Instruction: Generate impression based on medical findings.

Input: Von Hippel Lindau. History of renal cell carcinoma and pancreatic tumor/cysts. Evaluate growth of existing pancreatic lesions and presence of new lesions. Prior left upper pole resection for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Stable appearance of a lobulated and septated segment 7 hepatic cystic lesion. The common bile duct is displaced anteriorly by a large pancreatic cyst which may account for the slight increase in biliary ductal dilatation, now moderate.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma is completely replaced by multiple cystic lesions, some of which contain proteinaceous fluid/hemorrhage. An enhancing lesion within the pancreatic tail measures 2.0 x 1.7 cm (series 100, image 67), unchanged. Medial to this lesion there is an additional enhancing lesion that measures 1.4 x 1.2 cm, not substantially changed from prior (series 100, image 60). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple cysts bilaterally. Status post partial left nephrectomy, with no evidence of local recurrence. Increased size of a complex cystic lesion within the right inferior pole measuring 2.0 x 1.8 cm (series 102, image 20), previously 1.7 x 1.6 cm, suspicious for renal cell carcinoma. Additional subcentimeter lesion within the midpole contains mural and septal enhancement and remain suspicious (series 1202, image 39).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slightly increased size of an enhancing nodular lesion within the right lower pole, probable renal cell carcinoma. Additional suspicious right midpole lesion is unchanged. 2.Status post left partial nephrectomy, without evidence of local recurrence. 3.Increased biliary ductal dilatation due to pancreatic head cyst.4.Unchanged enhancing pancreatic lesions suspicious for islet cell tumors.


Instruction: Generate impression based on medical findings.

Input: NF1 and epilepsy, as well as scoliosis, status post correction with rods with constant mid back pain. Brain: There is enlargement of multiple segments of the optic nerves bilaterally, left more than right, with dilatation of the optic nerve sheaths. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse patchy T1 hyperintensity in the bilateral basal ganglia and thalami. There are also several small foci of high T2 signal in the medial portions of the cerebellum. The lateral ventricles are asymmetric, but not enlarged. However, there is prominence of the subarachnoid space in the anterior left middle cranial fossa measuring up to 10 mm in width, with associated anterior bowing of the overlying lateral orbital wall. A similar finding is present on the contralateral side, but to a lesser degree. There is no midline shift or herniation. The major cerebral flow voids are intact. The scalp soft tissues are unremarkable, but there is a small enhancing nodule in the left cheek skin and subcutaneous tissues.Spine: There is focal kyphosis at C5-6 with mild anterior wedge deformity of the C5 and C6 vertebral bodies. There also appears to be mild narrowing of the spinal canal at this level, but no spinal cord compression. There is no evidence of tumors in the cervical spine, although assessment is limited based on only the localizer images of this region. There are postoperative findings related to multilevel thoracolumbar scoliosis surgery. Metal artifact obscures surrounding anatomy, including the spinal cord and most of the vertebral bodies. There is moderate apex right thoracic and apex left lumbar scoliosis. There is a cerebrospinal fluid signal collection in the left paraspinal region that spans the lower thoracic and upper lumbar spine levels, with what appears to be associated enlargement of the adjacent neural foramina. There are numerous scattered subcutaneous nodules. There is also a more infiltrative lesion that is partly imaged in the left lateral lower back subcutaneous tissues.

Output: 1. Bilateral optic nerve gliomas, mild sphenoid wing dysplasia, and other stigmata of neurofibromatosis type 1 in the brain.2. Multiple cutaneous nodular neurofibromas and what may represent a large left lateral lower back superficial neurofibroma, although this is incompletely imaged.3. Focal kyphosis at C5-6 with mild anterior wedge deformity of the C5 and C6 vertebral bodies. 4. Postoperative findings related to multilevel thoracolumbar scoliosis surgery with persistent scoliosis, whereby metal artifact obscures surrounding anatomy. Nevertheless, what likely represents a large left thoracolumbar pseudomeningocele is partly discernible.


Instruction: Generate impression based on medical findings.

Input: Right brain tumor with left sided weakness: preoperative planning for biopsy. There is a dominant heterogeneous mass in the right perirolandic region that measures up to approximately 4 cm. There are also several subcentimeter lesions adjacent to the mass. The ventricles are normal in size and configuration. There is no midline shift. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Fiducial markers are present.

Output: Preoperative planning MRI shows a dominant heterogeneous mass in the right perirolandic region that measures up to approximately 4 cm and several subcentimeter satellite lesions.


Instruction: Generate impression based on medical findings.

Input: Images are degraded secondary to patient motion. Given this caveat:Straightening of the cervical spine is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: There is a small midline disc protrusion without resulting stenosis.C3/4: There is a small midline disc protrusion without resulting stenosis.C4/5: There is a small midline disc protrusion without resulting stenosis. There is also right uncinate hypertrophy causing mild right neural foraminal stenosis.C5/6: There is a small midline disc protrusion without resulting stenosis.C6/7: There is a small midline disc protrusion without resulting stenosis. C7/T1: Unremarkable

Output: 1.Multilevel small disc protrusions without resulting stenosis.2.C4/5: Mild right neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Right ptosis and diplopia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered nonspecific cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild right maxillary sinus mucosal thickening.Orbits: There is no evidence of orbital mass lesions. The bilateral globes, optic nerves, extraocular muscles, lacrimal glands, and orbital fat are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of orbital mass lesions.


Instruction: Generate impression based on medical findings.

Input: Patient with neck stiffness, hyperreflexia, spasticity of the bilateral lower extremities Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. 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 or neural foramina.C3-4: Small disc osteophyte complex without compromise to the spinal canal. Mild right neural foraminal narrowing related to facet arthropathy. Left neural foramen is patent.C4-5: Uncovertebral hypertrophy and facet arthropathy contribute to mild left and minimal right neural foraminal narrowing. C5-6: There is mild to moderate degree of spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening. No cord signal abnormality. There is mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C6-7: There is mild degree of spinal canal stenosis related to disc osteophyte complex and ligamentum flavum thickening. No cord signal abnormality. Mild to moderate left and mild right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina.There is a heterogeneous nodule along the posterior aspect of the left thyroid lobe measuring 2.8 x 1.8 cm which is not well assessed but present on prior CT from 6/23/2006.

Output: 1. Multilevel degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis at the C5-C6 level and mild spinal canal stenosis at the C6-C7 level. No evidence of higher grade stenosis or cord signal abnormality. Varying degrees of mild to moderate neural foraminal narrowing as described above.2. 2.8 x 1.8 cm heterogeneous nodule at the level of the left thyroid lobe which may represent large thyroid nodule or perhaps enlarged parathyroid tissue and was present on prior CT neck from 6/23/2006. Ultrasound can be considered for further evaluation if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old, history of esophageal cancer and brain metastases, status post resection/drainage of cystic lesion, status post SRS in 7/14. There is an enhancing lesion involving the left parieto-occipital lobe measuring approximately 4.2 x 2.3 x 3.4 cm in the AP, transverse, and craniocaudal dimensions, respectively. Most recent MRI was obtained without gadolinium. Compared to earlier MRI brain with gadolinium dated 1/19/2015, there is been marked interval increase in size of this enhancing lesion, at which time it measured 17 x 20 x 18 mm. There is gradually increasing associated edema compared to 1/19/2015 and 4/16/2015. Enhancement extends to the left lateral ventricular surface. Again seen is susceptibility compatible with chronic blood products within this lesion. Restricted diffusion is noted along the inferior aspect of the lesion which may related to blood products.There is increased associated mass effect with effacement of the left parieto-occipital sulci as well as increased effacement of the left lateral ventricle. 6 x 7 x 8 mm mm enhancing lesion in the right cerebellar hemisphere is not significantly changed in size compared to 1/19/2015. There is relatively mild associated FLAIR hyperintensity which is slightly increased since 1/19/2015 and may be related to treatment changes.No new enhancing lesions are seen within the brain to definitively indicate progression of intracranial metastatic disease. There is no midline shift or evidence of downward herniation. Parenchymal volume loss is again seen including in the cerebellum. Left posterior parietal burr hole again seen related to prior drainage/resection.

Output: 1. Please note most recent MRI brain dated 4/16/2015 was obtained without gadolinium. Compared to MRI brain with gadolinium from 1/19/2015, there has been marked increase in size of the left parieto-occipital enhancing lesion as well as gradually worsening associated edema and mass effect compared to 4/16/2015 and 1/19/2015. Findings may represent radiation necrosis although recurrent tumor is not entirely excluded. Consider follow-up PET or MRI with perfusion and spectroscopy sequences for differentiation. Of note, prior PET dated to 2/12/2015 did not demonstrate significant uptake within this region, favoring radiation necrosis.2. Small right cerebellar enhancing lesion is not significantly changed in size.3. No new lesions are seen to definitively indicated metastatic disease progression.


Instruction: Generate impression based on medical findings.

Input: Right knee pain. Evaluate for meniscal injury. There is susceptibility artifact from an intramedullary rod and anchoring within the femur extending to the metaphysis and limiting evaluation in this area.MENISCI: There is blunting of the free edge of the medial meniscus which otherwise appears intact. Globular high T2 signal within the anterior horn of the lateral meniscus which does not extend to the articular surface and is compatible with intrasubstance degeneration. There is branching linear signal within the posterior horn and body of the lateral meniscus which likely represents a combination of prior tear, postsurgical change and degeneration. There is no evidence of acute, new tear however, there is increasing extrusion of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: The articular cartilage in the medial compartment is thinned and there is full-thickness loss along the anterior aspect of the femoral condyle spanning an AP image of 9 mm (series 1, image 9).Full thickness cartilage degeneration is seen along the posterior aspect of the lateral femoral condyle and has progressed since the previous exam. There is a fissure along the weightbearing of the lateral femoral condyle surface with delamination extending over an AP dimension of 7 mm and underlying reactive marrow change.Cartilage degeneration has progressed in the patellofemoral compartment where there is mild fraying of the patellar cartilage but full thickness degeneration along the femoral trochlea.No acute fracture. There are post surgical changes from prior anterior cruciate ligament reconstruction.LIGAMENTS: Status post anterior cruciate ligament reconstruction. There is linear high T2 signal within the ACL graft fibers near its tibial attachment which raises question of a small split tear however the graft otherwise appears intact. The posterior cruciate and medial collateral ligaments are intact. The fibular collateral ligament appears mildly redundant without evidence of discrete tear or acute abnormality.EXTENSOR MECHANISM: The extensor mechanism is intact. There is a small amount of nonspecific prepatellar edema.ADDITIONAL

Output: 1.Branching linear signal within the posterior horn and body of the lateral meniscus likely represents a combination of prior tear, postsurgical change and degeneration. There is increased extrusion of the lateral meniscus but no evidence of new, acute tear.2.Progression of cartilage degeneration with full-thickness loss over the lateral femoral condyle and femoral trochlea.3.Intact ACL graft.4.Small joint effusion with synovitis.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for patellofemoral pathology History: L knee pos patellar apprehension test MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal without fluid filled defects. There is mild edema within the superolateral corner of Hoffa's fat pad which can be associated with patellar tracking disorders and/or patellar instability. The Insall-Salvati ratio is 1.2, indicating borderline patella alta. The superior aspect of the femoral trochlea appears slightly shallow, which is suggestive of mild dysplasia. There is slight lateral tilt of the patella. The TTTG distance is approximately 1.6 cm, which is borderline. LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal. ADDITIONAL

Output: Slight lateral tilt of the patella with borderline Insall-Salvati ratio and TTTG distance and perhaps mild femoral trochlear dysplasia.


Instruction: Generate impression based on medical findings.

Input: Malignant (primary) neoplasm, unspecified [C80.1] / Human immunodeficiency virus (HIV) disease [B20] / Secondary malignant neoplasm of bone [C79.51] / Disorder of bone, unspecified [M89.9], Reason for Study: ^Reason: cord compression protocol - rule out Cervical MRI:Motion artifacts degraded exam quality.There is normal cervical lordosis. The cranial-cervical junction is normal.Spinal cord signal intensity is normal.There are focal protrusion of discs without creating spinal stenosis at the level of C45 (central to left) and C56 (central to right) level.There is an enhancing mass on the left side paravertebral muscle (21.6mm x 19.8mm) indicating possible lymph node enlargement or muscle mass.Vertebral bodies appears to be within normal limits.Thoracic MRIThere is normal thoracic kyphosis and spine alignment is normal.Spinal cord signal intensity is normal.There is T2 high signal intensity lesion at T10 vertebral body which most likely represent hemangioma. There is irregular shaped enhancing mass lesion on the left side of upper mediastinum which is adjacent to the junction of aortic arch and descending aorta as well as proximal subclavian artery suggesting possible malignant lesion. Dedicated imaging study such as Chest CT scan with enhancement can be considered for further imaging evaluation.No evidence of cord compression.Lumbar MRINormal lumbar lordosis. The spine alignment is anatomic.No evidence of spinal cord compression. The conus medullaris terminates at the level of T12-L1. There is 16.9mm x 18.5mm left adrenal gland nodule. The clinical significant of the lesion can be assessed with dedicated adrenal gland imaging, please consult to abdominal imaging department.There is evidence of soft tissue mass replacing cortical bone on the left side pedicle of the L1 vertebral body with the mass extension toward posterior aspect of the L1 body. The mass appears to be extended toward the left side neuroforamen. There are multifocal vertebral body marrow replacing lesions including L2 vertebral body left side, S1 vertebral body and right side ilium, most likely represent metastatic lesion.This lesion is consistent with metastatic lesion.

Output: 1. No evidence of spinal cord compression.2. Multiple enhancing soft tissue mass lesions including left posterior upper mediastinum, left adrenal gland and left side pedicle with L1 vertebral body indicating possible metastatic lesions.3. Soft tissue masses on the L2, S1 and right side ilium indicating possible metastatic lesions. Comment: considering multiple bony and adrenal metastatic lesions, dedicated imaging studies such as adrenal gland imaging and lumbar spine or pelvic imaging can be considered.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Malignant neoplasm of lung. The patient has abnormal gait associated with lower extremity hyperreflexia.Clinical question: With a history of newly diagnosed lung cancer and unsteady gait, there is concern that the cause of the abnormal gait is related to spinal metastasis. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.There is a 6 x 5 mm sagittal dimension lesion present along the right posterior lateral aspect of the C5 vertebral body which is bright on T1-weighted imaging. This lesion is also bright on the T2 STIR image acquisitions. It is associated with some contrast enhancement.No abnormal enhancing lesions are identified in the cervical spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level. There are uncovertebral osteophytes present on the right side at this level which mildly narrow the right neural foramen. There is mild facet hypertrophy present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level. There are uncovertebral osteophytes present on the right side at this level which narrow the right neural foramen. There is mild facet hypertrophy present at this level.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present which narrow the neural foramina bilaterally in the face the fat surrounding the exiting nerve roots. At C6-7 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present which narrow the neural foramina bilaterally in the face the fat surrounding the exiting nerve roots. There are some endplate reactive changes at this levelAt 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 thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.There is a mass present in the right lung measuring approximately 5.7 cm in diameter

Output: 1.There is no convincing evidence for metastatic disease to the cervical or thoracic spinal cord or the cervical or thoracic spine. A lesion within the C5 vertebral body most likely represents a vertebral body hemangioma.2.There is a mass in the right lung. Please refer to chest CT from 6/19/2015 for further comments.3.There are degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is encroachment of the exiting nerve roots within the neural foramina due to uncovertebral osteophytes.


Instruction: Generate impression based on medical findings.

Input: The cerebellar tonsils are rounded in configuration and extend approximately 5 mm below the level of the foramen magnum. There is mild reversal of the normal cervical lordosis. There is anomalous morphology with butterfly configuration of the C3 vertebral body, and likely also involving C4 and C5 vertebral bodies. There is a rudimentary disc at the C6-C7 level with diminished anterior-posterior dimension of the C6 and C7 vertebrae as well as partial fusion of the right C6-C7 facet. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is no significant disk bulge, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1. Prone sequences are degraded by motion artifact. However, there is a fibrofatty filum terminale from L4 to L5/S1 with probable tethered cord. Please correlate clinically.2. Multiple segmentation anomalies and butterfly vertebrae within the cervical, thoracic and lumbar spine as described above. Partial fusion of the L1-L2 vertebral bodies with posterior angulation, contributing to effacement of the ventral thecal sac at this level.3. Low-lying cerebellar tonsils with rounded configuration, not meeting strict criteria for Chiari 1 malformation.


Instruction: Generate impression based on medical findings.

Input: headache, chronic migraine with acute worsening. No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Male 21 years old Reason: eval meniscus . and cyst History: knee pain MENISCI: Radial tear of the anterior horn/body of the lateral meniscus with a large, complex, multiloculated, parameniscal cyst which measures approximately 6.7 x 2.2 x 4.0 cm and extends into the lateral gutter and Hoffa's fat pad.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Radial tear of the anterior horn/body of the lateral meniscus with a large 6.7-cm, multiloculated para-meniscal cyst.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old, with altered mental status and hypertension. Assess for PRES, cerebral edema. Image quality is compromised by motion artifact. A relatively linear region of encephalomalacia is redemonstrated within the right aspect of the pons with associated pontine volume loss. The pontine parenchyma, and to a lesser degree the midbrain parenchyma, show mild ill-defined T2 hyperintensity. There may also be some T2 hyperintensity within the right middle cerebellar peduncle.Elsewhere, only a few scattered punctate foci of white matter T2 hyperintensity are seen. No evidence of cortical or subcortical edema is detected. No restricted diffusion is evident. There are no findings to suggest acute or chronic intracranial hemorrhage. No abnormal fluid collections are seen. The ventricular system is normal in size and morphology.

Output: 1.No change in the appearance of a chronic right pontine infarct.2.Ill-defined signal within the remainder of the pons and the midbrain may reflect chronic microvascular ischemic disease or sequelae of degenerating fibers related to pontine infarction.3.No acute intracranial abnormality is suspected. No evidence of cerebral edema is seen. In particular, no findings to suggest PRES are noted.


Instruction: Generate impression based on medical findings.

Input: 71 year old male with history of recent pericardial effusion diagnosis by echocardiography without associated symptoms, referred for cardiac MRI for additional evaluation. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 74%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 136 ml (normal range 142+/-34), the LV end systolic volume index is 17 ml/m2 (normal range 25+/-9), the LVESV is 35 ml (normal range 47+/-19). There is hypokinesis of the most apical segments. There is eccentric hypertrophy in a pattern of apical hypertrophy. The hypertrophy also extends to the mid lateral wall, but is clearly not concentric, with maximal wall thickness of 18mm in the mid to apical lateral wall. There is patchy late gadolinium enhancement im multiple myocardial segments. The apex and distal-mid lateral are most heavily involved, but there is also mild enhancement of the the mid anterior and inferior wall. It is not subendocardial and is not consistent with previous myocardial infarction. This pattern would suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The gadolinium pattern in the hypertrophied areas likely represents scarring, but the involvement outside the most hypertrophied segments suggests either a more mild hypertrophic process in these segments, or a super imposed infiltrative disorder. The native T1 myocardial relaxation time is elevated between 1100-1200ms. There is no myocardial iron overload. There is [no]LV thrombus. Left AtriumThe left atrium is severely 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 70 ml/m2 (normal range 82+/-16), the RVEDV is 146 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is chordal SAM noted with at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a moderate-large circumferential pericardial effusion which predominantly posterior, overlying the left atrium and ventricle. There is no evidence of abnormal septal motion with respiratory variation, nor is there evidence for right atrial or right ventricular collapse. The maximal width of the effusion is 2.5cm posteriorly.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is eccentric hypertrophy in a pattern of apical hypertrophy. The hypertrophy also extends to the mid lateral wall, but is clearly not concentric, with maximal wall thickness of 18mm in the mid to apical lateral wall. There is patchy late gadolinium enhancement im multiple myocardial segments. The apex and distal-mid lateral are most heavily involved, but there is also mild enhancement of the the mid anterior and inferior wall. It is not subendocardial and is not consistent with previous myocardial infarction. This pattern would suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The gadolinium pattern in the hypertrophied areas likely represents scarring, but the involvement outside the most hypertrophied segments suggests either a more mild hypertrophic process in these segments, or a super imposed infiltrative disorder.2. Chordal SAM is noted with at least mild regurgitation. 3. Normal size RV with normal systolic function (EF 52%).4. Marked biatrial enlargement.5. Large pericardial effusion which is circumferential, but predominantly posterior overlying the left ventricle (maximal depth of 2.5cm). There is no definitive associated pericardial inflammation. There is no evidence for overt hemodynamic compromise due to the effusion.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male patient with left shoulder pain and concern for rotator cuff tear. Note that the examination is limited, as patient refused to continue and no sagittal T2 images were obtained. Also note that there are numerous foci of blooming metallic artifact about the shoulder joint.ROTATOR CUFF: Limited examination with a full thickness tear of the supraspinatus tendon at its insertion measuring approximately 3 mm in AP dimension. There is no associated retraction of the tendon, however, there is moderate atrophy of the supraspinatus muscle. Moderate tendinopathy affects the supraspinatus tendon at its insertion. The subscapularis, infraspinatus, and teres minor muscles and tendons appear within normal limits given this limited examination.SUPRASPINATUS OUTLET: There is increased T1 signal intensity within the rotator interval.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the anterior and posterior labrum, compatible with degenerative changes. There are numerous screws seen in the humeral head.BICEPS TENDON: The proximal biceps tendon is not well seen. The distal biceps tendon appears grossly within normal limits. ADDITIONAL

Output: 1.Limited examination due to patient's refusal to complete all sequences.2.Full-thickness tear of the supraspinatus tendon with moderate muscle atrophy and tendinopathy.3.Postsurgical changes in the humeral head.4.Irregularity of the anterior and posterior labrum, compatible with degenerative changes.5.Increased signal in the rotator interval and questionable thickening of the inferior glenohumeral ligament may represent adhesive capsulitis in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: 11 month old female with a cerebellar vermis lesion. Expected postoperative changes are again seen from the previous vermian mass biopsy through a small right paramedian occipital burr hole with resolution of the previous pneumocephalus and trace subdural blood products. Redemonstrated is a polypoid non-enhancing right cerebellar vermian lesion with normal T2/Flair signal intensity, which extends into the fourth ventricle and which is not significantly changed. The small hypothalamic lesion and subtle thickening of the tectal plate which narrows the cerebral aqueduct are also not significantly changed.Unchanged small focus of enhancement just above the tectal plate which is suspected to represent normal enhancing pineal tissue.There is a stable right frontal approach ventriculostomy catheter with tip in the midline on the anterior aspect of the septum pellucidum. The ventricles and sulci are within normal limits and there is no midline shift or mass effect. The major cerebral flow voids are intact. There is a fluid in the right greater than left mastoid air cells. There is patchy opacification of the ethmoid air cells bilaterally. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: No significant change in the hypothalamic lesion, polypoid cerebellar vermis lesion extending into the fourth ventricle, or the thickening of the tectal plate which narrows the cerebral aqueduct. These lesions may be hamartomatous/developmental especially given their absence of associated signal abnormality or enhancement but recommended continued follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old, with low back and bilateral leg pain. Alignment is anatomic. Vertebral body heights are preserved. The L5 vertebral body and the sacrum are relatively fatty replaced with a more heterogeneous mottled appearance of the remaining lumbar vertebral body levels. However, no evidence of marrow edema is seen. The visualized spinal cord, conus and cauda equina are unremarkable.T11-12: Ligamentum flavum thickening and facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.T12-L1: Unremarkable.L1-2: Moderate left and mild right facet hypertrophy with ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Severe left and mild right foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Small left ligamentum flavum cyst which slightly indents the left dorsal thecal sac. No significant spinal canal or neuroforaminal stenosis. L4-5: Moderate facet hypertrophy. Small left ligamentum flavum cyst causing no significant deformation of the thecal sac. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small right paracentral and foraminal protrusion. No significant spinal canal stenosis. Moderate to severe right and moderate left foraminal narrowing.

Output: 1.No significant or high-grade spinal canal stenosis is seen.2.Posterior element hypertrophy at L1-2 causes a severe left and mild right foraminal narrowing.3.Posterior element hypertrophy and disc disease at L5-S1 causes a moderate to severe right and moderate left foraminal narrowing.4.Marrow signal characteristics are somewhat mottled and heterogeneous except at the L5 level and in the sacrum where the marrow is more uniformly fatty replaced. The etiology of this finding is uncertain, but no evidence of marrow edema is seen to suggest an active pathologic process.


Instruction: Generate impression based on medical findings.

Input: Male 47 years old Reason: Shoulder pain possible RC tear. Motion artifact as well as internal rotation of the humeral head degrades image quality within multiple sequences which limits interpretation.ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus tendon consistent with moderate tendinosis. There is full thickness tearing of the supraspinatus tendon with retraction of approximately 2.0 cm and some intact posterior fibers. There is atrophy of the supraspinatus muscle at the myotendinous junction subjacent to the acromioclavicular joint. There is intermediate signal intensity within the infraspinatus tendon consistent with moderate tendinosis and small foci of interstitial tearing. The teres minor tendon and muscle are unremarkable. There is diffuse thickening and intermediate signal within the subscapularis tendon, most marked in the superior tendon fibers consistent with tendinosis.SUPRASPINATUS OUTLET: There is an os acromiale with a small hook osteophyte on the lateral margin of the ossicle. Moderate/severe osteoarthritis affects the acromioclavicular joint. There is trace fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The labrum is diminutive but appears grossly intact within the limitations on this non-arthrographic study.BICEPS TENDON: There is diffuse thickening and intermediate signal within the long head of the biceps tendon consistent with tendinosis.ADDITIONAL

Output: 1. Full thickness tearing of the supraspinatus tendon on a background of moderate tendinosis. 2. Infraspinatus, subscapularis and long head of the biceps tendinosis.3. Osteoarthritis of the acromioclavicular joint.4. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 47 year old woman with long QT and syncope, referred for further evaluation of underlying structural abnormalities and scar. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There are no regional wall motion abnormalities present. The myocardial T1 time is borderline increased (1050-1100ms). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 136 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). No focal right ventricular wall motion abnormalities or aneurysms.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 trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%. There are no regional wall motion abnormalities present. The native myocardial T1 relaxation times are borderline increased. 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 normal systolic function. The overall RV ejection fraction is 59% without MRI evidence of arrhythmogenic right ventricular cardiomyopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question:CVA. Signs and symptoms : CVA Nonenhanced head CT :There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.If concern for acute ischemic stroke persist recommend an MRI.

Output: Negative head CT.


Instruction: Generate impression based on medical findings.

Input: Assess for compression, need DWI, suspicion for cord ischemia. Acute loss of lower extremity function. Evaluation of the cervical and thoracic spine is somewhat limited due to motion degradation, however no evidence of cord compression is identified. Please note this exam is inadequate to assess for cord signal abnormality in the cervical and upper/mid thoracic cords.There is abnormal T2 hyperintensity involving the lower thoracic cord from the mid T10 level and extending inferiorly to the conus at the L1-L2 level. There is associated restricted diffusion (sag DWI series 801, image 88; sag ADC series 803 image 84).Mild degenerative changes are seen in the lumbar spine including mild L4-L5 disc bulge and small disc protrusion at L5-S1 level. There is no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine. Vertebral body heights and alignment in the lumbar spine are maintained. There is edema involving the bilateral paraspinous musculature as well as the right iliac is and psoas muscles.Motion degraded cervical spine images demonstrate small disc osteophyte complexes with mild degree of spinal canal stenosis, particularly at C3-C4.Innumerable cysts in the bilateral kidneys.

Output: No evidence of extrinsic cord compressionAbnormal T2 hyperintensity with restricted diffusion involving the lower thoracic cord from the mid T10 level to the conus at the lower L1 level. Finding is most consistent with cord infarct.Nonspecific edema involving the bilateral paraspinous musculature as well as the right iliacus and psoas muscles.


Instruction: Generate impression based on medical findings.

Input: Mild subcortical white matter T2/FLAIR signal abnormality consistent with chronic small vessel ischemic disease. No diffusion-weighted abnormalities to suggest acute ischemia. No mass, mass-effect, or midline shift. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Mild chronic small vessel ischemic disease without evidence of a mass, mass-effect, or acute ischemia.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with esophageal cancer, status post chemotherapy, evaluate for disease to status and compared with prior. Signs and symptoms: Pericardial cancer. Pre-and post-enhanced brain MRI:Examination demonstrate interval improvement in postoperative enhancement in the left frontal lobe since prior exam. There is however no significant change of the surrounding flair hyperintensity in the pattern of vasogenic edema demonstrate no significant change.There is revisualization of right inferior frontal, right anterior temporal and superior left cerebellar and right inferior cerebellar enhancing metastatic lesions without definitive evidence of interval change since prior exam in their size and pattern of enhancement.Residual surrounding flair hyperintensity of these lesions also remain nearly identical to prior exam.There is periventricular and subcortical flair hyperintensity of bilateral cerebral hemisphere likely representing treatment/radiation changes.There is no evidence of new metastatic lesions.

Output: 1.Revisualization of multiple supra-and infratentorial metastatic lesions without convincing evidence of change in their size, pattern of enhancement or their surrounding or hyperintensity.2.Slight interval decrease in postsurgical enhancement at the surgical site in the left frontal lobe.3.No detectable pneumatized and lesions.4.Stable white matter flair hyperintensity suggestive of treatment-related changes.


Instruction: Generate impression based on medical findings.

Input: There are 5 enhancing masses, 3 within the supratentorial brain, 2 within the infratentorial cerebellum:*Left lateral occipital lobe, heterogeneous enhancement, 23 mm AP x 19 mm transverse x 20 mm craniocaudal.*Left temporal occipital junction, homogeneous enhancement, 8 x 8 x 8 mm.*The right cerebellar hemisphere, heterogeneous enhancement, 35 mm AP x 37 mm transverse x 33 mm craniocaudal.*Left cerebellar hemisphere, heterogeneous enhancement, 35 mm transverse x 3 mm AP x 29 mm craniocaudal.*Tiny nodular enhancement right frontal lobe (image 25, series 1101)Significant vasogenic edema and mass effect is noted within the cerebellar hemispheres resulting in deformation and partial effacement of the fourth ventricle. The third and lateral ventricles are enlarged with T2 hyperintense findings suggesting transependymal CSF resorption from early hydrocephalus. Note is made of what appears to be bilateral, connatal cysts with right frontal horn coarctation. Additionally, there are few foci of T2 hyperintensity in the white matter, especially involving the right caudate head.The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for 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: 1.There are 5 enhancing masses, 3 within the supratentorial brain, 2 within the infratentorial cerebellum, most suggestive of metastatic disease.2.Significant vasogenic edema and mass effect is noted within the cerebellar hemispheres resulting in deformation and partial effacement of the fourth ventricle.3.Findings suggestive of early hydrocephalus with lateral and third ventricle enlargement and a suggestion of CSF resorption.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Seizure activity. Signs and symptoms: Seizure activity. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is noted. Diffuse patchy areas of periventricular and subcortical low attenuation are nonspecific however in the presence of risk factors of diabetes, hypertension and hyperlipidemia he may represent advanced to small vessel disease of indeterminate age. Follow-up with an MRI is recommended. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Findings concerning for advanced to small vessel disease.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with ESRD, diabetes, severe peripheral vascular disease, and hypertension with gangrenous toes of the right foot and sacrum decubitus ulcerIMAGE ACQUISITIONS: Pelvis CT after intravenous administration of 120 mL Omnipaque 350 There is soft tissue ulceration adjacent to the sacrum. Anteroverted coccyx bone is noted which could be posttraumatic. This bone is demineralized, and we cannot rule out infection. MRI is recommended if further imaging is indicated.L5-S1 degenerative changes with vacuum disk phenomenon.Calcified uterine fibroids are noted.

Output: 1. Sacral soft tissue ulceration2. Anteroverted coccyx which is demineralized. Infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 16-year-old female patient with history of pancreatic lymphangioma status post distal pancreatectomy and splenectomy in March 2015. Now with recurrent left-sided pain, similar to how she presented before surgery. Assess pancreatic duct, evaluate for recurrence of lymphangioma. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The common bile duct is normal in diameter without dominant stricture.SPLEEN: Splenectomy has been performed.PANCREAS: Distal pancreatectomy has been performed. No dilatation of the main pancreatic duct. No focal pancreatic lesion is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A fluid-filled mass within the left retroperitoneum has been resected. A few small cystic foci are noted just superior and posterior to the left renal vein, along the inferior margin of prior tumor, which are nonspecific. Otherwise, there is no specific evidence of residual or recurrent disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Numerous bilateral ovarian follicles are present. The uterus is normal in appearance.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Changes of the distal pancreatectomy and splenectomy without specific evidence of residual or recurrent disease; a few cystic foci along the inferior margin of the tumor are nonspecific and should be followed on subsequent imaging.2.No specific findings to account for the patient's symptoms in the abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: Clinical question of CVA. Signs and symptoms: Left-sided facial numbness. Nonenhanced head CT:No detectable acute intracranial process.CT is insensitive for early detection of acute ischemic strokes.Examination demonstrates small focus of low attenuation in the left paramedian pons which is not a specific however it could represent an age indeterminate lacunar infarct. Consider MRI if concern for a stroke remains high.Unremarkable cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Paranasal sinuses are unremarkable.There is evidence of an old blowout fracture of left floor of the orbit as well as lamina papyracea.

Output: 1.Minimal small vessel ischemic strokes of indeterminate age.2.No acute intracranial hemorrhage, mass effect or hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old, with history of metastatic breast cancer now with worsening low back pain. Thoracic:Marrow replacement of the T2 vertebral body and pedicles is again seen. Mild progressive extraosseous disease spread is seen along the left anterior paraspinal space. There is mild encroachment of the ventral and lateral epidural spaces at T2, but no significant thecal sac narrowing. The vertebral body otherwise appears similar to prior. No loss of height or retropulsion is seen. Since the prior examination, however, multiple new patchy and nodular areas of marrow replacement are seen in almost every thoracic vertebral body and to a lesser degree the posterior elements. None of these new lesions is associated with any significant epidural disease spread. No retropulsion or loss of vertebral body height is detected.The thoracic spinal canal remains patent throughout. There is no evidence of significant spinal canal stenosis. The left T2-3 and right T3-4 neural foramina are narrowed due to expansile tumor.The visualized spinal cord shows normal signal intensity and morphology. No pathologic intradural enhancement is seen.Lumbar:Again seen is evidence of instrumented posterior fusion of L5 and S1. Posterior element resection has also likely been performed.Since the prior examination, extensive tumor involving the left aspect of the L5 and S1 vertebral bodies appears more heterogeneous and less bulky perhaps representing the effect of therapy. As before, this lesion results in no significant epidural encroachment or spinal canal narrowing.However, as in the thoracic spine, there are numerous new patchy areas of marrow replacement in every lumbar vertebral body level. None of these lesions is associated with significant epidural encroachment. No loss of vertebral body height or retropulsion is seen.No significant degenerative disc disease is seen. The spinal canal and neural foramina remain patent although the L5-S1 foramina which are not well assessed due to artifact.The visualized distal spinal cord, conus and cauda equina show normal signal intensity and morphology. No pathologic intradural enhancement is seen.

Output: 1.Slight interval expansion of metastatic tumor involving the T2 vertebral body with mild epidural encroachment but no significant spinal canal stenosis.2.Metastatic disease involving the L5 and S1 vertebral bodies appears somewhat less bulky than on the prior examination which may reflect response to therapy.3.Multiple new metastatic lesions are evident within the marrow space involving nearly every level of the thoracic and lumbar spine. None of these new lesions is associated with any significant epidural encroachment or spinal canal stenosis. No vertebral body compression or retropulsion is seen.


Instruction: Generate impression based on medical findings.

Input: Cervical spine:There is reversal of the upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Grade 1 anterolisthesis C2 on C3, posterior osteophyte disc complex, ligamentum flavum thickening, and facet hypertrophy. There is mild central and moderate to severe bilateral neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is moderate central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is moderate central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is moderate left neural foraminal and moderate to severe right neural foraminal stenosis.Degenerative changes of the upper cervical spine result in moderate neural foraminal stenosis at T1/2 and mild neural foraminal stenosis at T2/3.Lumbar spine:There are no fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: Asymmetric bulge to the left, ligamentum flavum thickening, mild bilateral facet hypertrophy, a tiny synovial cyst along the left anteromedial facet joint, and a small left facet effusion. There is moderate left neural foraminal and mild right neural foraminal stenosis.L3/4: Diffuse annular disc bulge, ligamentum flavum thickening, mild-to-moderate bilateral facet hypertrophy, and a moderate left facet effusion. There is mild central and mild bilateral neural foraminal stenosis.L4/5: Grade 1 anterolisthesis of L4 on L5, diffuse annular disc bulge, ligamentum flavum thickening, severe bilateral facet hypertrophy, and mild to moderate bilateral facet effusions. There is moderate to severe central, severe bilateral lateral recess, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.L5/S1:Mild disc bulge and minimal bilateral facet hypertrophy. Bilateral S1 nerve root sheath origins are blunted and flattened without displacement.

Output: 1.C2/3: Mild central and moderate to severe bilateral neural foraminal stenosis.2.C3/4: Mild central and severe bilateral neural foraminal stenosis.3.C4/5: Moderate central and severe bilateral neural foraminal stenosis.4.C5/6: Moderate central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.5.C6/7: Mild central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.6.C7/T1: Moderate left neural foraminal and moderate to severe right neural foraminal stenosis.7.Degenerative changes of the upper cervical spine result in moderate neural foraminal stenosis at T1/2 and mild neural foraminal stenosis at T2/3.8.L2/3: Moderate left neural foraminal and mild right neural foraminal stenosis.9.L3/4: Mild central and mild bilateral neural foraminal stenosis.10.L4/5: Moderate to severe central, severe bilateral lateral recess, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.11.L5/S1:Bilateral S1 nerve root sheath origins are blunted and flattened without displacement.


Instruction: Generate impression based on medical findings.

Input: Male; 81 years old. Reason: hx left vocal cord paralysis, concern for RLN injury, special attention to LEFT RLN History: hx left vocal cord paralysis, concern for RLN injury, special attention to LEFT RLN CHEST:LUNGS AND PLEURA: Redemonstration of a left upper lobe lobectomy and accompanying post surgical changes with volume loss, bronchiectasis, and pleural thickening, similar when comparing to prior CT on 8/11/14. In retrospect, there was mild interval increased fibrotic changes in the left apex when comparing CT from 1/28/14. Dense left paramediastinal post radiation fibrotic changes, similar when comparing to prior CT on 8/11/14.Pleural thickening and fibrotic changes demonstrate mild contrast enhancement and restricted diffusion, but there is no focal, suspicious lesion seen.No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Cardiac size is normal without evidence of pericardial effusion.No hilar or mediastinal lymphadenopathy.Small hiatal hernia.CHEST WALL: As described on MRI neck exam from 4/13/15, there is T2 hyperintense lesion within the central canal at the level of T7, most likely due to an arachnoid cyst and similar in size when comparing to prior CT.UPPER ABDOMEN: Stable small, nonspecific cystic lesions in the pancreatic body, which may be due to sidebranch IPMN(s). Small, faint T2 hyperintense splenic lesion, most likely benign in etiology.

Output: 1. No evidence of residual or recurrent disease. 2. Stable postoperative and radiation changes in the left upper thorax since prior CT on 8/11/14. 3. No specific finding to account for the patient's symptoms, though as described above, there was mild interval increased fibrotic changes in the left apex when comparing CT from 1/28/14 .


Instruction: Generate impression based on medical findings.

Input: 28-year-old male with a history of neurofibromatosis type I presents with lower back pain radiating to the left leg and sciatic distribution. Evaluate for pelvic/sciatic neurofibroma. Note is made of multiple foci of increased signal abnormality on fluid sensitive sequences within the cutaneous, subcutaneous tissue and musculature of the pelvis compatible with the stated history of neurofibromatosis, although these are incompletely characterized on this noncontrast examination. More specifically, the largest lesion in the region of the left gluteus medius muscle measures 2.0 x 1.2 cm (image 15; series 6) which is suggestive of a neurofibroma, although this is again incompletely characterized on this noncontrast examination. The sciatic nerve is normal in appearance, bilaterally. The imaged musculature of the hips is normal in appearance. No bone marrow signal abnormality is identified. Note is made of an apparent disc bulge at the level of L5/S1 with apparent annular fissure, although this is incompletely characterized on this examination.

Output: Multiple foci of signal abnormality within the subcutaneous tissue and musculature of the pelvis consistent with the stated history of neurofibromatosis, although these are incompletely characterized on this noncontrast examination. The left sciatic nerve is normal in appearance. Disc bulge at the level of L5/S1. This could be better characterized with a dedicated lumbar spine MRI if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Back pain Tendons: The gluteus medius and gluteus minimus tendinous insertions on the greater trochanter are intact. The iliopsoas tendon is intact. The hamstring tendon origin is intact.Joints: The hip joints are normal. The sacroiliac joints appear unremarkable and without evidence of erosion, fluid, degenerative change, or abnormal enhancement. The pubic symphysis is unremarkable.Joint effusion/Bursa: No evidence of joint effusion. No trochanteric bursitis present.Muscles: No muscle atrophy or tear seen.Bone marrow: No focal marrow replacing lesions are identified. There is no fracture.

Output: Normal MRI of the pelvis/sacroiliac joints.


Instruction: Generate impression based on medical findings.

Input: 89-year-old female, Jehovah's Witness, status post 2 falls at home yesterday. Evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse hyperdensities within a periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Round focus of low attenuation in the left cerebellum consistent with previous stroke.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic changes as described above, no acute findings. If there is clinical concern for acute ischemia, an MRI may be considered


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old, with GBM status post resection. Evidence of wide left temporoparietal craniotomy is seen. Extracranial soft tissue swelling and a 7 mm layer of extra-axial fluid beneath the craniotomy are expected postoperative findings.A large resection cavity is now present at the site of the previous enhancing left anterior temporal lesion containing fluid and a small amount of dependent layering blood product. At the posterior margin of the resection cavity, along the temporal horn, there is a patch of amorphous enhancement measuring 9 x 7 mm which could represent residual tumor or postoperative change. Elsewhere, only nonspecific amorphous enhancement is seen along the cavity margins.T2 hyperintensity spreading through the parenchyma surrounding the resection cavity into the occipital lobe, the operculum, the parietal lobe, the insula and thalamus appears similar to that seen on the preoperative study.Moderate generalized mass effect is seen in the left cerebral hemisphere with sulcal effacement and partial effacement of the lateral ventricle. Only minimal midline shift is seen without evidence of herniation.No evidence of acute ischemia is seen. Scattered small foci of T2 hyperintensity within the cerebral white matter may reflect chronic microvascular ischemic disease.

Output: 1. Expected findings status post resection of a large left temporal tumor.2. The previously seen tumor has been completely or near completely resected. Only a small amount of enhancing tissue is seen along the posterior margin of the resection cavity which could reflect trace residual tumor or postoperative change.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: assess for ischemia History: altered mental status, h/o 2 prior CVAs. MRI is somewhat limited by patient motion.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. Incidental note is made of a persistent cavum septum pellucidum. 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.Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 45 years Male (DOB:11/28/1970)Reason: Eval for cord lesion, concern for NMO History: b/l optic neuritis PROVIDER/ATTENDING NAME: RIMAS V. LUKAS JAMES A MASTRIANNI Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are appreciated within the cervical spinal cord, though, artifacts may obscure more subtle abnormalities.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal lesions are appreciated within the thoracic spinal cord, though, artifacts may obscure more subtle abnormalities.No abnormal enhancing lesions are appreciated in the thoracic spine.

Output: 1.No abnormal lesions are appreciated within the cervical or thoracic spinal cord, though, artifacts may obscure more subtle abnormalities.2.There is no significant compromise to cervical thoracic spinal cord exiting nerve roots appreciated.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with brain metastases, status post stereotactic radiosurgery Redemonstrated are enhancing lesions involving the right inferior parietal lobule as well as left post central gyrus, unchanged in appearance. A left temporal occipital lesion is no longer discernible. There are no new enhancing foci.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Redemonstrated are enhancing lesions involving the right inferior parietal lobule as well as left post central gyrus, unchanged in appearance. A left temporal occipital lesion is no longer discernible. There are no new enhancing foci.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with left shoulder pain, evaluate for left shoulder rotator cuff or labral tear ROTATOR CUFF: There is a small amount of gadolinium entering the distal fibers of the supraspinatus tendon indicating a poorly defined undersurface tear that extends longitudinally for approximately 8 mm within the articular surface fibers of the tendon and with additional extension towards the bursal surface fibers, but without disruption of the most superficial fibers. No full thickness tear identified. The remainder of the supraspinatus tendon and muscle appears normal.The infraspinatus tendon is intact. There is minimal fatty infiltration along the myotendinous junction but otherwise the muscle appears normal.The teres minor tendon and muscle are intact.The subscapularis tendon and muscle are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the AC joint. Trace fluid in the subacromial bursa is of doubtful clinical significance, and no gadolinium is seen within the bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The entire anterior labrum is separated from the glenoid indicating a Bankart lesion; the anterior aspect of the glenoid appears abnormally flattened suggesting a Bankart fracture that would be better evaluated with CT if clinically warranted. There is globular increased signal intensity of the superior labrum indicating degeneration and tearing that extends into the posterior labrum to approximately the 9 to 10 o'clock position. There is also a Hill-Sachs defect.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps likely representing tendinosis or perhaps iatrogenic injection of gadolinium into the tendon during the procedure.

Output: 1. Bankart fracture and labral tears as described above as well as Hill-Sachs deformity.2. Small partial thickness tear of the supraspinatus tendon as described above.3. Mild osteoarthritis of the acromioclavicular joint and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 74 year old female status post vertebroplasty of L1. Low back pain. Evaluate cement placement. Since the prior MRI exam, there has been interval placement of methacrylate into the L1 vertebral body, which redemonstrates a compression fracture. There is stable mild retropulsion of the superior fracture fragment. No extravasation of methacrylate is seen. No evidence of complication of recent vertebroplasty procedure.Diffuse degenerative disk disease affects the lumbar spine. Degenerative change with vacuum phenomenon is seen at T11/12. Please refer to recent MRI for more specific description of neuroforaminal and central spinal stenosis.

Output: Findings of recent L1 vertebroplasty without evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecified Other postprocedural status(V45.89)Clinical question: recurrent disc herniation?Signs and Symptoms: RLE radic s/p microdiscx 3 mos 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. There is some T2 hyperintense signal present along the superior and anterior aspect of the T12 vertebral body which on the accompanying plain films appears represent discogenic sclerosis.At L5-S1 there is a right lateral recess disc extrusion which appears similar in size compared to the prior exam and extends towards the right lateral recess and encroaches on the nerve root at the right lateral recess. There is loss of disc space height, disc desiccation and some mild endplate reactive changes present at this level. The exiting nerve roots within the neural foramina are surrounded by fat. The patient is status post L5-S1 surgery along the right posterior elements. There is contrast enhancement at the right laminotomy site at L5-S1. There is contrast enhancement present adjacent to the disc protrusion at the L5-S1 right lateral recess which involves the right nerve root at the right lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy present at this level. There is a mild disc desiccation at this level associated with a minor disc bulge.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: 1.Since the prior examination the patient is undergone surgery at the L5-S1 level. There is a large disc extrusion present at the right lateral recess at the L5-S1 level which affects the nerve root at the right lateral recess (most likely right S1 nerve root) associated contrast enhancement at this level could represent a small amount of scar formation adjacent to the nerve root. The disc extrusion appears similar in size when compared to the prior exam


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unilateral primary osteoarthritis, left knee Lumbago with sciatica, right side Lumbago with sciatica, left sideClinical question: DDD of lumbar spineSigns and Symptoms: back and leg pain 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. There is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate osteophytes at this level. There is mild facet and ligamentum flavum hypertrophy present at this level. There is a left far lateral disc protrusion present which abuts the left-sided exiting nerve root after it exits the neural foramen.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation, endplate reactive changes and diffuse disc bulge at this level associated with mild facet hypertrophy and moderate ligamentum flavum hypertrophy. There is a left far lateral disc protrusion present which abuts the left-sided exiting nerve root after it exits the neural foramen.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height and a disc bulge at this level associated disc desiccation. There is mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height and a disc bulge at this level associated disc desiccation. There is mild ligamentum flavum hypertrophy at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.The uterus is large and contains a multiple large calcific lesions probably representing fibroids.There are large retroperitoneal lymph nodes present. A lymph node in the right periaortic region at the level of the C2-3 disc space currently measures 31 x 15 mm axial dimensions. Additional lymph nodes are identified elsewhere in the retroperitoneal space.

Output: 1.There are multilevel degenerative changes present in the lumbar spine without significant compromise to spinal canal or neural foramina. There are left-sided far lateral disc protrusions at L4-5 and L5-S1 which affects the left-sided exiting nerve roots at these levels.2.Multiple uterine fibroids.3.Findings suggest retroperitoneal lymphadenopathy. This was also present on the prior CT of the abdomen. A better assessment would be made using abdomen CT if clinically appropriate.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o osteo History: osteo on Xray, pain There is confluent decreased T1-weighted and increased T2-weighted signal within the proximal and middle phalanx of the fifth toe, with overlying soft tissue defect, compatible with osteomyelitis. The pathologic fracture of the fifth proximal phalanx is better evaluated on recent radiograph. There is associated bone marrow edema within the distal phalanx of the fifth toe, as well as the fifth metatarsal head.Low T1-weighted signal associated with increased T2-weighted signal within the middle phalanx of the fourth toe is also compatible with osteomyelitis.Additionally, confluent decreased T1-weighted and increased T2-weighted signal in the distal first phalanx is compatible with osteomyelitis. There is an ulceration along the medial aspect of the great toe.No discrete fluid collections are identified in the soft tissues, however, evaluation is somewhat limited given the lack of intravenous contrast.

Output: Osteomyelitis affects the proximal and middle phalanx of the fifth digit, the middle phalanx of the fourth digit, as well as the distal phalanx of the great toe.


Instruction: Generate impression based on medical findings.

Input: 94 years, Male, memory deterioration. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are prominent likely reflective of moderate degree of global parenchymal volume loss and commensurate with patient's advanced age. There is patchy T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which is nonspecific, but compatible with moderate degree of chronic small vessel ischemic disease. There are a few scattered foci of susceptibility compatible with chronic microhemorrhages and in a nonspecific distribution. Brain parenchyma is otherwise unremarkable for age. Postgadolinium images are slightly motion degraded. There is however no appreciable abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Calvarium and extracranial soft tissues are grossly unremarkable. Bilateral lens implants.

Output: 1. No evidence of acute infarct. No intracranial mass or mass effect. 2. Moderate degree of chronic small vessel ischemic disease. Few scattered nonspecific foci of chronic microhemorrhage.3. Moderate degree of global parenchymal volume loss commensurate with patient's advanced age.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male status post right knee arthroscopy, chondroplasty of a patellar chondral lesion, as well as a DeNovo NT procedure in the right knee trochlea. Now presenting with persistent knee pain. MENISCI: There is mild intrasubstance degeneration of the menisci, but no discrete tears are identified.ARTICULAR CARTILAGE AND BONE: There is full thickness degeneration and marked fraying of the articular cartilage of the medial facet of the patella, which appears progressed from the prior study. There is a full-thickness cleft within the articular cartilage just lateral to the median eminence of the patella with additional fraying of the articular cartilage of the patella centrally.Full-thickness central trochlear defects seen on the prior study have been replaced with heterogeneous signal intensity, presumably the site of prior microfracture, likely reflecting new cartilage formation, which is either immature or degenerated, based on the signal characteristics. There is a near full-thickness cleft within the articular cartilage along the inferior margin of this heterogeneous signal, best seen on the sagittal images. There is a near full-thickness cleft traversing the articular cartilage of the lateral trochlear facet with what appears to be delamination of the articular cartilage from the underlying bone. There is mild increased signal within the underlying bone consistent with edema, which is likely degenerative in etiology.There is a new near full-thickness to full-thickness defect of the articular cartilage of the medial femoral condyle, measuring just under one cm in AP dimension, just above the posterior horn of medial meniscus with heterogeneous signal of the adjacent articular cartilage posteriorly, suggesting degeneration. There is also what appears to be thinning of the articular cartilage of the lateral femoral condyle above the anterior horn of the lateral meniscus, but this may be artifactual.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments are intact, as are the medial collateral and lateral collateral ligament complexes.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Findings of trochlear microfracture, but with overall progression of cartilage degeneration in the patellofemoral and medial tibiofemoral compartments as described above.


Instruction: Generate impression based on medical findings.

Input: Pancreatic cancer with fever, altered mental status, hallucinations. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal cerebral white matter T2 hyperintensity and a punctate focus of high T2 signal in the left thalamus. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is a retention cyst in the left maxillary sinus.

Output: 1. No evidence of intracranial metastases.2. Minimal cerebral white matter T2 hyperintensity and a punctate focus of high T2 signal in the left thalamus may represent chronic small vessel ischemic disease and lacunar infarct, respectively, without evidence of acute infarction.


Instruction: Generate impression based on medical findings.

Input: Reason: lesion History: history of NMO The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Since the prior exam T2 signal hyperintensity previously noted from approximately C3 down to T8 to 3 disk space level has a regressed and is not readily identified. At the edge of the film at the C7 vertebral body level there appears to be right hemicord signal hyperintensity on T2 imaging which is not completely included on this exam. At the T9 T10 disk space level there is right hemicord signal hyperintensity on T2 imaging.

Output: 1.Since the prior exam thoracic spinal cord lesion extending from me cervical spinal cord has regressed.2.There is a right hemi-cord lesion present in the C7 level which is not completely included on this exam. Perhaps an MRI of the cervical spine with help further assess this lesion. The possibility of demyelination cannot be excluded.3.There is a lesion present in the right hemicord at T9-10. The possibility of demyelination cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 72 year-old female, twisted knee with pain MENISCI: There is extensive degeneration and loss of substance/degenerative tearing of the anterior horn, body, and posterior horn of the lateral meniscus. There is intrasubstance signal within the medial meniscus likely representing mucoid degeneration without extension to an articular surface.ARTICULAR CARTILAGE AND BONE: There is diffuse near full-thickness cartilage loss involving the patellofemoral joint and bilateral tibiofemoral joint compartments. There is minimal subchondral signal abnormality along the lateral femoral condyle and the median eminence of the patella. A small bone island is noted in the distal femur. The bone marrow signal is otherwise within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. There is pre-patellar edema.ADDITIONAL

Output: 1. Extensive degeneration and degenerative tearing of the lateral meniscus, as described above.2. Tricompartmental articular cartilage loss, as detailed above. 3. Moderate joint effusion.4. Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: Female; 61 years old. Reason: 61 y/o recurrent acute pancreatitis, dilated PD and CBD with concern of ampullary stricture, but new episode of pancreatitis after double sphincterotomy. ABDOMEN:MRCP SECRETIN STUDY:Normal physiologic response to secretin with pancreatic secretions seen readily filling the duodenum and proximal jejunum. Unchanged anatomic appearance of the biliary tree as detailed on yesterday's MRI exam. Again seen is a dilated main pancreatic duct and common bile duct with possible short segment stricture at the level of the ampulla Vater. A normal caliber ventral accessory pancreatic duct is seen draining into a superiorly located minor papilla.

Output: 1. Normal physiologic response to secretin.2. Possible short segment stricture at the level of the ampulla Vater.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: 64 yo male s/p whipple for IPMN in 4/14; please evaluate for abnormalities History: pancreas mass LUNG BASES: Right basal scarring/atelectasis.ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Subcentimeter T2 hyperintensity within the posterior right hepatic lobe is consistent with a hepatic cyst. SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple. There is marked dilatation of the pancreatic duct throughout its course, measuring up to 8 mm and increased compared to most recent CT abdomen 26/04/14. No definite enhancing mass is identified within the pancreas. Given the time interval, stricture is the most likely etiology.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Nonspecific mildly prominent portacaval lymph node.BOWEL, MESENTERY: Changes related to prior Roux-en-Y.BONES, SOFT TISSUES: T2 hyperintensities within the lower thoracic vertebral bodies are suggestive of hemangiomas.

Output: 1.Increased dilatation of the pancreatic duct in this patient who is status post Whipple. Given the time interval favor stricture as most likely etiology of the dilatation. While pancreatic mass or a main branch IPMN are differential considerations, there are no specific imaging findings to suggest these diagnoses which are therefore felt much less likely. 2.Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Decubitus ulcers Note that the exam is limited by the presence of only the axial T1 and axial T2 fat sat sequences.BONE MARROW: The marrow demonstrates a diffusely heterogeneous appearance however there is no discrete low T1 signal to confirm osteomyelitis. Sclerotic changes noted within the femoral head bilaterally likely relate to avascular necrosis. The right femoral head is superiorly migrated but remains within the acetabulum.SOFT TISSUES: There is diffuse fatty atrophy of the pelvic musculature. There is mild decubitus ulceration of the subcutaneous tissues of the right buttock. Underlying this area is a heterogeneous collection containing low peripheral signal with central areas of fluid signal intensity. A similar appearing collection is seen within the left gluteal tissues again demonstrating a low peripheral signal with areas of fluid signal centrally. These findings are thought to represent hematomas although the possibility of superimposed infection cannot be excluded. Note that the collection along the left gluteal musculature does not demonstrate a fistulous tract with the skin surface.

Output: 1. No definite evidence of osteomyelitis. The marrow signal is heterogeneous in nature with probable avascular necrosis of the femoral heads although correlation with recent CT is recommended.2. Ill-defined collections within the gluteal musculature bilaterally are thought to represent hematoma, likely chronic, although the presence of superimposed infection cannot be excluded.3. Additional chronic findings described above.


Instruction: Generate impression based on medical findings.

Input: 37 year old with BRCA2 mutation and strong family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are scattered enhancing foci in both breasts (right greater than left).No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 34 years, Female, Reason: assess for crohns dz, bowel wall thickening History: hx abd pain/diarrhea. endo shows apthous ulcers in distal stomach \T\ ileum. family hx Crohn's dz. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense focus with enhancement (2001/65) is too small to accurately characterize, but most likely represents a hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or abnormal enhancement. The terminal ileum appears normal. No abscesses or fistulas. No findings suggesting chronic inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of inflammatory bowel disease.


Instruction: Generate impression based on medical findings.

Input: Breast density study, exam for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not to be used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not to be used for clinical purposes.


Instruction: Generate impression based on medical findings.

Input: Female 74 years old with urethral cancer receiving CRT. Evaluate for extent of disease for radiation planing. PELVIS:UTERUS, ADNEXA: Atrophic or surgically absent uterus.BLADDER: A Foley catheter is in place and the urinary bladder is nondistended. Mild trabeculation of the bladder wall is again seen which may reflect chronic bladder outlet obstruction. There is a stable T1 isointense, nonenhancing nodular intraluminal focus along the right lateral aspect of the Foley catheter (series 902, image 306) which is nonspecific and unchanged, this may be related to hemorrhagic material.LYMPH NODES: The reference right inguinal lymph node has decreased in size and is no longer enhancing. Reference measurement is provided below.BOWEL, MESENTERY: Severe sigmoid and descending colonic diverticulosis with thickening of the wall suggesting chronic inflammation. No evidence of acute diverticulitis.BONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine.OTHER: Comparison of the reference enhancing urethral mass is difficult due to changes in areas of intralesional enhancement, with areas of internal nonenhancement likely from treatment-related necrosis. There was previously confluent enhancement but on the current exam the enhancement pattern is more that of concentric circles. The maximal thickness anteriorly measures 7 mm (series 904, image 233), previously the region of maximal thickness was posteriorly and measured 11 mm. Amorphus enhancement extending towards the vaginal cuff has improved. The amount of diffusion restriction associated with the mass has improved.A moderate degree of perineal enhancement is new and nonspecific. Mild cellulitis cannot be excluded and correlation with physical exam is suggested.INDEX LESION MEASUREMENTS (Current exam date/time: 12/8/2016 06:30:00)URETHRAL MASS: 2.8 x 2.6 cm (Image 238, Series 904); 2.8 x 2.6 cm on prior (10/7/2016) (Image 140, Series 9).RIGHT INGUINAL LYMPH NODE: 1.4 x 1.3 cm (Image 238, Series 904); 2.1 x 1.9 cm on prior (10/7/2016) (Image 145, Series 9).

Output: 1.The urethral mass consistent with the patient's known urethral squamous cell carcinoma is stable in size but the enhancement pattern and diffusion restriction have improved indicating treatment response.2.Interval decrease in size and enhancement of metastatic right inguinal lymph node. 3.No new sites of disease.4.A moderate degree of perineal enhancement is new but nonspecific. Mild cellulitis is not excluded and correlation with physical exam is suggested.


Instruction: Generate impression based on medical findings.

Input: History of meningioma. Evaluate for residual/new disease. There are postoperative findings related to right-sided craniotomy, with encephalomalacia in the right frontal and temporal lobe surrounding the resection cavity. There are small unchanged foci of dural enhancement in the surgical bed region. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions in the right maxillary sinus and what may represent a left antronasal polyp.

Output: 1. Postoperative findings related to right-sided craniotomy, with encephalomalacia in the right frontal and temporal lobe surrounding the resection cavity and small unchanged foci of dural enhancement in the surgical bed region, which may represent treatment effects, but otherwise no evidence of enlarging tumors to suggest recurrent meningioma. 2. Findings suggestive of acute right maxillary sinusitis and what may represent a left antronasal polyp.


Instruction: Generate impression based on medical findings.

Input: A 71 year old male with CNS lymphoma with suspected cardiac involvement according to PET study. Referred to cardiac MRI to evaluate cardiac involvement. Left VentricleThere is motion artifact secondary to breathing which limits the quality of the examination. The left ventricle is mildly enlarged with mildly reduced systolic function. There is thinning of the inferior wall from the base to the apical two thirds of the left ventricular chamber. The thickened segments are akinetic. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 221 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 115 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 91 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 167 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 64 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. The patient was unable to cooperate with breathing instruction and thus the image quality is limited. Contrast was not injected for this reason.2. The left ventricle is mildly enlarged with mildly reduced systolic function, the LVEF is 48%. There is thinning of the inferior wall from the base to the apical two thirds of the left ventricular chamber, favoring prior myocardial infarct. The segments are akinetic.3. The right ventricle is normal in size with normal systolic function, the RVEF is 62%.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: Evaluate for middle ear lesion or brain tumor: right CN V2 paresthesias. The middle ear regions appear unremarkable bilaterally. The bilateral pterygopalatine fossae, foramina rotundum, cavernous sinuses, and Meckel caves appear to be intact. A venous structure abuts the superior aspect of the cisternal segment of the right trigeminal nerve. The cisternal portions of the trigeminal nerves otherwise appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is moderate mucosal thickening within the right maxillary sinus.

Output: 1. No evidence of intracranial or temporal bone mass lesions. 2. A venous structure abuts the superior aspect of the cisternal segment of the right trigeminal nerve without discernible impingement of the nerve. Thus, this likely represents an anatomic variant rather than a vascular loop syndrome of trigeminal neuralgia. 3. Findings suggestive of right maxillary sinusitis.