see no plantar fascial tear.2. Post-operative changes of distal fibular fixation.3. Ligamentous abnormalities, as described above, may be due to old trauma.4. Partial-thickness longitudinal tearing of the peroneus brevis of questionable current clinical significance.


Instruction: Generate impression based on medical findings.

Input: Ms. Preston is a 60-year-old female with personal history of right breast mastectomy in 2013 for DCIS/LCIS followed by tamoxifen therapy. Family history of breast cancer in paternal cousin and six paternal aunts. Mild parenchymal enhancement is noted in the left breast. Status post right mastectomy with implant based reconstruction.No abnormal enhancement is seen in the left breast or right reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Dementia. There are small areas of encephalomalacia in the bilateral basal ganglia and cerebellar hemispheres. There is scattered cerebral white matter T2 hyperintensity as well. In addition, there are numerous scattered punctate foci of susceptibility effect in the bilateral cerebral hemispheres, basal ganglia, and pons. There is mild diffuse cerebral volume loss. There appears to be a defect in a portion of the septum pellucidum. There is no evidence of intracranial mass or acute infarct. 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: Probable chronic lacunar infarcts in the bilateral basal ganglia and cerebellar hemispheres, chronic small vessel ischemic white matter disease, probable chronic hypertensive microhemorrhages, as well as mild diffuse cerebral volume loss, but no evidence of acute infarct.


Instruction: Generate impression based on medical findings.

Input: Left leg weakness, increased severity. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is partial ankylosis involving the C6 and C7 vertebral bodies likely representing a developmental segmentation anomaly. There is mild reversal of cervical lordosis with apex at the C4-C5 level where there is a prominent disc osteophyte complex. Bone marrow signal is benign with marrow signal changes at the C4-C5 levels on a degenerative basis.There is flattening of the cord at the C4-C5 level as described below. Cervical cord is otherwise normal in signal characteristics and morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is a prominent disc osteophyte complex with moderate to severe spinal canal stenosis. There is mild flattening of the cervical cord, particularly on the left. No definite cord signal abnormality. There is mild to moderate left and mild right neural foraminal stenosis. C5-6: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Degenerative changes at C4-C5 level with moderate to severe spinal canal stenosis at this level. There is mild flattening of the cord, particularly on the left, without definite cord signal abnormality.2. Partial fusion involving the C6 and C7 vertebral bodies which likely represents a developmental segmentation anomaly.3. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess for llH, rule out mass/tumor. Signs and symptoms: Headache that is worse with sneezing, bowel movement/stranding and razing arms above head. Pre-and post-enhanced brain MRI:Diffusion-weighted images are severely distorted due to metallic artifact likely from patient's braces. No gross areas of acute ischemic change.Examination demonstrates normal signal intensity and morphology of the cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.There is no evidence of abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.The signal intensity of intracranial venous sinuses is again normal and normal pattern of enhancement.Paranasal sinuses cannot be assessed due to significant metallic hardware artifact.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of 8-foot fall complaining of headache, loss of consciousness. Rule out hemorrhage or cervical fracture. In the right high parietal convexity, seen in image 27/36, is a high density focus within the cortex. Inferior to this, on image 21/36 there is an additional focus of high density which could lie on the surface of the cortex or be within the subarachnoid space. These findings are likely cortical hemorrhage given the history. Continued follow up is recommended, and MRI may be helpful. No associated extra-axial hemorrhage. Otherwise, there is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE

Output: 1. Focal cortical high density is likely hemorrhage given the history (though calcification could potentially have this appearance). Additional small focus of high density inferior to this could be with in the subarachnoid space or in the surface of the cortex. Continued follow-up is recommended, and MRI should be considered.2. Unremarkable examination of the cervical spine.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old, with epidural abscess status post debridement. There is been interval removal of the interbody cage at L4-5, posterior left iliac crest bone graft, and interbody fusion at L4-5. Revision hemi-laminotomies at L1-2, L4-5 and L5-S1 have also been performed. There is a small fluid collection within the posterior left iliac crest defect, with surrounding likely surgical packing material (T2 hypointense signal) and enhancement, which is nonspecific.Previously demonstrated ventral epidural fluid collection from L1 through L3 appears to be resolved. A persistent fluid collection involving the left laminotomy defect at L4-L5 is slightly increased in size since 8/12/2016 with encroachment on the dorsolateral left aspect of the thecal sac. A smaller fluid collection with surrounding enhancement is also again demonstrated in the paraspinal soft tissues at the level of the L2-3 left hemilaminotomy. Heterogeneous signal representing likely a combination of postoperative fluid and blood products within the ventral epidural space at L4 and L5 is slightly increased in size since prior examination. There is also enhancing granulation tissue on the left at this level. The combination causes mild to moderate effacement of the thecal sac and severe effacement of the left lateral recess with extension into the left L4-5 neural foramen. Bone graft placement may be better assessed with CT of the lumbar spine.Spinal alignment is anatomic. Lumbar vertebral body heights are preserved. There is prominent Schmorl's node and mild loss of anterior vertebral body height at T12. Signal changes at L4-5 are seen which may be postoperative in nature. No significant disc degeneration is detected.Within the posterior subcutaneous soft tissues in the midline, there is again a fluid collection, which is smaller than on prior exam, with surrounding enhancement and edema.

Output: 1. Postoperative findings are seen compatible with removal of interbody cage and interbody fusion at L4-5 and multilevel laminectomy for debridement of a large epidural abscess involving a majority of the spine. Resolved epidural fluid in the upper and mid lumbar spine.2. Likely postoperative fluid blood products and granulation tissue at the L4 and L5 levels causes severe effacement of the left lateral recess and extending into the left L4-5 neural foramina. Residual abscess cannot be completely excluded. 3. Fluid collections in the region of left iliac bone graft, left L2-3 and L4-5 paraspinal soft tissues, and posterior superficial subcutaneous soft tissues are most likely postoperative in nature. However, infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Dedicated images through the sella demonstrate a normal height of the pituitary gland. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.Patient is status post left sided craniotomy. Previously demonstrated left infratemporal fossa mass and left intraorbital tumor component is incompletely visualized in the current exam. Please refer to dedicated MRI dated 12/23/2015 for details.There is opacification of the left mastoid air cells.

Output: 1. No abnormal lesions are identified in the pituitary gland.. 2. Please refer to dedicated MRI dated 12/20/2015 for the details pertaining to the left infratemporal fossa mass and intraorbital extension.


Instruction: Generate impression based on medical findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: pre op navigation tumor History: rue weakness, transient dysarthria Multiple fiducial markers attached on scalp.Re demonstration of the left parietal operculum irregularly enhancing mass lesion with surrounding edema.The size (38.1mm x 31.3mm), MR characteristics and the extent of surrounding edema appear to be unchanged since prior scan.The left lateral ventricle appears to be slightly deformed.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: No interval change of the size, MR characteristics and surrounding edema of the left parietal opercular intra axial mass since prior scan.


Instruction: Generate impression based on medical findings.

Input: There are postoperative findings related to right parietal craniotomy for resection of a subjacent tumor. There is unchanged encephalomalacia in the right parietal and temporal lobes with T2 hyperintensity surrounding the resection cavity as well as ex vacuo dilatation of the right atrium. There is no abnormal enhancement surrounding the resection cavity or elsewhere within the brain. There is a right parietal approach ventriculostomy catheter that courses through the right atrium and terminates immediately adjacent to and with mass effect upon the right hippocampal body. The hippocampi are otherwise symmetric and normal in appearance. There are multiple punctate foci of susceptibility effect in the region of the surgical bed compatible with blood products as well as multiple additional punctate foci of susceptibility effect within the bilateral hemispheric white matter. There are also additional punctate foci of susceptibility effect within the left frontal horn and the 4th ventricle that correspond to calcification on prior CT. Stability of some of these foci is difficult to determine due to differences in technique. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is sphenoid sinus mucosal thickening and bilateral maxillary sinus retention cyst.

Output: 1.Unchanged postoperative findings related to right parietal tumor resection without evidence of recurrence.2.A right parietal approach ventriculostomy catheter terminates immediately adjacent to and with mass effect upon the right hippocampal body. The shunted ventricles are unchanged in size and the hippocampi otherwise normal in appearance.3.Multiple bilateral supratentorial punctate foci of susceptibility effect may represent chronic microhemorrhages, cavernous malformations, or calcification. Stability is difficult to determine due to differences in technique. Additional intraventricular foci of susceptibility effect corresponding to calcification on prior CT and are of uncertain etiology.


Instruction: Generate impression based on medical findings.

Input: A 67 year old female with hypertension, hyperlipidemia and mitral valve prolapse. A recent echocardiography showed significant mitral and aortic regurgitation and suspected hypertrophic cardiomyopathy. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 159 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 38 g/m2 (normal range 67+/-11), and the LV mass is 62 g (normal range 114+/-24). There is mild focal hypertrophy of the basal anterior wall (12mm). The posterior wall thickness is 8mm. There is a significant left ventricular outflow tract gradient secondary to systolic anterior motion of the mitral leaflet and the above mentioned focal region of hypertrophy.There are no regional wall motion abnormalities present and intra-myocardial deformation within the hypertrophied segment is relatively normal. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No myocardial iron overload was noted.No intracavitary thrombus was seen.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 75 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 54 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation (regurgitant fraction 13%).Mitral ValveThe mitral valve opens widely and there is at least moderate to severe mitral regurgitation likely secondary to significant systolic anterior motion of mitral leaflets. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. The ascending thoracic aorta is mildly dilated (40mm). The thoracic aorta is mild to moderately tortuous.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 a trivial pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function, the LVEF is 64%. 2. There is mild focal hypertrophy of the basal anterior wall which is associated with significant systolic anterior motion of the mitral leaflets resulting in a substantial left ventricular outflow tract gradient and at least moderate to severe mitral regurgitation. Based on myocardial tagging, the intra-myocardial deformation within the hypertrophied segment is relatively normal. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process within the hypertrophied segment or elsewhere in the left ventricle. Although definitive diagnostic criteria for hypertrophic cardiomyopathy are not met on this MRI study and the morphology of the hypertrophy is consistent with a sigmoid septum associated with aging, a variant of hypertrophic cardiomyopathy remains on the differential diagnosis given the severity of the systolic anterior motion of the mitral leaflets and the presence of a basal anterior wall to posterior wall ratio of 1.5. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 56%. 4. The left atrium is moderately dilated. 5. The ascending aorta is mildly dilated and there is mild aortic regurgitation. 6. There is at least moderate to severe mitral regurgitation secondary to systolic anterior motion of the mitral leaflets.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: Headache. Left posterior approach ventriculostomy is unchanged, with the tip terminating medial to the left occipital horn. Unchanged dilated dysmorphic lateral ventricles. Persistent diminutive fourth ventricle and small vermis. Caudal extension of the cerebellar tonsils below the foramen magnum, unchanged from prior.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Dysplastic cerebellum, with caudal extension below the foramen magnum, small vermis, compatible with Chiari I malformation.2.Unchanged left posterior approach ventriculostomy with tip terminating medial to the left occipital horn and dysmorphic dilated lateral ventricles.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Chiari malformation, syrinx, evaluate for change, yearly follow-up, do CSF flow study. Signs and symptoms: Yearly follow-up. Nonenhanced brain MRI:Negative diffusion weighted images.Redemonstration of Chiari malformation with approximately 12 mm herniation of the tonsils and with flattening deformity of the inferior poles similar to prior exam.There is normal signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.CSF flow study is of very poor quality due to extensive motion artifact.Patient was also unable to continue and MRI of the spine was not performed. Patient requested to reschedule an return for completion of the study.

Output: 1.Nonenhanced brain MRI demonstrate stable Chiari malformation and unremarkable otherwise.2.CSF flow study is of severely degraded due to motion artifact and MRI of spine was not performed due to patient's inability to continue and requested to reschedule the exam for a later date.


Instruction: Generate impression based on medical findings.

Input: 3 month follow-up of brain lesion Peripherally enhancing left occipital lesion has increased in size and now measures 1.0 x 1.2 x 1.5 cm (image 36, series 1201; image 172, series 1202), previously 0.6 x 0.8 x 1.0 cm. The surrounding T2/FLAIR hyperintensity has increased, likely representing a combination of edema and gliosis. No new intraparenchymal mass lesion or new abnormal areas of enhancement are identified.Status post right frontal craniectomy. The underlying confluent increased T2 signal is seen throughout the right frontal lobe is unchanged. Periventricular increased T2/FLAIR signal is also unchanged and may be treatment related small vessel ischemic disease.No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. No abnormal areas of enhancement are seen. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature.Enhancing right temporal bone lesion is unchanged from the prior study.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Increase in size of peripherally enhancing left occipital lesion with increase in surrounding edema/gliosis.2.No change in right temporal osseous metastasis.3.Right frontal lobe postsurgical changes.


Instruction: Generate impression based on medical findings.

Input: 47 years Female (DOB:8/10/1968)Reason: lumbar radiculopathy History: lower backPROVIDER/ATTENDING NAME: TARIQ M MALIK TARIQ M MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.