Instruction: Generate impression based on medical findings.

Input: 76 year old man with coronary artery disease s/p TECAB CABG in May 2015. He presents with persistent dyspnea on exertion and referred to evaluate for ischemia and viability.MEDICATIONS: aspirin, clopidogrel, atorvastatin, HCTZ, lisinopril, metoprolol, insulin First Pass PerfusionDuring hyperemia, a large, severe perfusion defect was seen involving the basal and inferolateral and anterolateral walls and also the apical lateral wall. The overall ischemia score is 9 out of 32 and 28% of the ventricle is ischemic.Viability/ Myocardial ScarThe possibility of a small transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal inferolateral wall can not be excluded. It is unclear if this segment is viable. However, the remainder of the heart is without late gadolinium enhancement and is very likely to be viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 48 ml/m2 (normal range: 74+/-15), the LVEDV is 97 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), the LV mass index is 46 g/m2, and the LV mass is 92 g. There is tardokinesis of the basal inferior wall. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 43 ml/m2 (normal range 82+/-16), the RVEDV is 86 ml (normal range 142+/-31), the RV end systolic volume index is 14 ml/m2 (normal range 31+/-9), and the RVESV is 28 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. Mild atherosclerosis is noted in the descending thoracic aorta.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. There is a large burden of pericardial fat.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 a large severe perfusion defect during hyperemia, as described above.2. The possibility of a small transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal inferolateral wall can not be excluded. It is unclear if this segment is viable. However, the remainder of the heart is without late gadolinium enhancement and is very likely to be viable. 3. Normal LV size and systolic function (LVEF 64%). There is tardokinesis of the basal inferior wall.4. Normal RV size and systolic function (RVEF 67%).


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out hemorrhage. Signs and symptoms: Post op. Nonenhanced CT of brain:Examination demonstrates expected postoperative changes of left suboccipital craniotomy. There is minimal residual fluid and air under the craniotomy flap, minimal residual air within the subarachnoid space in both supra-and infratentorial space. Minimal punctate high density at the expected level of the left foramina of Luschka is noted. There was tumor at this site on prior exam. This findings has the appearance of calcification and or hemorrhage which may be a postop change or represent residual tumor. This finding measures approximately 7 mm times 14-mm in size and should be further followed with an MRI examination. Subtle mass effect on the fourth ventricle with minimal deviation to the right is similar to prior study. There is no evidence of any opacification of mastoid air cells although the craniotomy line traverses the posterior mastoid air cells. Middle ear cavities are well pneumatized and unremarkable. A retention cyst within the left chamber of the sphenoid sinus is noted.

Output: 1.Expected postoperative changes of left suboccipital craniotomy for removal of left cerebellopontine angle tumor.2.Suspect small residual tumor in the left cerebellopontine angle and follow-up with an MRI is recommended.3.No evidence of acute hemorrhage or cerebral edema.


Instruction: Generate impression based on medical findings.

Input: The pituitary gland measures up to 3 mm in height and is slightly heterogeneous. However, there is no evidence of a focal lesion within the pituitary gland. The pituitary stalk is intact and lies in the midline. The posterior pituitary bright spot is also intact. The suprasellar cistern, optic apparatus, and cavernous sinuses appear unremarkable.

Output: Mildly atrophic pituitary, without discernible pituitary lesion. 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: Eval growth of anaplastic astrocytoma. Pt on Avastin+CCNU. Along the posterior right superior frontal gyrus, there is increased extent and confluence of DWI hyperintensity with ADC isointensity in the location of previous focal DWI hyperintensity. This lesion measures 1.8 x 1.3 cm (series 11 image 27). There is corresponding increase in FLAIR/T2 signal and enhancement of this lesion. Questionable mild hyperperfusion conforming to the signal abnormality.There is mild residual patchy speckled enhancement remaining of the previously seen left paracentral lobule lesion. There is corresponding focal diffusion restriction appearing similar to prior study. Compared to more remote prior exams there is increase confluence of the T2/FLAIR hyperintensity in the left centrum semiovale. Compared to most recent prior exam, this region appears similar without enhancement or hyperperfusion.There is redemonstration of a small focus of enhancement with associated T2/FLAIR hyperintensity laterally adjacent to the left occipital horn, with stable post-contrast appearance, and stable to minimally progressed FLAIR abnormality. There is more conspicuous progression when compared to remote exams. It is associated with a faint susceptibility.Ill-defined gyriform enhancement along the posterior aspect of the left temporal lobe appears similar to the most recent comparison, with associated ill-defined FLAIR hyperintensity which is overall decreased immediately in the area of enhancement, although appears similar with gyral thickening as well as focal sulcal effacement just inferiorly.There are two new tiny nodular foci of enhancement seen adjacent to the left occipital periventricular and left posterior temporal lobe lesions with FLAIR abnormality, as seen on 11/15.Other scattered non-enhancing foci of FLAIR hyperintensity in the bifrontal and right parietal subcortical white matter appear unchanged, and are nonspecific. Susceptibility artifacts along the left frontal craniotomy site and left thalamus, stable from prior study. There is stable intrinsic T1 hyperintensity along the left thalamus, with subtle minimal superimposed enhancement especially along the medial left thalamus.Right ethmoid mucous retention cyst.

Output: Redemonstration of multiple scattered ill-defined enhancing lesions scattered in both cerebral hemispheres of the brain, with some findings stable, although there are others which are progressed such as in the posterior right superior frontal gyrus with mild diffusion restriction and questioned hyperperfusion, as well as a few new tiny lesions in the left temporo-occipital white matter.


Instruction: Generate impression based on medical findings.

Input: MRI brain:There has been interval resolution of previously seen multiple areas of bilateral T2/FLAIR hyperintensity predominantly involving the cortex and subcortical white matter. There are no areas of abnormal signal or pathologic enhancement. The ventricles and sulci are prominent, consistent with mild global volume loss greater than expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening of the frontal sinuses, ethmoid air cells and bilateral maxillary sinuses. MRA brain:The intracranial internal carotid arteries are normal in course and caliber. Slightly inhomogeneous areas of flow related enhancement in the cavernous carotids likely relates to turbulence and flow related artifact. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. Interval complete resolution of previously seen scattered prominent areas of abnormal cortical and subcortical abnormal signal, presumably related to PRES as well as possible superimposed areas of seizure activity given history of status epilepticus.2. No evidence of acute infarct.3. Unremarkable MRA of the head.


Instruction: Generate impression based on medical findings.

Input: C-Spine MRI:The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. T-Spine MRI: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber. There is trace prominence of the central canal, which is of doubtful clinical significance, and without evidence of a discrete syrinx. There is no pathological enhancement. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.L-Spine MRI: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.

Output: MRI of the complete spine appears within normal limits.


Instruction: Generate impression based on medical findings.

Input: Severe neck stiffness (less than 20 degrees in any direction x1 month). History of Hepatocellular carcinoma. There is an enhancing lesion in the dens and a portion of the C2 body anteriorly. There is diffuse heterogeneous bone marrow signal from C3 through C7 with endplate irregularities and small disc-osteophyte complexes that appear to mildly indent the spinal cord. The vertebral body heights appear to be grossly preserved, however. There is no evidence of significant lymphadenopathy in the neck. The salivary glands are unremarkable. There is a T1 and T2 hyperintense nodule in the left thyroid gland that measures up to 7 mm. There are T1 hyperintense secretions in the right sphenoid sinus. There is a small amount of fluid in the left mastoid air cells. The imaged portions of the intracranial structures and orbits are unremarkable.

Output: 1. A lesion in the dens and a portion of the C2 body anteriorly likely represents metastatic disease. 2. Diffuse heterogeneous bone marrow signal from C3 through C7 is likely degenerative in nature, with endplate irregularities and small disc-osteophyte complexes that appear to mildly indent the spinal cord. 3. A small nodule in the left thyroid gland likely represents a colloid cyst.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 74 year old female with metastatic breast cancer with involvement of prevertebral and paravertebral tissues in the cervical spine. Status post RT. Evaluate for change. Compared to prior exam from 6 -- 15 -- 11. Enhanced CT of soft tissues of neck:40 cc of Omnipaque 350 was given for this study. Multidetector helical CT of entire soft tissues of neck are acquired. Coronal and sagittal 2-D reformatted images are also acquired.Examination demonstrates a soft tissue mass in the right carotid space at the level of the skull base and C1 level. The mass surrounds the right transverse process of C1 and is inseparable from right vertebral artery at C1 level. There are diffuse lytic changes in the C1 vertebrae as well as lateral mass of C2 on the right. There is subtle mass effect and anterior displacement of the right internal carotid artery secondary to tumor. The tumor also reaches the right styloid fragment. The right internal jugular is compressed by the mass however remains patent. When compared with prior exam there is subtle interval decrease in the bulk of the tumor and apparently less mass effect on the carotid. There is no definitive extension of tumor into the spinal canal on this exam. On prior study there was a slight widening of the right epidural space likely secondary to tumor at C1 level. The very irregular shape of tumor makes precise measurement difficult however on axial image 22 at C1 level the extra osseous component of tumor measures 22 x 27.5-mm. And coronal post infused reformatted image 40 cranial cephalad axis of tumor measures 22-mm. A previous reported right-sided lymph node at the level of two also demonstrate interval decrease in its size. This node measures 6.6-mm in size compared to prior measurements of 11.8 times 8.6-mm. Or there is no evidence of any new lymphadenopathy. The vasculature of the neck remains intact. Limited images through the apices of the lungs demonstrate apical scarring and without definitive evidence of metastases. No appreciable interval change since prior exam. Please review dedicated report of CT of chest performed the same date as this study. Possible small metastatic lesions in C5 and C7 best appreciated on sagittal reformatted bone density image 22. These findings were present on prior study. If further evaluation of spine metastatic lesions are desired dedicated pre-and post enhanced MRI of cervical spine is recommended.

Output: 1.Interval significant decrease in the size of tumor at C1 and C2 right paraspinal region. Lytic metastatic lesions in C1 and C2 may be the source of this right-sided paraspinal soft tissue mass. Interval necrosis and decrease in the size of right-sided level 2 lymph node. No evidence of new lymphadenopathy.2.Residual tumor at C1 -- C2 level on current exam measures 22 x 27 x 40 mm.3.suspected small intra-osseus lytic metastatic lesions at C5 and C7. Questionable other lytic changes in the cervical spine. If further evaluation is desired dedicated pre-and post enhanced MRI of spine is recommended.


Instruction: Generate impression based on medical findings.

Input: Follow-up evaluation of mass. Evaluate for ventricles history of normal pressure hydrocephalus and mass anterior to pons. Implanted defibrillator. Status post VPS placement Nonenhanced CT of brain:There is revisualization of a left sided extra axial mass in the left cerebellopontine angle with extension across the midline posterior to the clivus. The mass superiorly reaches the dorsum sella. There is subtle mass effect on the pons. There is no detectable in edema of brain parenchyma. On this non-infused study this lesion remains similar in size and density.Findings a brief to represent a meningioma. Fourth ventricle is normal in size and unchanged since prior exam.Images through supratentorial space demonstrated enlargement of supratentorial ventricles with a right sided ventricular catheter. The measurements of lateral ventricles demonstrate a very subtle interval decrease in their size. There is better visualization of subarachnoid space surrounding the knee to high complexity of brain parenchyma compared to prior exam. I suspect a small nonhemorrhagic subdural in these locations. This can be only definitively diagnosed with an MRI examination or a post infused CT of brain. The thickest portion of this collection measures approximately 5 mm.

Output: 1.Stable extra-axial left cerebellopontine and prepontine mass to represent a meningioma.2.Slight interval decrease in the size of the supratentorial ventricular system.3.Better visualization of extra-axial CSF in the midpole hypodensity bilateral frontal -- parietal regions which suspect the extra-axial subdural nonhemorrhagic collections.


Instruction: Generate impression based on medical findings.

Input: 17-year-old male with right knee pain We see no findings to account for the patient’s pain. The site of microfracture seen on prior MRI exam is not evident on the current study.

Output: No findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old, with right arm pain, paresthesias and weakness. Mild reversal of the cervical lordosis is again seen, unchanged. Grade 1 retrolisthesis of C4 relative to C5, and C5 relative to C6, are also unchanged.Vertebral body morphology is otherwise unremarkable. No concerning marrow signal abnormality is detected.Spinal cord signal intensity and morphology are within normal limits.Mild/moderate facet hypertrophy is evident at every level, unchanged. Scattered perineural root sleeve cysts are seen, not significantly changed. Level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. No interval changes.C3-4: Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. No interval changes.C4-5: Posterior disk osteophyte formation. No significant spinal canal stenosis. Severe bilateral foraminal narrowing. No interval changes.C5-6: Posterior disk osteophyte formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes. C6-7: Posterior disk osteophyte formation. No significant spinal canal stenosis. Mild left neuroforaminal narrowing. No significant interval changes. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. T1-2: As assessed on sagittal images only, disk osteophyte formation is evident but without significant spinal canal compromise. The right neural foramen may be narrowed.

Output: 1. No significant change in degenerative disk disease which causes no significant spinal canal stenosis.2. No significant interval change in scattered foraminal narrowing which ranges from mild to severe as above.3. No new findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 67 year-old female with seizure today. No history of seizure. History of CVA and encephalopathy, mental retardation. There is no evidence of intracranial hemorrhage, mass or edema. Extensive carotid calcification. Dystrophic calcifications within the bilateral basal ganglia. Multiple hypodensities in periventricular distribution consistent with extensive small vessel disease, age indeterminate. Multifocal old cerebellar strokes. No evidence of supratentorial cortical stroke. If there is clinical concern for acute ischemia an MRI may be considered. Prominent sulci with proportionally enlarged ventricles.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with shoulder pain. Evaluate cuff, biceps. ROTATOR CUFF: There is intermediate signal intensity within the distal fibers of the supraspinatus tendon anteriorly indicating tendinosis. A tiny (2 mm) focus of fluid signal intensity within the distal fibers of the tendon at its insertion is suggestive of an interstitial tear but we see no disruption of either surface of the tendon. The supraspinatus muscle appears normal. The infraspinatus muscle and tendon appear normal. The teres minor muscle and tendon appear normal. There is increased signal intensity and thickening of the subscapularis tendon indicating tendinosis and possibly undersurface fraying but we see no fluid-filled tear. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Os acromiale. There is edema within the os acromiale with minimal, if any, osteoarthritic changes at the acromioclavicular joint. There is a small amount of fluid in the subacromial subdeltoid bursa which may represent a mild bursitis. GLENOHUMERAL JOINT AND GLENOID LABRUM: Joint alignment is normal. There is a small amount of fluid in the joint but no effusion. Given the limitations of a non-arthrogram study we see no labral tear. The articular cartilage appears normal. There are small cysts along the posterolateral aspect of the humeral head which is not necessarily of any current clinical significance.BICEPS TENDON: There is increased signal intensity within the long head of the biceps tendon at its transition from the intertubercular groove to the rotator interval indicating mild tendinosis.

Output: 1. Os acromiale with edema within the os which may reflect instability.2. Mild subacromial subdeltoid bursitis.3. Mild supraspinatus tendinosis and tiny insertional interstitial tear.4. Subscapularis tendinosis and undersurface fraying.5. Tendinosis of the long head of the biceps tendon.


Instruction: Generate impression based on medical findings.

Input: Bilateral lower extremity and upper weakness, known metastasis in the thoracic spine CERVICAL: There is evidence of diffuse osseous metastatic disease throughout the cervical spine affecting all levels and grossly similar in distribution to prior studies. Vertebral body heights in the cervical spine are grossly maintained. There is loss of cervical lordosis. There is abnormal enhancement involving the right ventral epidural space at the C4-C5 level suspected to represent small amount of epidural tumor. There is effacement of the ventral thecal sac at this level without evidence of cord compression. No signal abnormality is seen in the cervical cord. Mild multilevel degenerative changes are present without high-grade spinal canal or neural foraminal stenosis at any level.LUMBAR:Numbering is performed as per prior studies with 5 lumbar type vertebral bodies and a sixth transitional segment labeled S1 for the purposes of this study.There is diffuse osseous metastases throughout the lumbar spine, pelvis, visualized chest wall. There is minimal loss of height involving the L1 vertebral body and relatively greater loss involving the T11 vertebral body. Vertebral body heights in the lumbar spine are otherwise grossly preserved. Alignment in the lumbar spine is grossly preserved. There is no evidence of spinal canal stenosis at any level in the lumbar spine. There is T2 hyperintensity within the distal cord related to intramedullary metastasis at the T12-L1 level as seen on recent thoracic spine study. There is associated enhancement which extends to the ventral leptomeningeal surface of the cord.There is no definitive evidence of epidural tumor in the lumbar spinal canal within the limitations of the artifact. There is no significant spinal canal stenosis in the lumbar spine at any level. There is bilateral paraspinous tumor centered at the L1 level left greater than right. Tumor is suspected in the neural foramina at the right L1-2 and right L2-L3 level. There is mild neural foraminal narrowing at the right L5-S1 level which may be related to disc disease versus small amount of epidural tumor but is not well assessed due to artifacts.Right-sided hydronephrosis and retroperitoneal lymphadenopathy again noted and better imaged on prior abdominal CT.

Output: 1. Diffuse osseous metastatic disease affecting all levels in the cervical and lumbar spine. Mild pathologic compression fractures including the T11 level and to a lesser degree at the L1 level. No associated osseous retropulsion. 2. Thin epidural tumor is suspected in the cervical spine at the right C4-C5 level without mass effect on the cord. No significant spinal canal stenosis is seen in the cervical spine or lumbar spine.3. Intramedullary metastasis involving the distal cord at the T12-L1 level again seen with enhancement extending to the leptomeningeal surface. 4. There appears to be small amount of tumor involving the neural foramina such as a the right L1-L2 and right L2-L3 levels which is not well evaluated due to artifact. Tumor involving the thoracic neural foramina and epidural space better assessed on recent thoracic spine MRI study.5. Right-sided hydronephrosis and retroperitoneal lymphadenopathy again noted.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: 72 years Female (DOB:11/15/1943)Reason: evaluate for stroke History: L-sided weakness, extensive aneurysmal burdenPROVIDER/ATTENDING NAME: JAMES J WALTER RICHARD J KRAIG MRI of the brainThere is a small focus of diffusion restriction present in the right centrum semiovale measuring approximately 10 mm in size which is high signal on FLAIR and T2 imaging.There is a focus of encephalomalacia present in the left inferior parietal lobule and adjacent precuneusThere is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Some patchy T2 and FLAIR signal hyperintensities are present in the thalami, brainstem and basal gangliaA subdural effusion the posterior fossa is likely related to atrophy.Punctate foci of signal loss are identified on susceptibility weighted imaging within the cerebellar hemispheres approximately 2 or 3 in each cerebellar hemisphere. These were also present on the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 10 mm x 9 mm aneurysm present along the left internal carotid artery originating from the posterior aspect of the clinoidal segment with any 2.5-mm in neck and suprasellar extension which abuts the optic nerve. There is fusiform ectasia of the left internal carotid artery at the distal cavernous segment where it dilates up to 7 mm in diameter. Immediately distal to this ectasia the internal coronary narrows down to 2.5 mm after which the aneurysm originates. The aneurysm abuts the left optic nerve. The aneurysm appears stable when compared to the prior exam. There is 40% narrowing of the left internal carotid artery at the distal cavernous segment.The right vertebral artery functionally appears to and in the right posterior inferior cerebellar arteryThere is a stenosis present at the distal left vertebral artery at the vertebrobasilar junction where there is approximately 80% stenosis over a 10 mm segment. There is 40% narrowing basilar artery along its midportion.The right P1 segment appears be occluded approximately 4 mm from its origin and the left P1 segment is stenotic approximately 7 mm from its origin where it narrows down to 1 mm diameter.There is a short segment 80% stenosis at the proximal left middle cerebral artery at the M1 segment with associated poststenotic dilation. This was also present on the prior exam. It does not appear to have progressed significantly.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is an acute lacunar infarct present in the right centrum semiovale.2.A 10 mm left internal carotid artery aneurysm at the clinoid segment is stable compared to the prior exam. This is associated with suprasellar extension. The aneurysm abuts the left optic nerve.3.There is 80% stenosis at the distal left vertebral artery near the V-B junction associated with milder narrowing of the basilar artery. The LVA appears to be effectively the sole supply to the basilar artery. It is associated with tandem foci of narrowing in the basilar artery.4.80% stenosis at the proximal left M1 segment.5.There is occlusion of the right P1 segment.6.There is a high-grade stenosis along the proximal left P1 segment.7.There are multiple old lacunar infarcts present in the brainstem and thalami. These were also present on the prior exam.8.There is a focus of encephalomalacia in the left parietal lobe. This was also present on the prior exam.9.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 10.Cerebellar microhemorrhages are stable.


Instruction: Generate impression based on medical findings.

Input: Cerebral cavernous malformation. There is a lesion with extensive susceptibility effect in the right peritrigonal white matter, which measures up to approximately 10 mm. There is no surrounding vasogenic edema, but there appears to be a small associated developmental venous anomaly. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Right peritrigonal white matter cavernous malformation measuring up to approximately 10 mm, with what appears to be a small associated developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: Stated history of auto-immune sclerosing cholangitis and cirrhosis. Pathology dated 11/30/2012 showed chronic hepatitis with focal bridging fibrosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion. No intrahepatic or extrahepatic biliary ductal dilatation. Normally distended gallbladder. The MRCP images demonstrate mild irregular narrowing of the right hepatic duct without a focal lesion or upstream dilatation, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Extrarenal pelvis bilaterally.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: Minimal non-specific irregularity of the right hepatic duct without a focal lesion or biliary ductal dilatation. No specific stigmata of cirrhosis or focal liver lesion.


Instruction: Generate impression based on medical findings.

Input: 41 years Male (DOB:4/20/1975)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular and subcortical white matter lesions present which are bright on T2 and FLAIR MRI and low signal on T1-weighted imaging which are perpendicularly oriented to the lateral ventricles. Additional similar appearing lesions are present in the left cerebral peduncle, the right pons, the right medulla as well as the right cerebellar hemisphere. Additional similar-appearing lesion is present along the left posterior lateral aspect of the spinal cord at the C2 vertebral level.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple periventricular and subcortical white matter lesions as well as brainstem lesions and cervical spinal cord lesion are present. These are compatible with patient's clinical history of multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with a fall backwards in March 2015 with right shoulder stiffness greater than left. ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus tendon indicating mild tendinosis. The supraspinatus muscle appears intact. There is a partial-thickness articular surface tear of the anterior fibers of the infraspinatus tendon, involving greater than 50% of the tendon width, measuring approximately 7 mm in AP dimension, without significant retraction. There is intermediate signal intensity and thickening of infraspinatus tendon indicating moderate tendinosis. The infraspinatus muscle appears intact. The teres minor and subscapularis muscles.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. The acromioclavicular joint alignment is anatomic.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the glenoid labrum, the glenoid labrum appears intact. No fluid-filled defects are identified.BICEPS TENDON: The long head of biceps tendon appears intact. There is circumferential fluid within the tendon sheath of long head of the biceps which may represent fluid extends from the glenohumeral joint. ADDITIONAL

Output: Partial thickness articular surface tear of the infraspinatus without significant retraction as described above.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unspecified symptoms and signs involving the nervous systemClinical question: evaluate for cerebellar degeneration / atrophySigns and Symptoms: ataxia (trunk only), word finding difficulty, fatigue The CSF spaces are appropriate for the patient's stated age with no midline shift. Artifact somewhat obscures visualization of the lower medulla. No abnormal mass lesions are appreciated in the cerebellum.There is a developmental venous anomaly present in the left lower medulla.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for cerebellar atrophy on this exam.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with metastatic breast cancer and known brain metastases with new onset atrial fibrillation. Now with mental status change. Evaluate for acute CVA or hemorrhage. Multiple low attenuation areas correspond to vasogenic edema secondary to known metastatic foci are seen involving both cerebral hemispheres. Some of these lesions correspond to those on MRI from 3 months prior, however all cannot be appreciated on this exam. No definite new lesions identified. There is no evidence of intracranial hemorrhage. 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: Multiple low attenuation areas correspond to vasogenic edema from known brain metastases are seen. MRI is suggested for further evaluation if clinical concern remains for acute CVA.


Instruction: Generate impression based on medical findings.

Input: 27 years Female (DOB:4/15/1989)Reason: r/o structural lesion History: seizuresPROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU MRI of the brainThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. The hippocampi appear symmetric and without an intrinsic lesion.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: No abnormal mass lesions are appreciated within the brain parenchyma to explain the patient's epilepsy.There is no evidence for dural venous sinus thrombosis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Back pain. Signs and symptoms: Back pain Nonenhanced lumbar MRI:The alignment of which column is clinical.Unremarkable lower most visualized thoracic spine and thoracic cord.T12 -- L1 is unremarkable.L1 -- L2 demonstrates mild disk desiccation without spinal canal or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy and mild (left greater than right) facet degenerative changes. Constellation of changes results in mild central spinal stenosis and mild left neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, asymmetric moderate left facet and ligamentum hypertrophy and to a lesser degree on the right is present. There is a large central disk extrusion at this level with resultant significant mass effect on the thecal sac and result in significant central spinal stenosis. Moderate left and mild to moderate right neural foraminal compromise is also present.There is more than 50% compression deformity of the superior endplate of L3 vertebrae. There is increased T2 and decreased T1 signal intensity compressed vertebrae which could represent edema. Please correlate with history regarding recent trauma/fall since the signal changes of marrow space may indicate edema secondary to recent fracture.L4 -- L5 demonstrate moderate disk disease and loss of disk height, asymmetric (left greater than right) moderate ligamentum flavum hypertrophy and facet disease. There is a small centrally located disk protrusion projecting into the ventral epidural space and without significant mass effect on the thecal sac. There is no spinal stenosis, however significant right and moderate left neural foraminal compromise is present.L5 -- S1 demonstrate moderate (left greater than right) facet hypertrophic changes and ligamentum flavum hypertrophy. No central spinal stenosis. Moderate to severe bilateral neural foraminal compromise is present.

Output: 1.L3 -- L4 there is advanced degenerative disk disease, large central disk extrusion with resultant significant central spinal stenosis. Bilateral neural foraminal compromise at this level is also present as detailed. More than 50% compression fracture of L4 vertebrae is noted without malalignment. T2/T2 stir hyperintensity of L4 vertebrae although could represent degenerative Modic signal changes, possibility of edema as result of recent fracture cannot be excluded. Correlate with history for recent fall or trauma to the back.2.Mild central spinal stenosis at L2 -- L3 is also noted and unremarkable at all other levels.3.Multilevel neural foraminal compromise (some significantly) as detailed per level above.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male. Evaluate prostate for cancer lesions. PELVIS:PROSTATE:Prostate Size: The prostate measures 5 cm in transverse, 3.3 cm in AP, and 4.6 cm in craniocaudal diameter.Peripheral Zone: In the posterior-lateral left mid gland, there is a 0.8 x 0.9 cm lesion that is hypointense on T2 and ADC that is consistent with the dominant tumor. No definite extracapsular extension. No seminal vesicle invasion. Other diffuse T2 hypointense foci are also noted on the right.Central Gland: No significant abnormality noted.Seminal Vesicles: Unremarkable.Extracapsular Extension: None.BLADDER: There are 2 posterior urinary bladder diverticula (axial series 1701 images 83, 92).LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant tumor in the posterior-lateral left mid gland measuring 0.8 x 0.9 cm.2.There are 2 posterior urinary bladder diverticula.


Instruction: Generate impression based on medical findings.

Input: Pain in left knee. MENISCI: Menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is edema within the lateral femoral condyle above the anterior horn of the lateral meniscus as well as within the anterolateral tibial plateau, likely representing bone contusions. There is also a small curvilinear subchondral low intensity within the lateral femoral condyle in the vicinity of the aforementioned edema likely representing a nondisplaced subchondral fracture. Additional edema is noted within the anteromedial tibial plateau. We see no fluid-filled cartilage defects.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Bone contusions as described above with a small nondisplaced subchondral fracture of the lateral femoral condyle. We see no meniscal or ligamentous injury.


Instruction: Generate impression based on medical findings.

Input: There is residual subcortical T2 hyperintensity within the occipital lobes bilaterally. There are a few punctate foci of susceptibility effect in the bilateral parietal and occipital lobes as well. There are also unchanged scattered punctate cerebral white matter T2 hyperintensities and a focal defect in the right aspect of the body of the corpus callosum. There is an unchanged configuration of the ventricular system, with prominence of the lateral ventricles, particularly posteriorly, with associated diminished periventricular white matter volume. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The hippocampi are symmetric without abnormal signal. There is no midline shift. There are unchanged minimally low-lying cerebellar tonsils. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the ethmoid sinuses.

Output: 1. Residual stigmata of previous posterior reversible encephalopathy syndrome are unchanged.2. Mild probable chronic small vessel ischemic disease without evidence of acute infarction.3. Unchanged ventriculomegaly with what appears to be colpocephaly.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: Pain. Possible triangular fibrocartilage complex tear versus lunotriquetral ligament tear status post distal radius fracture Some sequences are limited by patient motion artifact. There is mild deformity of the distal radius and its articular surface reflecting a healing/healed fracture. There is a resultant small gap along the articular surface of the distal radius in the coronal plane, but minimal if any articular surface depression. There is also mild deformity of the tip of the ulnar styloid with underlying cyst formation, indicating prior trauma. Small ossicles are again noted along the dorsal aspects of the scaphoid and capitate perhaps representing ununited fracture fragments as seen on recent CT scan. Mild osteophytes affects the wrist.Contrast is present within the radiocarpal and midcarpal articulations. Contrast extends between the two articulations via a defect in the membranous portion of the scapholunate ligament; the dorsal and volar components of the ligament appear intact. The lunotriquetral ligament perforation suspected on the conventional arthrogram component of the study is not clearly evident on this MRI exam. No contrast is seen traversing the triangular fibrocartilage and entering the distal radioulnar joint indicate a full-thickness tear; however, there is mild generalized deformity and heterogeneity of signal of the articular disc, with contrast filling small defects along its distal surface suggesting partial thickness tearing. The tendons of the wrist are unremarkable.

Output: 1.Mild post-traumatic deformity of the distal radius and ulnar styloid indicating healing/healed fractures.2.Mild osteoarthritis of the wrist.3.Tear of the membranous portion of the scapholunate ligament. The lunotriquetral ligament perforation suspected on the conventional arthrographic component of the study is not clearly evident on this MRI exam.4.Partial thickness tearing of the articular disk of the triangular fibrocartilage.


Instruction: Generate impression based on medical findings.

Input: Reason: progressive ataxia, please look for hot cross bun sign History: ataxia There is atrophy of the cerebellum and brainstem with a cross a cross bun sign.No abnormal enhancing lesions are identified within the brain parenchyma.A punctate T2 signal hyperintensity in the right external capsule is probably of little clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrator minor opacity in the left sphenoid sinus and left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Atrophy of the posterior fossa structures are suspicious for SCA or MSA with cross bun sign as suspected.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with a history of large B cell non-Hodgkin's lymphoma status post 6 cycles of chemotherapy. Evaluate left scapula mass/lesion. There is heterogeneous signal abnormality affecting the scapula. Again seen is deformity and fragmentation of the scapula, particularly along the inferior and medial aspect of the glenoid, consistent with the patient's history of osseous destruction complicated by pathologic fracture. Note is made of a 9 mm focus of pathologic enhancement along the lateral border of the body of the scapula suspicious for residual osseous disease (image 15; series 15). Additionally, note is made of multiple subcentimeter foci of enhancement within the subscapularis muscle belly which are also suspicious for residual tumor/disease. There is a 3.1 x 1.8 x 2.7 cm left axillary mass/lymphadenopathy with thin peripheral enhancement. There is nonenhancing increased signal abnormality within the deltoid, subscapularis, supraspinatus, and infraspinatus which is nonspecific and may reflect post therapy change versus subacute denervation. The visualized musculature is otherwise within normal limits. There is a small amount of fluid within the glenohumeral joint with associated thick enhancement suggesting a synovitis.

Output: Enhancing scapular lesion suspicious for residual osseous disease as described above. Persistent left axillary mass as well as enhancing foci within the subscapularis muscle which are also suspicious for residual disease. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female 69 years old Reason: diminished ROM History: pain in the shoulder. ROTATOR CUFF: There is a full thickness tear of the distal fibers of the supraspinatus tendon, with retraction of the tendon fibers to beneath the distal clavicle. The tear measures approximately 1.0 cm in the AP dimension. There is mild to moderate fatty atrophy of the supraspinatus muscle. Mild tendinosis affects the infraspinatus tendon with possibly a small undersurface tear at its insertion. There is minimal fatty atrophy along the myotendinous junction. The teres minor tendon and muscle appear normal. There is thickening and increased signal intensity of the distal subscapularis tendon indicating tendinosis and, perhaps, undersurface fraying at its insertion. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: There is mild to moderate osteoarthritis of the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the glenohumeral joint with extension into the subscapularis recess. There is also fluid anterior to the subscapularis tendon, suggesting a subcoracoid bursitis. The glenoid labrum appears normal for age. Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps compatible with mild tendinosis. The tendon also appears perched on the lesser tuberosity, which may reflect pulley dysfunction. There is a small amount of fluid in the biceps tendon sheath of questionable significance.

Output: 1.Full thickness tear of the supraspinatus tendon and an additional rotator cuff tendinosis as described above.2.Degenerative arthritic changes of the acromioclavicular and glenohumeral joints.3.Tendinosis of the long head of the biceps and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Ms. Edens is a 58 year old female presenting for MRI evaluation of screen detected calcifications in the left breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.LEFT BREAST: Spanning the entire left superior breast is a segmental distribution of clumped nonmass enhancement spanning approximately 9.0 x 2.3 x 3.4 cm (AP x ML x SI). This clumped nonmass enhancement extends to within 1 cm from the left nipple base and approximates the distribution of the mammographically detected calcifications. There are a few additional foci of enhancement seen in the left inferior and left lower outer breast, none of which are more suspicious than the rest.RIGHT BREAST: Slight motion artifact limits sensitivity of the right breast. However, there is no abnormal enhancement seen in the right breast.AXILLA: There are two abnormal morphology lymph nodes identified in the left axilla, the largest one of which measures approximately 2.1 cm. There are no abnormal lymph nodes identified in the right axillary region.

Output: (1) 9.0 cm of clumped nonmass enhancement in a segmental distribution in the left superior breast, approximating the distribution of the mammographically detected calcifications. A two site ultrasound-guided biopsy with clip placement is recommended for further evaluation.(2) Abnormal morphology lymph node in the left axilla. An MR directed ultrasound with ultrasound-guided biopsy is recommended for further evaluation.(3) No MRI evidence of malignancy in the right breast.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for ligament/tendon damage History: effusion, instability, knee giving out, increased patellar mobility. Due to the patient's body habitus, the high-resolution knee coil could not be used and the flex large array coil had to be used, resulting in slightly suboptimal image quality.MENISCI: Given the aforementioned limitations, the medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Mild edema within the posterior aspect of the lateral tibial plateau and also more anteriorly within the lateral femoral condyle, representing bone contusion. Evaluation of the articular cartilage is suboptimal, but we see no gross defects. The femoral trochlea is slightly shallow which may represent mild dysplasia.LIGAMENTS: The anterior cruciate ligament is poorly defined compatible with full-thickness tear. The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: The visualized components of the extensor mechanism are intact.ADDITIONAL

Output: ACL tear with associated bone contusions and joint effusion.


Instruction: Generate impression based on medical findings.

Input: Seizure. History of neurofibromatosis type I. Assess for seizure focus. Small foci of subtle T2-hyperintensity are present in the globi pallidi, posterior thalami, brainstem and cerebellar white-matter, compatible with the diagnosis of neurofibromatosis type I. The corpus callosum is diffusely, but mildly thickened without a focal lesion. There is no space-occupying or contrast-enhancing brain lesion. There is no intracranial hemorrhage or acute infarct. The ventricles, sulci and basal cisterns are normal in size. The major intracranial vascular flow voids are preserved.The optic nerves and the other orbital structures are grossly unremarkable. The mastoid air cells and middle ear cavities are clear. There is no skull destructive lesion.

Output: 1.Stigmata of neurofibromatosis type I including multiple small focal T2-hyperintense lesions without mass-effect or contrast enhancement in the brain (FASI) as well as mildly thickened corpus callosum. 2.No appreciable intracranial neoplasm or other focal lesion to suggest seizure focus.


Instruction: Generate impression based on medical findings.

Input: Trigeminal nerve entrapment versus CNS demyelinating lesion: right facial pain. Internal Auditory Canals: A small venous structures courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve. The bilateral trigeminals nerves are otherwise intact. There is no evidence of mass lesions. The bilateral cavernous sinuses and Meckel caves appear unremarkable. Brain: 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is hypertrophy of the posterior left inferior turbinate. There is cosmetic filler material in the bilateral cheeks, but not near the infraorbital foramen. There are postoperative findings related to maxillary reconstruction, with metal susceptibility artifact that obscures surrounding structures.

Output: 1. A small venous structures courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve, which is nonspecific and may be indicative of a vascular loop syndrome or represent an incidental anatomical variant. Otherwise, no evidence of tumor or demyelinating lesions.2. Postoperative findings related to maxillary reconstruction and cosmetic fillers in the bilateral cheeks.


Instruction: Generate impression based on medical findings.

Input: Reason: hx failed back syndrome. s/p epidural injection: c/o pain down leg and weakness/ back pain. r/o abnormality History: back and leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post instrumentation with posterior effusion with a pedicle screws at L3, L4 and L5 bilaterally, laminectomies at L3, L4 and L5 and disk spacer at L4-5. There is epidural fat accumulation in the lower lumbosacral canal.There is mild ill-defined dural enhancement present at L4, L5 and S1.At L5-S1 there is no significant compromise to spinal canal or neural foramina. L5 is minimally posteriorly subluxed relative to S1. There is a disk bulge present at this level associated with the signal hyperintensity on T2 within the posterior aspect of the annulus fibrosis. This is stable when compared to the prior examAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild intra-subluxation of L4 on L5 which is unchanged when compared to the prior exam.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.Findings suggest an inflammatory reaction in the lower lumbar spinal canal. It is possible this represents reaction to epidural injection, given the clinical history, although any inflammatory process including early infection may have a similar appearance.2.Status post lumbar spine surgery with instrumentation for fusion and laminectomies from L3 through L5 .3.There is mild anterior subluxation of L4 on L5 which is stable.4.There is no significant compromise of spinal canal or exiting nerve roots appreciated.5.Findings suggest epidural lipomatosis in the lower lumbosacral canal. This is not changed substantially the prior exam


Instruction: Generate impression based on medical findings.

Input: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. There is a aneurysm proximal to the left ophthalmic artery origin likely involving the left distal cavernous internal carotid artery, which measures approximately 4 mm in height and 4 mm at the base, and projects medially.MRA NECK

Output: 1. No significant stenosis in the intracranial circulation or the extracranial circulation in the neck.2. 4 mm left distal cavernous ICA aneurysm.


Instruction: Generate impression based on medical findings.

Input: 72 years, Female, Reason: History partial nephrectomy, positive parenchymal margin, assess for recurrence History: RCC (clear-cell) ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild atrophy of the pancreatic tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes in the right kidney. No residual mass. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for soft tissue mass, subcutaneous on the right upper paraspinal back, likely lipoma; evaluate for depth and size. Signs and symptoms: Large subcutaneous nodule. Nonenhanced thoracic spine MRI:There is normal anatomical alignment the vertebral column. Examination demonstrate a well demarcated foci of marrow signal changes in the vertebral bodies of T6 consistent with a skeletal capillary hemangioma an unremarkable signal intensity of vertebral column otherwise. Mild degenerative changes of the thoracic spine are noted. There is however no evidence of spinal canal or neural foraminal compromise/stenosis at any level. There is normal signal intensity and caliber of thoracic cord.Examination demonstrate a subcutaneous right paramedian loculated fatty signal intensity consistent with a lipoma. The superior extent of the lipoma goes beyond the field of study approximately C7 and inferiorly to T3 -- T4 disk level. The finding measures maximum of 82-mm in transverse diameter from midline to the right T2 level. The largest AP diameter of the lipoma measures approximately at 24-mm and the visualized cranial cephalad axis of lipoma measures at 56-mm. finding is seen subcutaneous space and results in sulcal mass effect and flattening deformity of the underlying musculature without evidence of extension into the deeper tissues.

Output: 1.Right paramedian upper thoracic subcutaneous lipoma measuring at 82mm (transverse) x 24-mm (AP) x 56 mm (cc). It extends from approximately C7 inferiorly to the T3 -- T4 disk level.2.Unremarkable nonenhanced MRI of the thoracic spine otherwise other than mild degenerative changes, however without spinal canal or neural foraminal compromise/stenoses at any level.


Instruction: Generate impression based on medical findings.

Input: Right-sided weakness with history of previous stroke. Evaluate for stroke. Motion artifact somewhat limits evaluation. There is no evidence of acute infarct. There is encephalomalacia and ex vacuo dilatation of the right lateral ventricle, related to chronic infarct in the right MCA territory involving the right frontal and temporal lobes as well as the insula and basal ganglia. There is hemosiderin staining in the region of the prior right MCA territory infarct. There is no evidence of acute intracranial hemorrhage or mass effect. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is chronic volume loss in the right cerebral peduncle, likely due to Wallerian degeneration. The ventricles and basal cisterns are unchanged in size and configuration. There is mild mucosal thickening in the small left maxillary sinus. The skull and extracranial soft tissues are unremarkable. There is attenuation of the right middle cerebral artery flow void.

Output: 1.No evidence of acute infarct or intracranial mass effect.2.Chronic right MCA territory infarct which has evolved since prior MRI from 3/17/2011. There is associated Wallerian degeneration along the right corticospinal tract.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 60 old male with bloody diarrhea ABDOMEN:LUNG BASES: 2 x 1.3 cm paracardiac hypodense lesion adjacent to the right atrium, Bessemer number 11, series number 3. This may represent a solid lesion versus pericardial cyst. Further evaluation with MRI may be helpful.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal stones. No hydronephrosis. Bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Wall thickening involving the sigmoid colon and rectum which may indicate colitis. Further ovation with endoscopy is recommended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Wall thickening of the rectosigmoid compatible with colitis.Right nephrolithiasis.Right paracardiac lesion which likely represents a complex pericardial cyst. Further evaluation with cardiac MRI may be helpful to differentiate from paracardiac adenopathy due to its high density..


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with pancreatic lesion, assess for IPMN. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter nonenhancing T2 hyperintense foci of the right hepatic lobe are likely small cysts (series 7 images 6, 21). Otherwise normal parenchyma. No intra or extrahepatic biliary ductal dilatation. Normal gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Stable appearance of a 4 mm cystic lesion of the pancreatic tail without clear communication to the pancreatic duct, likely a sidebranch IPMN. No pancreatic ductal dilatation. The pancreatic duct measures less than 3 mm in diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis. Bilateral punctate T2 hyperintense foci are too small to fully characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace bilateral pleural effusions.

Output: 1.Stable 4 mm cystic lesion of the pancreatic tail, likely a sidebranch IPMN.


Instruction: Generate impression based on medical findings.

Input: 43-year-old man with hypertension, altered mental status in the setting of ESRD. There is no evidence of intracranial hemorrhage or mass. Subtle low attenuation is present in the subcortical white matter. This is nonspecific and most likely signifies age-indeterminate small vessel ischemia. In the proper clinical setting, this finding could also represent sequela of PRES.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are diffusely sclerotic, possibly indicating renal osteodystrophy. There is groundglass opacification and sclerotic bone formation around the left chamber of the frontal sinus. This is most suggestive of fibrous dysplasia but could be better evaluated with MRI.

Output: 1. Widespread subcortical white matter hypoattenuation -- this finding is nonspecific and most likely represents age-indeterminate small vessel ischemic disease. This could also represent sequela of PRES. If clinically indicated, MRI could provide further evaluation.2. Groundglass opacification and bony remodeling involving the left chamber frontal sinus -- possibly representing fibrous dysplasia. This finding could also be better evaluated with MRI.


Instruction: Generate impression based on medical findings.

Input: There is moderate motion artifact limiting evaluation. Given this limitation, there is no abnormal enhancement, acute infarct, mass effect, or cerebral edema. There are patchy periventricular and subcortical white matter T2 signal abnormalities which are nonspecific, likely representing advanced chronic microvascular ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is bilateral maxillary sinus mucosal thickening. The skull and extracranial soft tissues are unremarkable.

Output: 1.Moderately motion degraded exam with no acute infarct, abnormal enhancement or mass effect.2.Advanced chronic microvascular ischemic changes.


Instruction: Generate impression based on medical findings.

Input: Lumbago with sciatica, unspecified side [M54.40], Reason for Study: ^Reason: evaluate for cord irritation History: new buttock and lower back pain, known L1 mets For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are extensive metastatic lesions involving thoracic, lumbar and sacral vertebral bodies as well as bilateral iliac bones and some ribs indicating interval progression since prior scan. Those lesions show enhancement on Gad.In addition, there are multiple various sized new enhancing soft tissue lesions involving paraspinal muscle and subcutaneous tissues which indicate soft tissue metastatic nodules.In particular, the left pedicle of L1 shows high signal intensity on STIR images indicating possible pedicular fracture.The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is minimal retrolisthesis of L4 on L5 and L5 on S1.Multilevel disc bulges with bilateral fact joint hypertrophy are seen without causing significant spinal canal stenosis, no change since prior scan.

Output: 1. Interval progression of metastatic lesions since prior scan. At this point, those lesions involve lower thoracic and lumbar spine, sacrum and bilateral iliac bones.2. Multiple soft tissue enhancing lesions likely represent metastatic nodules.3. Possible left pedicular fracture of the L1 vertebral body.4. Spinal cord signal intensity appears to be normal.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male patient with prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.5 x 3.8 x 4.6 cm.Peripheral Zone: There is ill-defined signal abnormality with T2 hypointensity, mild ADC hypointensity, and early enhancement extending from the left base to the mid gland with more focal abnormality within the left base measuring approximately 7 x 4 mm (image 17, series 701). Of note, the left peripheral zone is atrophic in comparison to the right peripheral zone.Central Gland: Post-surgical changes of a transurethral resection of the prostate.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No specific evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: There is a small left external iliac lymph node (image 127, series 1501); this is non-specific, however, metastatic disease is not excluded.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Atrophic left peripheral zone with ill-defined signal abnormality within the left base and mid-gland. 2. No evidence of extra-prostatic extension.3. Small left external iliac lymph node is non-specific; metastatic disease is not excluded.


Instruction: Generate impression based on medical findings.

Input: Rheumatoid arthritis and neck pain. There is 6 mm anterior subluxation of the left C1 inferior facet relative to the C2 superior facet, which is unchanged compared to prior MRI. Alignment of the rest of the cervical spine is within normal limits. Again noted is mild superior subluxation of the tip of the dens superiorly. There is no evidence of significant change when compared to prior MRI study. The tip of the odontoid is above the Wackenheim line, which is abnormal. However, the odontoid tip is inferior to the McRae foramen magnum line, and intersect with the Chamberlain line, which is still within normal limits. There is impression of the dens on the ventral aspect of the cervicomedullary junction, which was best seen on the prior MRI study. Accounting for technical differences, there is no evidence of interval change. The atlantodental distance is slightly increased, measuring 5.5 mm. The spinal canal at the C1 level is slightly narrowed to 9 mm. The rest of the cervical spine demonstrates mild arthritic changes of the facet joints seen at multiple levels, but there is no spinal canal or neuro-foraminal compromise.This a hypodense nodule in the right thyroid gland, measuring 1.2 x 1.7 ccm approximately. There is no associated calcification.

Output: 1. Arthritic changes at C1-C2 level, with mild superior subluxation of the dens and narrowing of the spinal canal, resulting in impression on the cervicomedullary junction. No significant interval change compared to the prior MRI study. 2. Right thyroid nodule. Please correlate with other clinical parameters.


Instruction: Generate impression based on medical findings.

Input: 50 year old with BRCA mutation and personal history of ovarian cancer. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual screening MRI and mammogram are recommended given her BRCA mutation. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male, evaluate for IBD or bowel dilationEXAMINATION: MR enterography without and with IV contrast 2/25/15 ABDOMEN:LIVER, BILIARY TRACT: Small T2 bright focus in the posterior right hepatic lobe without associated enhancement is nonspecific and may in part be artifactual. No biliary ductal dilatation.SPLEEN: No focal lesion.PANCREAS: Normal morphology and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys enhance symmetrically without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: There is wall thickening and enhancement of the ileocecal valve and terminal ileum extending approximately 6-8 cm proximal to the ileocecal valve with mildly dilated distal ileum just proximal to the inflamed terminal ileum. Mild wall thickening of the proximal cecum is also noted, which was seen on the prior CT and is improved from the CT dated 1/11/15. No evidence of fistula or abscess. Inflammatory changes in the adjacent mesentery are again noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Moderately distended and otherwise normal.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: There is wall thickening and enhancement of the ileocecal valve and terminal ileum extending approximately 6-8 cm proximal to the ileocecal valve with mildly dilated distal ileum just proximal to the inflamed terminal ileum. Mild wall thickening of the proximal cecum is also noted, which was seen on the prior CT and is improved from the CT dated 1/11/15. No evidence of fistula or abscess. Inflammatory changes in the adjacent mesentery are again noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Wall thickening and enhancement of the terminal ileum, ileocecal valve, and proximal cecum as described above without abscess or fistula.


Instruction: Generate impression based on medical findings.

Input: Reason: lesion left kidney. lesion pancreas on prior CT scan. Evaluate characteristics and interval change History: lesion left kidney. lesion pancreas ABDOMEN:LIVER, BILIARY TRACT: Loss of signal on a phase images suggests steatosis.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a cystic lesion in the left upper pole which is increased in size since the prior MRI measuring 1.6 x 1.5 cm, previously 0.9 x 0.9 cm. There is mild increase intrinsic T1 signal. On postcontrast sequences, there is a small septation with nodular enhancement (20/54, 100/24, 11 704/60).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.Cystic lesion in the left upper pole has increased in size and has a septation with nodular enhancement. This lesion is consistent with a Bosniak 3 and while indeterminate, renal cell carcinoma remains on the differential.2.Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: Calvarium metastases from breast cancer. There has been gradual decrease in size of multiple heterogenously enhancing skull lesions. The largest of these is located in the occipital bone with epidural extension and mass effect upon the torcula herophili. This lesion now measures approximately 20 x 65 mm in cross-section, versus 32 x 72 mm in January 2015. There is no evidence of abnormal brain parenchymal or leptomeningeal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The pituitary gland appears unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is unchanged deformity of the right lamina papyracea defect with protrusion of orbital fat. There is nonspecific fluid within the mastoid air cells, right more than left.

Output: 1. Gradual decrease in size of multiple skull metastases.2. No evidence of leptomeningeal or intraparenchymal brain metastases.


Instruction: Generate impression based on medical findings.

Input: Snuffbox tenderness. Evaluate for scaphoid fracture. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact. TRIANGULAR FIBROCARTILAGE COMPLEX: Mildly increased signal intensity within the triangular fibrocartilage tissue likely reflects mild degeneration. No fluid-filled tear is seen.TENDONS: Note is made of multiple slips of the tendon of the flexor pollicis longus, a normal variant. The extensor carpi ulnaris tendon appears medially subluxed from the ulnar groove, however the tendon appears normal without fluid within the sheath.BONES: Bandlike focus of abnormal signal traverses the waist/proximal pole of the scaphoid, consistent with a nondisplaced fracture. There is minimal adjacent edema, suggestive of a subacute healing fracture. Also seen is curvilinear abnormal signal in the proximal end of the scaphoid suggestive of avascular necrosis with adjacent edema. No abnormal contour or fragmentation of the scaphoid is seen. The remaining bones appear normal.ADDITIONAL

Output: Findings consistent with a subacute healing fracture of the scaphoid with mild avascular necrosis of the proximal pole. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: There skull appears heterogeneous with multiple skull lesions, which are otherwise incompletely characterized without contrast. There is also an incompletely imaged and characterized left mandibular lesion. There is no mass effect upon the underlying brain parenchyma. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged minimal nonspecific scattered nonspecific T2 hyperintense foci in the supratentorial white matter. There is chronic right cerebellar infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: 1. No evidence of intracranial hemorrhage or acute infarct.2. Redemonstration of multiple skull lesions and left mandibular lesions,are incompletely characterized in the absence of contrast, but are compatible with multiple myeloma.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with stage I adenocarcinoma of the cervix status post abdominal trachelectomy PELVIS:UTERUS, ADNEXA: Bilateral hemorrhagic and physiologic ovarian cysts. Interval decrease in size of 4.0 cm follicle in the left ovary. Status post trachelectomy without evidence of a focal enhancing mass. Small amount of fluid within the endometrial canal.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy is evident. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No enhancing mass or pelvic lymphadenopathy to suggest recurrence.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old, with multiple sclerosis and paresthesias. Evaluate for progression. Brain:Multiple T2 hyperintense lesions are redemonstrated within the periventricular and juxtacortical white matter. To a much lesser extent, lesions are also seen in the brainstem and posterior fossa. A periventricular lesion on the left (image 52 series 41) does appear to have increased in size from prior, and there may be two or three very small new periventricular lesions, but this is equivocal and could reflect differences in technique.No evidence of cortical edema or mass effect is seen. The corpus callosum is thinned, particularly posteriorly. The lateral and third ventricles remain enlarged, similar to that seen on the prior examination. No abnormal fluid collections are detected.C-spine:The previously demonstrated ill-defined lesions within the cervical spinal cord are no longer distinctly visualized and no new discrete lesions are demonstrated. The spinal cord demonstrates normal morphology throughout.Straightening of the cervical lordosis may be positional. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement or edema is seen. The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is detected.

Output: 1.Numerous lesions are redemonstrated in the brain compatible with demyelinating disease. In comparison with the prior examination, one left-sided periventricular lesion may be slightly larger and there are perhaps two or three equivocally new lesions.2.Chronic ventriculomegaly is again seen, similar to prior.3.The previously demonstrated lesions in the cervical spinal cord are no longer clearly seen, and no discrete new lesions are identified


Instruction: Generate impression based on medical findings.

Input: A 68 year old male with history of hypertrophic cardiomyopathy, Crohn's disease, remote colon and bladder cancer status post resection, nephrolithiasis. Referred to cardiac MRI to assess the cardiomyopathy. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 45 ml (normal range 47+/-19). There is concentric hypertrophy with increased myocardial mass. At end diastole, the antero septum is 18mm. The inferolateral wall is 16mm. There is focal, intermediate signal enhancement at the mid myocardial insertion points of the interventricular septum. There are no cardiac MRI findings to suspect cardiac amyloidosis.No intracardiac thrombus.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 57 ml/m2 (normal range 82+/-16), the RVEDV is 113 ml (normal range 142+/-31), the RV end systolic volume index is 20 ml/m2 (normal range 31+/-9), and the RVESV is 40 ml (normal range 54+/-17).Right AtriumThe right atrium is normal size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mitral regurgitation. This was not quantified but is estimated to be at least moderate in the presence of left atrial chamber dilation. Associated moderate to severe systolic anterior motion of the anterior leaflet of the mitral valve with acceleration of antegrade flow at the subvalvular left ventricular outflow tract.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 thoracic aorta 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 a trace pericardial effusion.Extracardiac FindingsLeft renal atrophy with lesions previously characterized as likely cysts. These are incompletely characterized on this exam.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function, the LVEF is 70%. There is hypertrophy with increased mass. Mid myocardial enhancement at RV insertion site at interventricular septum. SAM with MR and accelerated flow in the subvalvular outflow tract. Constellation of findings are compatible with hypertrophic cardiomyopathy.2. The right ventricle is normal in size with normal systolic function, the RVEF is 64%.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old, with history of amyotrophic lateral sclerosis and bilateral upper extremity weakness with EMG showing denervation in the cervical and thoracic myotomes. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of concerning marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed below.At T5-6, there is a central disc protrusion with mild flattening of the ventral cord but no significant cord signal abnormality. The neural foramina are patent.At T6-7, there is a central/left paracentral disc protrusion with mild flattening of the ventral cord but no cord signal abnormality. The neural foramina are patent.At T7-8, there is a central/right paracentral disc protrusion with mild flattening of the ventral cord but no cord signal abnormality. The neural foramina are patent.At T11-12, there is moderately severe facet hypertrophy and a mild disc bulge but without significant spinal canal or foraminal stenosis.Mild disc degeneration is evident in the partially visualized lower cervical region.

Output: 1.No significant abnormalities of the spinal cord are identified.2.Relatively mild degenerative findings are seen with small disc protrusions at T5-6 through T7-8, as well as a disc bulge and facet hypertrophy at T11-12. 3.No high-grade spinal canal or foraminal stenosis is observed.


Instruction: Generate impression based on medical findings.

Input: 62 years, Male, GBM, 4 week post RT. Again seen are postsurgical changes related to biopsy of paramedian right frontal lobe mass which measures approximately 3.5 x 2.3 cm in the AP and transverse dimensions, previously 2.9 x 1.7 cm, measured similarly in the axial plane. In particular, there has been significant increase in masslike nodular thickening involving the right lateral aspect of the lesion. More medial necrotic component is slightly increased in size as well, and there appears to be more necrosis involving the previously more solid component medially. Lesion again extends to the dural surface and associated with mild adjacent leptomeningeal enhancement which was seen previously and suspicious for leptomeningeal involvement. There is surrounding T2/FLAIR hyperintensity in the adjacent right posterior frontal lobe which is significantly increased since prior studies. There is no midline shift or herniation. Blood products within the lesion are similar to prior. No new lesions elsewhere in the brain are appreciated. There is increased linear enhancement along the biopsy tract compatible with evolution. Ventricles remain stable in size without evidence of hydrocephalus.

Output: 1. Mild interval increase in size of right paramedian frontal lobe lesion related to known high-grade glioma. There is more pronounced increase in surrounding FLAIR hyperintensity, much of which which likely represents vasogenic edema. Given history of recent radiation these findings may represent superimposed post treatment change but recommend continued close follow-up. 2. Adjacent leptomeningeal enhancement is again seen and was present pretreatment and suspicious for leptomeningeal spread.


Instruction: Generate impression based on medical findings.

Input: The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is unchanged clumping of left caudate equina nerve roots from L1 to L4 without corresponding abnormal enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine.

Output: Continued stable appearance of clumped cauda equina nerve roots likely relating to arachnoiditis. No evidence of drop metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old, with history of prolactinoma, outside hospital records and images pending, evaluate size mass effect. A hypoenhancing nodule is evident within the right aspect of the pituitary gland measuring up to 7 x 5 x 7 mm. The right aspect of the gland is slightly enlarged by this process, but no evidence of significant suprasellar extension is seen. Likewise, there is no evidence of cavernous sinus invasion. The gland is otherwise unremarkable. The pituitary stalk enhances normally and enters the gland at midline.

Output: A subcentimeter hypoenhancing nodule in the right aspect of the pituitary gland is seen compatible with the stated history of prolactinoma. No evidence of suprasellar or cavernous sinus encroachment is seen.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for cervical myelopathy History: LE weakness, hyperreflexia, LE numbness Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine. There is multilevel disk desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small central broad-based disk protrusion present at this levelAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt 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 enhancing lesions are appreciated in the thoracic spine.

Output: 1.No spinal cord lesions are appreciated.2.There are mild degenerative changes present in the cervical spine.


Instruction: Generate impression based on medical findings.

Input: Pancreatic ductal dilatation and concern for pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. Segment VII peripheral subcentimeter hepatic cyst.Cholelithiasis without evidence of acute cholecystitis.No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No suspicious pancreatic mass. Pancreatic duct is normal in caliber and is again tortuous at the level of the pancreatic tail. Stable subcentimeter T2 hyperintense foci in the pancreatic head and tail some of which appear to communicate with the main pancreatic duct likely represent small branch type IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination with small T2 hyperintense foci in the pancreatic head and tail likely representing very small IPMNs.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for stress fx History: shin pain sports Left tibia/fibula:There is edema type signal within the medullary cavity of the mid diaphysis of the tibia compatible with stress reaction. We see no linear focus or definable fracture line. The remaining marrow signal intensity is normal. The soft tissues are normal.Right tibia/fibula:There is mild edema within the medullary cavity of the proximal tibial diaphysis along the posterior endosteum compatible with a stress reaction. We see no discrete linear focus or definable fracture line. The bone marrow signal intensity is otherwise normal. The soft tissues appear normal.

Output: Bilateral tibial stress reactions as described above. We see no discrete fracture line at this time.


Instruction: Generate impression based on medical findings.

Input: Recto-urethral fistula status post repair. Please evaluate for resolution. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER/URETHRA: Suprapubic catheter in place. Foley catheter in place. Note that presence of the Foley catheter, local soft tissue edema, and lack of IV contrast results in suboptimal evaluation for rectourethral fistula (series 5, image 27). No definite tract is seen on diffusion-weighted images to suggest a large fistula.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. No tract is visualized from the urethra to the rectum.BONES, SOFT TISSUES: Fat-containing right inguinal hernia.OTHER: Bilateral scrotal hydroceles noted.

Output: Limited evaluation due to Foley catheter, local soft tissue edema, and lack of IV contrast, without large rectourethral fistula identified.


Instruction: Generate impression based on medical findings.

Input: Evaluate for recurrence of medulloblastoma. There are post-treatment findings in the posterior fossa, including diffuse right greater than left cerebellar hemisphere encephalomalacia, but no evidence of measurable tumor in this region. There are unchanged scattered nonspecific foci of susceptibility effect in the brain and cerebellum. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Unchanged post-treatment findings without evidence of measurable tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female patient with past history of possible IBD and generalized abdominal pain. Evaluation is limited secondary to suboptimal distension of bowel due to the patient's inability to tolerate oral contrast.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Inadequate distension of a majority of the small bowel for evaluation. A few loops of adequately distended ileum appear normal. There are no areas of abnormal enhancement or diffusion abnormality. No evidence of a small bowel obstruction.BONES, SOFT TISSUES: Rightward thoracolumbar scoliosis. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suboptimal evaluation of the bowel secondary to inadequate distension of small bowel. Within this limitation, no acute abdominal abnormality noted.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female patient with right knee pain, locking, clicking, and impaired flexion. Evaluate for meniscal tear. MENISCI: There is a small vertical tear of the posterior horn of the lateral meniscus (image 26, series 601). The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signals within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small vertical tear of the posterior horn of the lateral meniscus.


Instruction: Generate impression based on medical findings.

Input: Ms. Discipio is a 67-year-old female with known left breast cancer. Recent MRI demonstrated an indeterminate enhancing mass in the right upper inner breast. She presents today for MR directed ultrasound of this finding. A targeted right ultrasound was performed for the MRI/mammographic area of concern. In the right breast 2:00 location, approximately 2 cm from the nipple, two adjacent anechoic lesions are identified, measuring up to 8 x 2 x 4 mm. These are compatible with simple cysts. Additional similar appearing cysts are seen in the vicinity. These correspond to the MRI area of concern.

Output: Multiple small cysts in the right upper inner breast, corresponding to the MRI area of concern. No sonographic evidence of malignancy. No additional imaging workup is necessary for the right breast. All results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.