Instruction: Generate impression based on medical findings.

Input: 76 year old male with dyspnea on exertion as anginal equivalent, found to have CTO on recent angiogram. Assess for viability.MEDICATIONS: aspirin, atorvastatin, chlorthalidone Viability/ Myocardial ScarThere was a nontransmural myocardial infarction (<50% wall thickness) involving the basal inferolateral wall. Based on late gadolinium enhancement imaging, this segment has an intermediate probability of viability; however, this segment has improved contractility which would suggest that the segment is in fact likely to be viable. The remainder of the ventricle is free of myocardial infarction and improves following dobutamine infusion which suggests that it is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 120 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 64 ml (normal range 47+/-19), the LV mass index is 51 g/m2, and the LV mass is 96 g. During resting conditions, there is mild global hypokinesis; however, following the administration of dobutamine, the systolic function normalizes. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 83 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a non-transmural myocardial infarction in the basal inferolateral wall; however, this segment has improved contractility following the administration of dobutamine suggesting that it is likely to be viable. The remainder of the myocardium is free of myocardial infarction and also viable. 2. Normal LV size with mildly reduced systolic function (LVEF 47%).3. Normal RV size with mildly reduced systolic function (RVEF 44%).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-year-old male patient with gait difficulty. Evaluate for cerebral ischemia. There is no diffusion diffusion abnormality to suggest acute infarct. Again seen is encephalomalacia with adjacent increased T2 signal involving the right occipital and posterior temporal lobes from remote infarct. There is associated susceptibility effect consistent with chronic blood products associated with the prior infarct. Patchy foci of T2 signal hyperintensity in the periventricular white matter and in the pons is compatible with chronic small vessel ischemic disease. Mild prominence of the ventricles and sulci likely from age-related atrophy.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.No evidence of acute infarct, hemorrhage, or mass effect.2.Chronic right temporal occipital infarct and chronic small vessel ischemic disease similar to prior.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: Newly diagnosed multiple, T2 signal hyperintensities in brain and c-spine: numbness in upper extremities. There is a punctate focus of high T2 signal in the left aspect of the lower thoracic spinal cord. The rest of the thoracic and upper lumbar portions of the spinal cord display normal signal and morphology. There is no evidence of enhancing lesions or tumors in the thoracic or lumbar spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved, aside from mild loss of disc fluid signal and height at L4-5 and L5-S1. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable, aside from dependent edema in the lower back subcutaneous tissues. There are nodules in the uterus.

Output: 1. A punctate focus of high T2 signal in the left aspect of the lower thoracic spinal cord may represent a demyelinating lesion.2. Nodules in the uterus may represent fibroids. Dedicated pelvic ultrasound may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 87-year-old female with basal ganglia lesion seen on recent head CT. Please further evaluate. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are subcentimeter areas of high T2 signal in the bilateral basal ganglia and right thalamus distinct from accompanying prominent perivascular spaces (etat crible). There is mild scattered T2 hyperintensity in the periventricular and subcortical white matter. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The right periorbital contusion has resolved.

Output: 1. Findings suggestive of chronic infarcts in the bilateral basal ganglia and right thalamus superimposed upon mild probable chronic small vessel ischemic white matter disease. 2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 22-year-old male with history of lateral knee pain status post ACL repair MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Old mild deformity of an impaction fracture of the lateral femoral condyle is seen overlying the anterior horn of the lateral meniscus. The overlying articular cartilage appears intact. The remainder of the articular cartilage is within normal limits. There is mild edema type signal within the intracondylar eminence of the tibia, particularly within the medial tibial spine just posterior to the graft, which may be reactive in etiology.LIGAMENTS: The patient is status post ACL reconstruction with the graft appearing slightly thickened and mildly heterogeneous in signal intensity, but otherwise intact. There is focal increased signal intensity within the anterior fibers of the graft, which can be seen in graft impingement. A small focus of intermediate signal intensity immediately anterior to the graft may represent scar tissue, also seen on the prior exam. The PCL is intact. The medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps tendon is intact. The patella tendon is bisected and thickened, representing changes from prior graft harvesting, appearing similar to the prior exam.ADDITIONAL

Output: Postoperative changes of ACL graft reconstruction appearing similar to the prior exam, with slight heterogeneity of the graft that could represent impingement in the appropriate clinical setting. We see no articular cartilage injury, meniscal tear or loose body.


Instruction: Generate impression based on medical findings.

Input: patient with posterior epidural fluid collection. Please aspirate sample. 61 yo female Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the fluid collection. Following needle removal images obtained demonstrate no complications . Air was present in the remaining cavity.

Output: Epidural fluid collection aspiration under CT guidance.


Instruction: Generate impression based on medical findings.

Input: 73 old female with history of breast cancer and left shoulder pain, concerning lesion seen on recent shoulder radiograph. The apparent lucent lesion seen on the prior radiographs does not have a correlate on MRI and may simply reflect osteopenia/osteoporosis. We see no findings to suggest metastatic disease to the shoulder. Moderate osteoarthritis affects the glenohumeral joint with subchondral cysts and edema within the glenoid and additional cysts in the humerus. There is a small joint effusion and synovitis of the glenohumeral joint. There is mild rotator cuff tendinosis with perhaps mild undersurface fraying of the supraspinatus tendon, but we see no frank fluid filled rotator cuff tear. Small cysts are noted in the greater tuberosity, which are most likely degenerative in etiology. There is an os acromiale and mild osteoarthritis of the acromioclavicular joint. No frank fluid is noted within the subacromial/subdeltoid bursa. There is thickening and increased signal intensity of the proximal tendon of the long head of the biceps indicating severe tendinosis.

Output: Glenohumeral joint osteoarthritis and other findings as above. We see no specific findings to suggest metastatic disease to bone.


Instruction: Generate impression based on medical findings.

Input: Intracerebral hemorrhage identified in March 2015. Evaluate stability. Breast cancer. Mild residual enhancement within the hemosiderin-stained hemorrhage bed within the left parietal lobe has diminished from prior, consistent with expected evolution of prior hemorrhage. There is confluent T2 hyperintensity within the left frontal and parietal white matter, consistent with evolving prior ischemic injury. There is left frontal encephalomalacia and gyriform intrinsic T1 hyperintensity along the middle frontal gyrus, consistent with evolution of ischemia. There is no evidence of new intracranial hemorrhage, mass, or acute infarction. There are scattered periventricular and subcortical T2 hyperintensities, which are nonspecific, but most likely secondary to chronic microvascular ischemic disease. There is unchanged T2 hyperintensity within the left basal ganglia and thalamus, probably chronic lacunar infarctions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Evolving left parietal intraparenchymal hematoma with diminished mild residual enhancement in the affected parenchyma. No findings are seen to suggest an underlying lesion or mass.2.Evolving left frontal lobe encephalomalacia and areas of left frontoparietal T2 hyperintensity also consistent with evolution of prior ischemic injury.3.No definite evidence of metastatic disease or new pathologic enhancement.


Instruction: Generate impression based on medical findings.

Input: Again seen at T10-T11 is disc height loss, endplate erosive changes, and T2 hyperintensity involving the disc space and the adjacent T10 and T11 vertebral bodies. There is associated abnormal enhancement of the vertebral bodies and the T10-T11 disc. There is mild loss of height involving the T10 and T11 vertebral bodies similar to prior. Edema and enhancement extends into the posterior elements. Compared to prior, there is improvement in the T2 hyperintensity within the disc space and progressive loss of disc height. Mild focal kyphosis is noted at this level, similar to prior.There is disc bulge at the T10-T11 level which results in effacement of the ventral thecal sac and deformity of the thoracic cord at this level. There is enhancement involving the epidural space including the bilateral neural foramina as well as the paraspinous soft tissues at the T10-T11. Epidural tissue appears decreased in comparison with the noncontrast sequences; please note prior imaging was without contrast. No discrete epidural abscess however is appreciated on the current study. No discrete abscess involving the paraspinous soft tissues is appreciated. There is narrowing of the T10-T11 neural foramina bilaterally.Remainder of thoracic vertebral bodies are appropriate height and alignment. No significant spinal canal or neural foraminal stenosis is seen in the remainder of the thoracic spine. There are small bilateral pleural effusions.

Output: Please note prior imaging was obtained without gadolinium. Compared to 4/21/2015, there is interval improvement in T2 hyperintensity within the T10-T11 disc space and progression of disc height loss. Enhancement involving the T10 and T11 vertebral bodies and the T10-T11 disc space persists but may be compatible with treated infection. No findings to suggest worsening infection. No epidural abscess is seen on the current study.There is persistent moderate spinal canal stenosis at the T10-T11 level with mild deformity of the thoracic cord. No new cord signal abnormality. Mild loss of vertebral body heights at the T10 and T11 levels and focal kyphosis at these levels again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old, with past medical history of cerebral venous thrombosis, originally diagnosed in 2000, not currently on anticoagulation, presenting with progressive headache. No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. Mild asymmetric T2 hyperintensity within the left ventral pons was present on the prior examination from 2011 and shows no significant interval change.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is normal in size and morphology. Cerebellar tonsillar ectopia is noted, a stable finding.On dedicated MRV imaging, the superior sagittal sinus is of small caliber and not well visualized at its anterior-most extent. The left transverse sinus is not well visualized, and the right shows at least one area of focal caliber change. Collateral venous vessels are evident along both transverse sinuses. The deep cerebral venous system, feeding into the vein of Galen and straight sinus, is prominent. Accounting for differences in scan technique, and for differences between MRV and CTV, no significant or convincing interval change is observed.

Output: 1.No acute intracranial abnormality is suspected.2.MRV imaging demonstrates chronic narrowing of the superior sagittal sinus and transverse sinuses, left more than right, with compensatory engorgement of the deep venous system. This could very well represent the chronic sequelae of prior venous sinus thrombosis or stenosis, but no convincing or significant interval change is appreciated when compared to multiple prior exams.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old, with GBM status post re-resection. Evidence of re-resection of the patient's left frontal lobe tumor is seen. The resection cavity has been expanded and contains predominantly FLAIR hypointense fluid. An oval collection of blood product is evident along the floor of the resection cavity which appears to be intraparenchymal but which probably represents clot within the prior cystic cavity in this location. The previously described, slowly progressive soft tissue thickening along the margins of the original resection cavity has been debulked. This includes a majority of the irregular enhancing tissue which was particularly prominent along the inferior margin of the cavity. Some irregular enhancing tissue does remain along the posterior aspect of the cavity with extension into the genu of the corpus callosum appearing similar to prior.The degree of T2 signal abnormality surrounding the resection cavity appears geographically similar to that on the preoperative examination. Ill-defined periventricular FLAIR hyperintensity is unchanged. No new parenchymal lesions are identified. The ventricles are stable and normal in size.

Output: Expected findings are seen status post debulking of the patient's left frontal lobe tumor. A small amount of residual tumor is seen mostly along the posterior resection margin with invasion of the genu of the corpus callosum appearing similar to the preoperative examination.


Instruction: Generate impression based on medical findings.

Input: Sudden left ear hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is mild fluid within the right mastoid air cells. The left mastoid air cells and middle ears appear unremarkable.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on medical findings.

Input: Pain. Cuff tear? ROTATOR CUFF: Intermediate signal intensity within the bursal surface fibers of the supraspinatus tendon posteriorly and infraspinatus tendon anteriorly suggests fraying, but I see no discrete fluid-filled rotator cuff tear. The rotator cuff musculature appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint, with edema in the distal end of the clavicle and the acromion process. There is a small amount of fluid within the acromioclavicular joint; I see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is a small amount of fluid in the glenohumeral joint, but I see no frank effusion. The posterior superior labrum appears attenuated and of slightly increased signal intensity, perhaps reflecting degeneration/degenerative tearing. There is low signal intensity adherent to the anterior labrum; this may simply reflect unusually prominent capsular tissue, as the underlying labrum itself appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: 1.Acromioclavicular joint osteoarthritis.2.Mild fraying of the bursal surface of the supraspinatus and infraspinatus, but I see no discrete fluid-filled tear.3.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old, history of CNS lymphoma, restaging examination. No evidence of pathologic enhancement, restricted diffusion or other new parenchymal signal abnormal is seen. Patchy T2 hyperintensity is again demonstrated in the bilateral basal ganglia, periventricular white matter, and the left lateral cerebellum, most which probably corresponds to sites of prior lymphomatous disease. No evidence of any new parenchymal edema or mass effect is seen. The ventricular system is stable in size and morphology including asymmetry with the left lateral ventricle larger than the right. No pathologic intracranial fluid collections are seen. No evidence of acute intracranial hemorrhage is noted.

Output: 1. No findings are seen to suggest new or recurrent intracranial lymphomatous disease.2. Scattered patchy areas of parenchymal signal abnormality are redemonstrated, perhaps representing a combination of sites of prior lymphomatous disease and some superimposed chronic microvascular ischemia.


Instruction: Generate impression based on medical findings.

Input: 42 years Female (DOB:7/7/1973)Reason: MS; F/U progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of multiple periventricular and subcortical white matter lesions within the brain parenchyma many of which are perpendicularly oriented to the lateral ventricles. In general there is not appear to be a substantial change in the number or size of these lesions. There are several punctate cerebellar white matter lesions and brainstem lesions which are also stable. Additional lesions in the corpus callosum were also stable. One brainstem lesion is present in the left posterior lateral aspect of the medulla whereas others are present in the left half of the pons.A previously noted lesion in the left inferior parietal lobule is not seen on the current examNormal 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: Since prior exam there is no significant change. There is a lesion left inferior parietal lobule which is not identified on the current exam and was present on the previous exam. There are multiple periventricular and subcortical white matter lesions as well as a few lesions in the cerebellum and brainstem which are compatible with the patient's diagnosis of demyelinating disorder.


Instruction: Generate impression based on medical findings.

Input: 17-year-old male presents with chronic left shoulder pain, evaluate for shoulder pathology. ROTATOR CUFF: There is no complete or partial rotator cuff tear. The subscapularis constituent of the rotator cuff is intact. No bursal effusion or thickening is seen. There is no muscular tear, contusion, or atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Humeral head articulates well with the glenoid. No labral tear is identified. There is no glenohumeral joint effusion. There are no SLAP or soft tissue Bankart lesions. No paralabral cysts are seen.BICEPS TENDON: The biceps tendon is normally situated within the bicipital groove. No complete or partial biceps tendon tear is present. ADDITIONAL

Output: Normal examination. No complete tear of the rotator cuff. No Hill-Sachs, reverse Hill-Sachs, or bone Bankart lesions are seen.


Instruction: Generate impression based on medical findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine.Localizing CT examination demonstrated a lytic lesion in the left humeral head with associated cortical destruction corresponding to the findings on recent MRI and PET/CT examination. Using CT guidance, a 16 gauge Achieve core biopsy needle was advanced into the lesion. Four 16 gauge core biopsy specimens were obtained and placed in formalin.The core biopsy specimens were hand carried to the Surgical Pathology lab.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT guided biopsy of left humeral head lesion.


Instruction: Generate impression based on medical findings.

Input: Right hip pain, evaluate known hip fracture. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a nondisplaced fracture of the right greater trochanter. There is surrounding soft tissue swelling and edema.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Nondisplaced fracture of the right greater trochanter with soft tissue swelling.


Instruction: Generate impression based on medical findings.

Input: Subcortical band heterotopia (DCX), seizures, developmental delay, ADHD. New choreiform-like movements and dystonia. There is extensive band-like subcortical grey-matter signal intensity bilaterally with associated mildly anomalous and simplified cerebral gyration pattern and enlarged ventricles, particularly the posterior lateral ventricles. There is also a prominent retrocerebellar space and diminutive appearance of the inferior cerebellum, particularly the vermis. There is a cystic pineal gland that measures up to 11 mm. The corpus callosum and pituitary gland are intact. There is no herniation or midline shift. The major cerebral flow voids appear to be grossly intact. The orbits are unremarkable. There is mild diffuse paranasal sinus mucosal thickening.

Output: 1. Stigmata of subcortical band heterotopia related to doublecortin gene mutation.2. A cystic pineal gland measures up to 11 mm.3. Findings suggestive of sinusitis.


Instruction: Generate impression based on medical findings.

Input: 65 year old with loss of consciousness rule out bleed The examination is somewhat compromised by patient motion. In several areas there is poor differentiation of gray white junction with the suggestion of subcortical hypodensity. In addition the sulci and basilar cisterns are small and I cannot rule a possibly of some increased intracranial pressure.I recommend obtaining an MRI with diffusion weighted imaging to evaluate.There is no evidence of intracranial hemorrhage as clinically questioned.Bone windows reveal no osseous abnormality.

Output: Somewhat compromised examination by patient motion does demonstrate poor definition of the gray white junction as well as suggestion of subcortical hypodensities. Cerebral sulci and basilar cisterns are somewhat small for the patient's stated age and the possibility of diffuse edema cannot be excluded. MRI of the brain is recommended to fully evaluate.


Instruction: Generate impression based on medical findings.

Input: Reason: cuff tear History: pain ROTATOR CUFF: There is a near complete tear of the supraspinatus at its insertion measuring approximately 2.3 cm in AP direction with 2.2 cm of retraction. This also involves the anterior fibers of the infraspinatus where there are regions of full thickness and partial thickness tearing. Fluid is seen within the subacromion subdeltoid bursa. There is partial-thickness articular surface tearing of the subscapularis at its insertion. Teres minor is intact. Atrophy of the supraspinatus, infraspinatus and subscapularis is noted.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular jointGLENOHUMERAL JOINT AND GLENOID LABRUM: Tiny osteophytes are present at the glenohumeral joint. There is increased T2 signal at the greater tuberosity which is likely reactive. Evaluation of coronal images is limited due to patient motion, however the glenoid labrum is grossly intact.BICEPS TENDON: The intra-articular portion of the biceps tendon is not well visualized.ADDITIONAL

Output: Near complete tear of the supraspinatus tendon involving the anterior portions of the infraspinatus. Partial thickness tear of the subscapularis tendon. Resultant atrophy of the infraspinatus, supraspinatus and subscapularis.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The degree of myelination is normal for corrected age. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits. There is no evidence of structural abnormality.

Output: Normal brain MRI.


Instruction: Generate impression based on medical findings.

Input: 27-year-old male with elevated alkaline phosphatase, positive anti-smooth muscle antibody, and ulcerative colitis. Evaluate for primary sclerosing cholangitis. ABDOMEN:LIVER, BILIARY TRACT: Scattered areas of intrahepatic biliary ductal dilatation and stricturing. Subtle biliary ductal wall enhancement is noted on the postcontrast series. Focal stricturing is also seen about the Klatskin point. There is a short segment of smooth stricturing of the distal CBD (approximately 3 cm). No dominant hepatic mass is identified. Normal morphology of the liver.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: Subtle enhancement of the colonic mucosa compatible with the history of ulcerative colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Constellation of findings consistent with primary sclerosing cholangitis.2.No dominant hepatic lesion. No evidence of cirrhosis.3.Subtle enhancement of the colonic mucosa is compatible with the history of ulcerative colitis.


Instruction: Generate impression based on medical findings.

Input: Ms. Levin is a 53-year-old female with family history of breast cancer in mother. Personal history of benign left breast biopsy. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Per our records, the patient's last screening mammogram was in 8/2013. If she obtained one at an outside institution, then this can be submitted for comparison purposes and an addendum can be issued. Otherwise, the patient is due for an annual screening mammogram.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: VHL and history of multiple hemangioblastoma; evaluate for growth and new lesions History: 54 yo female with VHL and history of multiple hemangioblastoma; evaluate for growth and new lesions. There is evidence of posterior element resection at most levels of the cervical spine. There is no evidence of spinal cord lesions. The cervical lordosis is mildly straightened. The vertebral body heights are preserved. Level specific findings are as follows:C2-3: There is no spinal canal stenosis or neural foraminal narrowing. C3-4: There is a small posterior disk osteophyte, but no significant spinal canal stenosis or neural foraminal narrowing.C4-5: There is a small posterior disk osteophyte, but no significant spinal canal stenosis or neural foraminal narrowing.C5-6: There is posterior disk osteophyte formation along with ligamentum flavum thickening, which results in a moderate spinal canal stenosis, as well as severe left and moderate right neural foraminal narrowing. C6-7: There is left facet hypertrophy and a small posterior disk osteophyte, but no significant spinal canal stenosis. However, there is moderate left and mild right neural foraminal narrowing. C7-T1: There is no significant spinal canal stenosis or neural foraminal narrowing. Thoracic spine: The thoracic kyphosis is mildly exaggerated at T12 secondary to mild vertebral body wedging without change. The bone marrow signal is unremarkable. There is no definite evidence of any spinal cord signal abnormality. There is a small central disk protrusion at T8-9 along with a left paracentral protrusion at T11-12. There is no significant spinal canal or neuroforaminal stenosis. There are innumerable bilateral renal and pancreatic cystic lesions, some of which contain heterogeneous material and/or fluid-fluid levels. The findings appear similar to those seen on the prior examination, though this examination is not adequate for assessment of individual lesions.

Output: 1. Degenerative spondylosis at multiple levels of the spine, but bi definite evidence of hemangioblastomas in the imaged spinal cord, although the lack of intravenous contrast limits evaluation.2. Innumerable bilateral renal and pancreatic cystic lesions are compatible with stigmata of VHL.


Instruction: Generate impression based on medical findings.

Input: Reason: history of pituitary enlargement and stalk thickening on outside imaging, hyperprolactinemia History: hyperprolactinemia. Please note that dynamic contrast-enhanced sequences were not obtained.The pituitary is slightly prominent measuring 9 mm with a convex superior margin as well as prominence of the inferior infundibulum. No identifiable microadenoma or macroadenoma. Small linear foci of low signal in the posterior pituitary favored to represent a tiny pars intermedius cyst/remnant.There is otherwise no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No convincing evidence of a pituitary microadenoma or macroadenoma. Please note dynamic postcontrast sequences were not obtained with slightly limits sensitivity for pituitary microadenomas. If clinically indicated, patient may return for this additional sequence at no additional charge. 2.Mild diffuse prominence of the pituitary and lower aspect of the infundibulum is nonspecific but within normal limits for patient's age.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: HCC screening History: PBC ABDOMEN:LIVER, BILIARY TRACT: The patient status post cholecystectomy. There is persistent mild intrahepatic biliary ductal dilatation. Single punctate focus of arterial enhancement in the right hepatic lobe (series 10/40) is nonspecific, and not seen on any other sequence-type or phase of contrast enhancement. The portal vasculature is patent. There is persistent mild intrahepatic biliary ductal dilatation, not substantially changed for multiple prior studies.SPLEEN: The spleen measures 13 cm in length and there are numerous perisplenic varices related to a splenorenal shunt.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Additional T2 hyperintense lesion in the superior pole of the left kidney is too small to characterize but presumably benign. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.Nonspecific punctate arterial hyperenhancement in the right lobe of the liver is not present on any other sequence. Continued imaging surveillance for hepatocellular carcinoma is suggested in this high-risk patient.2.Mild intrahepatic biliary ductal dilatation, unchanged.3.Splenomegaly with perisplenic varices related to a splenorenal shunt unchanged.4.No ascites.


Instruction: Generate impression based on medical findings.

Input: The pituitary gland measures up to 5 mm in craniocaudal thickness. The pituitary gland displays mildly heterogeneous enhancement, although no discrete mass is apparent. The pituitary stalk lies in the midline. The suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. There is a small retention cyst in the right sphenoid sinus. There may be a small arachnoid cyst in the medial right middle cranial fossa.

Output: The pituitary gland measures up to 5 mm in craniocaudal thickness, which is smaller than average, but does not meet the criteria for partially empty sella.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Mass or infectious lesion? Signs and symptoms: 51 year-old female with intractable headache, limited vertical gaze. Pre-and post enhanced brain MR:Negative diffusion weighted series.There is normal anatomical development and morphology brain parenchyma with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal enhancement of brain parenchyma or the meninges is detected.Unremarkable images through the orbits and including axial fat sat post enhanced series.Unremarkable calvarium and soft tissues of the scalp.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.Pre and post enhanced cervical MRI:There is normal anatomical alignment of the vertebral column however mild straightening of cervical lordosis which may be positional.There is generalized uniform narrowing than expected size of the spinal canal which is believed to represent congenitally small canal/short pedicles.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes however mild central spinal stenosis or congenital is present.C3-C4 demonstrate mild disc disease, mild bilateral uncovertebral hypertrophic changes without significant facet or ligamentum flavum hypertrophy. There is a tiny central disc protrusion which in combination with congenitally small canal results in moderate central spinal stenosis at this level. Moderate bilateral neural foraminal compromise is also best appreciated on oblique sagittal plane images.C4-C5 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum degenerative changes. Mild central spinal stenosis without neural foraminal compromise.C5-C6 demonstrate moderate disc disease and loss of disc height, moderate asymmetrical left sided uncovertebral hypertrophy and mild bilateral (R>L) facet disease. Moderate left and patent right neural foramina and mild central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, moderate bilateral uncovertebral hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. No significant facet disease. Constellation of changes results in slight flattening and posterior displacement of the cord and moderate central spinal stenosis. Moderate to severe right and mild left neural foraminal compromise is present.C7-T1 is unremarkable with the exception of mild symmetrical bilateral ligamentum flavum hypertrophy.T1-T2 and T2-T3 levels are unremarkable.There is subtle increased T2, T2 STIR signal intensity of the cord primarily at C6-C7 disc level concerning for myelopathy.Postcontrast images demonstrate no abnormal enhancement of the cord or the leptomeninges and no detectable abnormal enhancement of the vertebral column.

Output: 1.Negative pre and post enhanced brain MRI.2.Pre and post cervical MRI demonstrate no abnormal enhancement. There is evidence of congenitally small canal with resultant moderate central spinal stenosis at C6-C7, mild to moderate central spinal stenosis at C3-C4 levels as detailed. Multilevel neural foraminal compromise (some severe) as detailed per level. Subtle T2 STIR hyperintensity of the cord at C6-C7 concerning for adenopathy secondary to degenerative disease.


Instruction: Generate impression based on medical findings.

Input: Cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Central disc protrusion similar to prior with minimal narrowing of the spinal canal at this level. No significant neural foraminal stenosis. C5-6: Disc bulge with central protrusion and ligamentum flavum thickening contribute to moderate spinal canal stenosis at this level, not appreciably changed since 9/29/2014. There is mild left worse than right neural foraminal stenosis, which is also similar to prior. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Compared to 9/29/2014, there is no significant change in degenerative changes at the C4-C5 and C5-C6 levels, with up to moderate spinal canal stenosis at the C5-C6 level. No cord signal abnormality. There is mild bilateral, left worse than right, C5-C6 neural foraminal stenosis which is also not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 71 year old female with a history of chordoma. Evaluate for progression. Again seen is a lobulated hyperintense lesion centered at the S3 level, measuring approximately 6.0 cm in the transverse dimension, 2.5 cm in AP dimension, and approximately 4.5 cm in the craniocaudal dimension. It is difficult to determine whether or not this mass has increased very slightly in size compared to the prior study due to slight positional differences between the examinations. Again seen is extension of the mass into the anterior presacral soft tissues. There is minimal enhancement of the lesion that appears predominantly peripheral in nature.Again seen is a small nodule posterior to the left sacroiliac joint that now measures approximately 2.0 cm in its greatest dimension, which appears to have increased in size when compared to the prior study, although it shows no enhancement following contrast administration.Edema and fluid extending along the posterior inferior right sacrum appears similar to the prior study, which may be postoperative in etiology.The reference subcutaneous lobular mass posterior to the right paraspinal musculature measures approximately 3.2 cm in the greatest dimension which perhaps has increased slightly in size when compared to the prior study, showing little, if any, enhancement following gadolinium administration.There is mild diffuse heterogeneity of the bone marrow which appears similar to the prior study and is of doubtful clinical significance. There is fatty atrophy of the gluteal musculature, right greater than left, appearing similar to the prior study. Note is made of decreased signal abnormality within the uterus consistent with fibroid. Severe degenerative disc disease affects the imaged lower lumbar spine.

Output: Sacral chordoma with satellite soft tissue lesions which have perhaps increased slightly in size when compared to the prior study.


Instruction: Generate impression based on medical findings.

Input: Lung cancer in two brain metastases treated with CyberKnife. Surveillance imaging. There is interval decrease in size of the ring-enhancing lesion in the left superior frontal gyrus, now measuring up to 14 mm, previously 18 mm, although the vasogenic edema persists. However, there is interval increase in size of an enhancing lesion in the inferior right parietal lobe, which now measures up to 5 mm, previously 2 mm, and there is development of associated vasogenic edema. There is also interval increase in size of the right inferior temporal gyrus enhancing lesion, now measuring up to 8 mm, previously 5 mm, as well as increased associated vasogenic edema. In addition, there are two new punctate enhancing lesions in the left middle frontal gyrus with trace vasogenic edema. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval decrease in size of the left superior frontal gyrus metastasis, but interval increase in size of the inferior right parietal lobe and right inferior temporal gyrus metastases and associated vasogenic edema and new punctate metastases is in the left middle frontal gyrus.


Instruction: Generate impression based on medical findings.

Input: Left hyperacusis, dizziness. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a hypoenhancing subcentimeter lesion in the right pituitary lobe. There is a prominent perivascular space in the left temporal stem. There are also minimal scattered T2 hyperintense foci in the cerebral white matter, which are nonspecific. There is no evidence of acute infarction.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. A hypoenhancing subcentimeter lesion in the right pituitary lobe likely represents a microadenoma.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with melanoma with brain and lung metastases. Evaluate progression. CT of brain without and with infusion:Enhancing lesion measuring approximately 7 mm times 6 mm in transaxial dimension within the pons is noted. No evidence of surrounding edema. This finding was noted on prior MRI and considering the difference in technique no definitive interval change is detected. Images two posterior fossa otherwise demonstrate no detectable metastatic lesion.Images through supratentorial space demonstrate an area of encephalomalacia along the interhemispheric aspect of right frontal lobe with no abnormal enhancement. This was noted on prior MRI examination at the site of prior craniotomy.A small calcific/hemorrhagic and with possible enhancement in the right posterior temporal adjacent to the trigone of right lateral ventricle measuring 4 mm x 4 mm is consistent with an additional metastatic lesion. This was noted on prior MRI exam and is stable. No definitive detectable additional lesions.Calvarium demonstrates post operative changes of right frontal craniotomy and is otherwise negative. Mastoid air cells and paranasal sinuses are unremarkable.120 cc of Omnipaque 350 was utilized for the above study.

Output: The visualized lesions on this exam are similar to what were noted on the prior MRI examination. CT is significantly less sensitive to detect smaller lesions.


Instruction: Generate impression based on medical findings.

Input: Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: preop planning for biopsy of brain lesion History: none- planning Multiple fiducial markers are seen on the scalp.Left parietal resection cavity with left fronto-parietal and corpus callosum abnormal high signal intensity on T2 weighted images without significant enhancement on Gad are again demonstrated, no change since prior scan.Lower pontine cavernous malformation again is seen, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst on the right maxillary sinus.

Output: Pre-operative scan with STEALTH protocol has been obtained.No change of left hemispheric lesion as well as lower pontine cavernous malformation since prior scan.


Instruction: Generate impression based on medical findings.

Input: Hand contraction, dystonia left greater than right. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex including small left foraminal disc protrusion and uncovertebral hypertrophy. There is partial effacement of the left ventral thecal sac without significant spinal canal stenosis overall. Mild to moderate left neural foraminal stenosis and mild right neural foraminal narrowing.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There is a subcentimeter focus of T2 hyperintensity in the left posterior aspect of the left thyroid lobe likely representing thyroid nodule, but not well evaluated.

Output: 1. Mild multilevel degenerative changes without significant spinal canal stenosis at any level or cord signal abnormality.2. Mild to moderate left C3-C4 neural foraminal stenosis. Mild neural foraminal stenosis at additional levels as above.


Instruction: Generate impression based on medical findings.

Input: Reason: new L hip pain, eval for new mets History: above Post contrast images are not able to be obtained due to the patient's inability to tolerate further examination. Note is made of decreased bone marrow signal abnormality affecting the imaged portions of the L3 and L4 vertebrae on both T1 weighted images and fluid sensitive sequences. There is also decreased bone marrow signal abnormality along the right acetabulum which extends into the right ilium, abutting the right sacroiliac joint. There is also decreased signal abnormality on T1-weighted images and fluid sensitive sequences within the left ilium about the left sacroiliac joint. Given the diffuse decreased signal abnormality on all pulse sequences, these findings may represent treated metastases, although these are incompletely characterized due to lack of contrast enhanced imaging. There is restricted diffusion within the left ilium, left acetabulum, left ischium, left pubic bone, and left femoral head/neck extending to the level of the intertrochanteric and subtrochanteric regions of the femur. There is also diffuse restricted diffusion within the sacrum.

Output: Limited examination due to lack of contrast enhanced images. However, there are multiple foci of restricted diffusion affecting the bones of the left hemipelvis and left femur which are suspicious for osseous metastasis, although these are incompletely characterized on this noncontrast examination. Multiple foci of decreased signal abnormality on all pulse sequences within the right acetabulum, ilium and ischium may represent treated metastases, although these are also incompletely characterized on this noncontrast examination.


Instruction: Generate impression based on medical findings.

Input: Female, 13 years old, with seizures and mesial temporal abnormalities on prior imaging. Evaluate by spectroscopy, in particular for lactate expression. Atrophy of the right temporal lobe gyri is again seen. In addition, the right mesial temporal lobe and hippocampal formation are also atrophic and there is abnormal T2 signal corresponding to the amygdala and hippocampal head. The left temporal lobe may also be affected but to a much lesser degree than the right. The gyri recti also seem to be somewhat thinned. The right temporal horn demonstrates mild ex vacuo dilatation. These findings show no significant change from prior exams.Short TE single voxel spectroscopy was performed over the rightamygdala and hippocampal head, at the site of the most conspicuous atrophy and signal abnormality. Artifact compromises the far left end of the spectrum, likely due to poor water suppression. However, the majority of the spectrum is of acceptable quality and shows a uniform reduction in all metabolite peaks. In particular, the NAA peak is not detectable above background noise suggesting significant neuronal loss. No evidence of any lactate is seen. Single voxel spectroscopy of the left mesial temporal lobe shows a reduction in metabolite peaks, but less severe than that seen on the right, and with detectable NAA indicating viable neuronal tissue. A small negative doublet between 1.1 and 1.0 ppm is seen, which does not clearly correspond to any typical metabolite and which may be artifactual.Single voxel spectroscopy was also performed over areas of predominantly gray matter and predominantly white matter in the cerebral cortex. The spectra from these regions are within normal limits. Again, no significant lactate is detected.No evidence of restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is observed. The atrophic right mesial temporal lobe shows some intrinsic T1 hyperintensity which may reflect cellular loss and laminar necrosis. No evidence of intracranial hemorrhage is seen. Except as above, the ventricular system is normal in size and morphology.

Output: Again seen is atrophy affecting a large portion of the right temporal lobe with particular volume loss and associated signal abnormality within the mesial temporal structures including the amygdala and hippocampal head. The left temporal lobe and inferior frontal lobes may also be involved, but to a much lesser degree. There has been no significant interval change in these findings.Single voxel spectroscopy performed over the right mesial temporal lobe shows a significant reduction in all major metabolites, particularly NAA which is not detectable above the level of background noise. This pattern is compatible with severe neuronal loss. No evidence of any significant lactate is seen. Spectroscopy of the left mesial temporal lobe shows some reduction in metabolite peaks, but much less severe than on the right, and again no evidence of lactate. Spectroscopy of normal-appearing gray matter and white matter is within normal limits.The above findings are again suggestive of sequelae of a prior encephalitis which could have been infectious/viral or autoimmune/para-neoplastic. Absence of detectable lactate would tend to argue against an ongoing failure of energy metabolism. However, it does not exclude metabolic disease in general as not all metabolic deficiencies are associated with detectable brain lactate.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with strong family history of breast cancer in mother diagnosed at 72 and sister with bilateral breast cancer. Personal history of a right breast fibroadenoma removed in 1989. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild 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. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize two foci of signal abnormality within the prostate gland. One anteriorly in the mid gland and a second in the left peripheral zone posteriorly at the apex. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the anterior aspect and left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesions, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained from each lesion.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the prostate gland as detailed above.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for episodic left facial numbness History: as above The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus and to a lesser degree in the left. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.MRI of the brain is within normal limits. Mucosal thickening in the paranasal sinuses is likely inflammatory in nature.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient hypoechoic, concern for cord paralysis. Signs and symptoms: Hypotonia. Enhanced CT of the soft tissues of the neck:Limited images of intracranial space demonstrated ring enhancing lesions in bifrontal lobes at the site of previously noted large parenchymal hemorrhages. There is complete resolution of head CT of blood product at this site since prior head CT from 10 -- 4 -- 10.Images through the skull base, cavernous sinuses, paranasal sinuses and bilateral petrous bones are within unremarkable.Examination demonstrates edematous changes of the left piriform sinus with partial effacement of sinus and subtle enhancement. There is also evidence of left vocal cord paralysis and thickening. There is no evidence of a mass. The above findings could be result of trauma and extended duration of intubation. There is evidence of a sclerotic changes of left aspect of thyroid cartilage with some irregularity. This finding could represent a healing fracture. Further evaluate an MRI of larynx is recommended. There is no evidence of compromise of the airway. The thyroid lobes are within normal size and density. Trachea is intact. No definitive abnormality of the cervical spine is noted. Limited images of the apices of the lungs and mediastinum are within normal limits.60 cc of Omnipaque 350 is administered.

Output: Edematous changes of the left piriform sinus with asymmetrical enhancement of the mucosal compared to the left may represent inflammatory change. There is evidence of left vocal cord paralysis with soft tissue thickening of the vocal cord. Above changes could be result of long term intubation. The sclerotic changes of the left aspect of thyroid cartilage compared to the right may be an anatomical variation however possibility of a posttraumatic fracture and healing process cannot be ruled out. Follow-up with a dedicated MRI of larynx is recommended if patient's symptoms do not resolve.


Instruction: Generate impression based on medical findings.

Input: Reason: Hx of relapsed Ewings in past, now with T10 vertebral body lesion History: above Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. following biopsy no hmatoma or complication was identified.

Output: T10 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis in two formalin jars.


Instruction: Generate impression based on medical findings.

Input: 19 year-old male status post left S1 tumor resection. Osteoblastoma. Lumbar spine:Since the previous examination there are new postoperative changes including bilateral pedicular fusion of the L5 vertebrae and trans-sacral alar fusion at the S1 level. There is no evidence of hardware complication including loosening or fracture of the osseous structures or hardware components. There is 1-2 mm of extracortical extension of the screw tip of the left S1 hardware component.Alignment of the lumbar spine is within normal limits. Attenuation and morphology of the vertebral bodies and intervertebral disk spaces is within normal limits. The pre-and paravertebral soft tissues are within normal limits. Limited intra-abdominal imaging is within normal limits.L1-2: within normal limits without central or neuroforaminal narrowing.L2-3: within normal limits without central or neuroforaminal narrowing.L3-4: within normal limits without central or neuroforaminal narrowing.L4-5: within normal limits without central or neuroforaminal narrowing. Left-sided L5 and S1 laminectomies. L5-S1: within normal limits without central or neuroforaminal narrowing. Mottled and expansile appearance of the left S1 facet with left-sided neuroforaminal narrowing from bony encroachment. Expansile and lytic/sclerotic appearance of the left S1 facet extends to the dorsal aspect of the body of S1 and minimally into the left transverse process, most likely representing postsurgical change. Soft tissues within the surgical site and within the intracanalicular space cannot be evaluated on this examination secondary to lack of contrast. If there is further need for soft tissue evaluation an MRI with contrast may be considered.

Output: 1. Postoperative changes including bilateral pedicular fusion at L5-S1 without gross hardware complication.2. Postoperative change including left-sided L5 and S1 laminectomies with mottled and expansile appearance of the left S1 facet joint, body of S1 and left transverse process as described above.


Instruction: Generate impression based on medical findings.

Input: This exam is severely degraded by motion artifact despite sedation. BRAIN: There are postoperative findings related to right suboccipital craniectomy and right internal auditory canal surgery. There is a small focus of subjacent T1 and T2 hyperintensity within the right cerebellum that is likely post-operative in nature. There are a few additional scattered small foci of T2 hyperintensity within the supratentorial white matter that most likely represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants.IAC: This portion of the exam is limited due to lack of precontrast images. The original protocol was based on the order indication that stated "neurofibromatosis type I". The IAC portion of the exam was added by the interpreting radiologist due to EPIC review but after the injection of contrast. Within the right internal auditory canal there is a 6 x 7 mm focus of presumed moderate enhancement and T2 hypointensity. The labyrinthine structures are grossly unremarkable but not well evaluated on this exam.

Output: 1.Severely motion degraded exam.2.Postoperative findings related to right occipital craniectomy and right internal auditory canal surgery. Presumed moderate enhancement and T2 hypointensity within the right internal auditory canal is non-specific and likely representing scar/ granulation tissue however less likely possibility of a schwannoma cannot be entirely excluded. Comparison with prior outside imaging is recommended to assess for growth. Otherwise, follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with persistent right knee pain. MENISCI: There is a radial tear of the posterior horn of the medial meniscus, at or just medial to its root, that appears to involve the full thickness of the meniscus. There is globular signal within the posterior horn and body of the medial meniscus indicating intrasubstance degeneration. There is slight medial extrusion of the body of the medial meniscus. There is intrasubstance degeneration of the lateral meniscus, but we see no tear.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the patellofemoral joint with full-thickness cartilage loss, particularly along the lateral facet of the patella and femoral trochlea with underlying subchondral cysts. There are multiple near full-thickness to full-thickness cartilage defects also affecting the tibiofemoral articulations with small subchondral cysts and mild degenerative edema type signal within the tibial plateau and medial femoral condyle. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is a thin focus of fluid signal intensity deep to the iliotibial band extending superficial to the lateral collateral ligament proper that may reflect a mild bursitis.EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL

Output: 1. Full-thickness radial tear of the posterior horn of the medial meniscus at or near its root.2. Severe osteoarthritis of the patellofemoral joint with moderate osteoarthritis of the tibiofemoral compartments.3. Fluid/edema along the iliotibial band may reflect a bursitis.


Instruction: Generate impression based on medical findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: evaluate for lesion History: weakness and loss of sensation Slight kyphotic angulation of cervical spine at C56 with disc dessication at the level of C23, C34, c45 and C56. There is no evidence of neuroforaminal stenosis. There is no evidence of spinal canal stenosis. Spinal cord signal intensity is normal.There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1. L12 disc shows dessication maintaining its height.Otherwise, the thoracic and lumbar intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass.

Output: 1. Loss of normal lordosis with disc dessication at cervical spine and disc dessication at the level of L12.2. Otherwise normal spinal cord signal intensity. Normal vertebral body height. No evidence of spinal canal stenosis nor neuroforaminal stenosis.3. No evidence of abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Parkinson's preoperative planning for DBS. There is blurring of the susceptibility effect in portions of the bilateral substantia nigra. There is a nonspecific punctate focus of susceptibility effect in the right parietal lobe periventricular white matter. There are also mild nonspecific scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right lens implant and scleral band and atrophy of the right optic nerve.

Output: Findings supportive of Parkinson's disease. Otherwise, unremarkable preoperative MRI of the purposes of preoperative planning.


Instruction: Generate impression based on medical findings.

Input: Headache, heart transplantation patient with immunosuppression. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is a focal small metallic artifacts on the right temporal bone, however, is no evidence of skull bone marrow abnormality.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Small metallic artifact on the right temporal bone, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: There appear to be six enhancing lesions in the bilateral cerebral hemispheres, the largest of which is located in the left superior frontal gyrus and measures up to 15 mm. Additional lesions are present in the left superior frontal gyrus, right precentral gyrus, left middle temporal gyrus, and right superior and inferior parietal lobules. There is minimal vasogenic edema associated with the lesions, There may also be associated leptomeningeal involvement and faint susceptibility effect within some the lesions, suggestive of microhemorrhage or hypervascularity, for example. There are confluent and punctate T2 hyperintense areas in the periventricular and subcortical cerebral white matter. There are also small areas of encephalomalacia in the right corona radiata, left pons, and left thalamus. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Multiple bilateral brain metastasis, without evidence of midline shift.2. Chronic small vessel ischemic disease and chronic lacunar infarcts in the right corona radiata, left pons, and left thalamus.


Instruction: Generate impression based on medical findings.

Input: Check for meniscal tear or Baker's cyst. Knee swelling MENISCI: The menisci are intact and unremarkable. Old demonstrate proper anchoring posteriorly. However, extensive multilobulated cysts are observed posteriolateral to the lateral meniscus and displacing the lateral head of the gastrocnemius. Additional similar cysts are observed posterior to the medial condyles and epiphyseal plate, compatible with ACL ganglion cysts.ARTICULAR CARTILAGE AND BONE: Moderate thinning with underlying contusion involving the patellofemoral compartment, specifically the medial facet. The remaining compartments are otherwise unremarkable. Marrow signal is normal. Small bone island observed in the medial femoral condyle.LIGAMENTS: No significant abnormality noted. Specifically the ACL appears intact with discrete fibers.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Multiple scattered para-meniscal and ACL ganglion cysts involving largely the postero-medial and lateral aspects of the knee. See detail provided


Instruction: Generate impression based on medical findings.

Input: 39 year old female status post left lumpectomy for invasive ductal carcinoma in 2012. Patient received chemotherapy, radiation and Herceptin. History of right reduction mammoplasty with keloid formation. History of benign right breast biopsy showing fat necrosis. No current breast complaints. Family history of breast carcinoma in her maternal aunt in her 40s. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A marker clip artifact is seen in the right outer breast.A scar from prior surgery is present in the left axilla.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Female 83 years old Reason: Etiology for memory deficit History: memory deficit. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive patchy and confluent scattered T2/FLAIR hyperintensity throughout the periventricular and subcortical white matter most consistent with chronic small vessel ischemic disease. No focal areas of brain parenchymal atrophy. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Extensive T2/FLAIR hyperintensity in the white matter consistent with chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval bony changes. History: MRI and CT. Would like to see bone on XR. The patient has undergone disarticulation of the right hip. There is gas density adjacent to the remaining proximal femur reflecting extension of underlying ulceration as seen on the prior MRI examination with periosteal reaction along the proximal femur likely representing a combination of acute and chronic osteomyelitis. There is also chronic deformity of the right iliac wing. A segment of the ischium is not visualized perhaps due to prior surgery or long-standing osteomyelitis. There is also deformity of the left ischium that appears chronic on this radiograph. Please note that the left greater tuberosity is not included in the field of view of this study. There are posterior stabilization rods affixing the lumbosacral spine which are incompletely imaged on this examination. Note is made of a left lower quadrant colostomy. There are surgical clips projecting over the right hemipelvis.

Output: Disarticulation of the right hip with gas density adjacent to the right femur and findings suggestive of osteomyelitis as well as other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 55 year old woman with history of PVCs. Evaluate for scar and sarcoidosis. Study moderately limited by cardiac arrythmia.Left VentricleQualitatively normal LV function. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly enlarged. Right VentricleQualitatively normal RV function. Right AtriumThe right atrium is nonenlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveTrace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsScattered pulmonary micronodules. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: Study moderately limited by cardiac arrythmia.No late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Qualitatively normal biventricular function.Quantitative measures of LV and RV function and size will be reported as an addendum.


Instruction: Generate impression based on medical findings.

Input: 66-year-old man with increasing PSA. PELVIS:PROSTATE:Prostate Size: 42 x 34 mm.Peripheral Zone: There is an area of T2 hypointensity, diffusion restriction, and avid enhancement seen in the anterior right paramedian prostate apex (series 801, image 13; series 43, image 264; series 1401, image 1366). This area measures approximately 17 x 13 mm in maximal cross-sectional dimension.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality or involvement of the seminal vesicles noted.Extracapsular Extension: The capsule at the 10:00 position of the right prostatic apex (series 1401, image 1367) appears to be involved.BLADDER: The bladder is markedly distended. Please note that the patient attempted to void prior to examination.LYMPH NODES: Inguinal lymph nodes are noted, likely reactive. No suspicious lymphadenopathy identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the right paramedian prostatic apex suspicious for prostate carcinoma with extraprostatic extension.2. Markedly distended bladder post-void without significant central zone hypertrophy.


Instruction: Generate impression based on medical findings.

Input: Male, 8 years old, with neurologic deterioration. Assess for cerebellar degeneration or cerebral atrophy. Diagnosis of hereditary ataxia, unspecified. Patchy areas of white matter T2 hyperintensity seen on prior examinations have essentially resolved. Perivascular spaces are noted within the periatrial regions but this is within normal limits. The pattern of white matter myelination is mature. No areas of parenchymal edema or mass effect are seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricles are normal in size and morphology. The cerebral sulci are questionably and subjectively more prominent than on prior examinations. The cerebellar fissures more clearly seem to show progressive widening when compared to the prior exams.Patchy mucosal thickening and/or secretions are noted within the paranasal sinuses.

Output: 1.Mild interval progression in loss of cerebellar volume is seen.2.Questionable progressive prominence of the cerebral sulci could also indicate some very mild loss of cerebral volume, though this finding is equivocal.3.No acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 14 years old. History of SLE, chronic HA. Ophthalmologic exam on 9/2/15 showed possible bilateral disc swelling vs pseudopapilledema. BRAIN:There is no evidence of intracranial hemorrhage, mass effect, midline shift, or acute infarct. Mild prominence of the ventricles and sulci appear similar to the prior study, compatible with global volume loss. The basal cisterns remain patent. The midline structures and craniocervical junction are within normal limits. Small areas of T2 hyperintensity within the left paramedian parietal lobe and anterior left frontal lobe are unchanged from the prior study dated 08/2014, without associated diffusion restriction or enhancement. There is no abnormal parenchymal or leptomeningeal enhancement. There is no diffusion abnormality.ORBITS:No abnormal mass or abnormal enhancement is seen. The optic nerves are normal in size and signal intensity. There is no definite elevation of the optic nerve head. No retrobulbar, chiasmatic, or parasellar abnormality is seen. The extraocular muscles are unremarkable.MRA:The intracranial internal carotid arteries are normal in course and caliber. 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.MRV:The 2-D MRV sequences are somewhat limited, and there is better evaluation of the venous structures on phase contrast images and 3-D T1 postcontrast images of the brain. The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1.Nonspecific small areas of T2 hyperintensity in the left paramedian parietal lobe and left frontal lobe are unchanged from the prior study.2.Normal MR appearance of the orbits, without morphologic or signal abnormality involving the optic nerves.3.The intracranial arterial and venous structures are normal, without aneurysm, flow-limiting stenosis, or thrombosis.


Instruction: Generate impression based on medical findings.

Input: Surgical planning: seizure. Per EPIC: brain lesion (unclear pathology), CVA during biopsy in 1990 with residual left sided weakness and seizure disorder. There are postoperative findings related to right frontal craniotomy with encephalomalacia and gliosis in the underlying right frontal lobe. There is a large area of encephalomalacia in the right basal ganglia, medial right temporal lobe, right midbrain, and right corona radiata with extensive susceptibility effect, Wallerian degeneration in the brainstem, and ex vacuo dilatation of the adjacent ventricles. There is linear high T2 signal in the left brainstem, which may also represent Wallerian degeneration. There is a punctate area of encephalomalacia in the left corona radiata. There are scattered foci of susceptibility effect in the right frontal lobe and overlying extra-axial space, which correspond to dystrophic calcifications demonstrated on CT. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Postoperative findings related to right frontal craniotomy with encephalomalacia and gliosis in the underlying right frontal lobe, but no definite gross tumor. 2. Chronic hemorrhagic infarction involving the right basal ganglia, medial right temporal lobe, right midbrain, and right corona radiata.3. Punctate chronic lacunar infarct in the left corona radiata.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with cavernous malformation. Redemonstrated is a patchy subcentimeter area of enhancement in the lateral right putamen associated with a small anomalous vein. There is also a nonenhancing focus of 4 mm susceptibility effect in the medial right putamen. There is no evidence of acute intracranial hemorrhage or acute infarct. As before, there are a few scattered punctate to small foci of T2 hyperintensity within subcortical white matter locations without susceptibility abnormality. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.Findings suggestive of a subcentimeter right putamen cavernous malformation and associated developmental venous anomaly which are unchanged in appearance. 2.Probable minimal chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old, with history of nasopharyngeal cancer, status post induction, evaluate response. Neck:The previously demonstrated nasopharyngeal mass has significantly decreased in size and definition. A discretely measurable lesion separate from the adenoids is no longer identified.Substantial decrease in the size of multiple metastatic lymph nodes is seen. The large aggregate at level II on the right now measures approximately 21 x 12 mm (image 30 series 20), previously 55 x 54 mm. A left level II node measures 23 x 13 mm (image 30 series 20), previously 37 x 18 mm. A left lateral retropharyngeal node now measures up to 19 x 11 mm (image 24 series 20), previously 21 x 12 mm.The salivary glands are within normal limits. The visualized airway is patent. Bone marrow signal characteristics are unremarkable. Disc herniations are seen at several levels in the visualized cervical spine with perhaps mild spinal canal stenosis at C4-5.Brain:No evidence of parenchymal edema, mass effect or pathologic intracranial enhancement is observed. Diffusion-weighted images are within normal limits. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. A few very small scattered foci of T2 hyperintensity within the cerebral hemispheres are nonspecific. Ventricular size and morphology are within normal limits.

Output: 1.Significant interval decrease in the size of a nasopharyngeal mass, such that there is no longer any discretely measurable lesion.2.Significant interval decrease in size of multiple pathologic lymph nodes and nodal aggregates in the neck.3.No evidence of intracranial metastasis.


Instruction: Generate impression based on medical findings.

Input: 15-year-old male baseball player with right elbow pain. Evaluate for ulnar collateral ligament insufficiency. The study is slightly limited due to the inability to optimally position patient due to pain and claustrophobia and inability to fully extend the arm.LIGAMENTS: The collateral ligament appears intact. The radial collateral ligament complex is grossly intact.TENDONS: The common flexor tendon appears intact. The common extensor tendon appears intact. The triceps tendon appears intact. The biceps and brachialis tendons appear intact.ARTICULAR SURFACES AND BONE: There is edema within the medial epicondyle as well as widening of the underlying physis compatible with physeal injury as suggested on prior radiographs. The bone marrow signal intensity is otherwise within normal limits. There is no evidence of an osteochondral defect. There are no loose bodies within the joint.SURROUNDING STRUCTURES: The remaining visualized soft tissue structures are within normal limits.ADDITIONAL

Output: Medial epicondyle physeal injury with intact ulnar collateral ligament.


Instruction: Generate impression based on medical findings.

Input: 77 year old woman with recent increasing shortness of breath with exertion and possible diagnosis of hypertrophic cardiomyopathy presents for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. There is asymmetric septal hypertrophy (septal wall thickness: 16 mm, posterior wall 8mm) with flow acceleration in the outflow tract and associated systolic anterior motion of the mitral valve. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVEDV is 121 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19), the LV mass index is 85 g/m2 (normal range 85+/-15), and the LV mass is 153 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is an atypical pattern of late gadolinium enhancement involving the basal inferior and inferolateral walls and the LV apex which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The overall burden of late gadolinium enhancement is 5-10% of the myocardial mass. Left AtriumThe left atrium is severely dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 112 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 51 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 at least mild mitral regurgitation. There is evidence of systolic anterior motion of the mitral valve.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is upper limits of normal in size (29 mm)Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. There is mild amount of pericardial fat present.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (65%)2. There is asymmetric septal hypertrophy (septal wall thickness: 16 mm, posterior wall: 8mm) with flow acceleration in the outflow tract and associated systolic anterior motion of the mitral valve. 3. There is an atypical pattern of late gadolinium enhancement to suggest the presence of an underlying fibrosing process, which involves only 5-10% of the myocardial mass. 4. The right ventricle is normal in size and systolic function (54%)5. Taken together, these findings support the diagnosis of hypertrophic cardiomyopathy and no high risk features of sudden cardiac death/ adverse cardiac remodeling are identified. Atypical patterns of late gadolinium enhancement are present in approximately two-thirds of individuals with hypertrophic cardiomyopathy. The presence of 15-20% late gadolinium enhancement burden is considered higher risk for sudden cardiac death and adverse cardiac remodeling.


Instruction: Generate impression based on medical findings.

Input: Reason: C4-5 disc herniation s/p MVA History: Neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. Incidental note is made of partial empty sella.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a very small central disk protrusion at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion at this level.At C4-5 there is redemonstration of a central disk extrusion with extrusion of disk material behind of the C3 vertebral body. There is associated effacement of spinal fluid ventral and posterior the spinal cord and compression of the spinal cord. Relative to the prior exam there is no significant change.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk protrusion at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is redemonstration of a large central disk extrusion at C4-5 which compresses the spinal cord and creates spinal stenosis. This has not changed substantially compared to the previous exam.2.There is degenerative disk disease also present at other levels.


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer with compression fracture. Increasing low back pain. The extensive metastatic involvement through the lumbar and included lower thoracic spine is now more T1/T2 hypointense and less contrast-enhancing which may reflect treatment response. The associated compression fractures at L4 and L5 as well as T12 have increased. There is severe height loss at T12 and L5, at 70% and 75% percent/ respectively. There is thickening of the soft tissue posterior to the compressed L5 vertebral body suggesting a small epidural component which now indents the thecal sac and the left lateral/subarticular recess. There is also slightly increased compression of the thecal sac at T12 level related to retropulsion, although without spinal cord compression.T11-T12: The increased T12 compression fracture is associated with moderate left and mild right foraminal narrowing. There is mild mass effect on the thecal sac related to retropulsion at T12 level but no spinal cord compression.T12-L1: There is mild-to-moderate left and mild right neural foraminal narrowing but no spinal canal narrowing.L1-L2 and L2-L3: There is no significant spinal canal or neural foraminal narrowing.L3-L4 and L4-5: There is minimal bilateral neural foraminal narrowing. No significant spinal canal narrowing.L5-S1: There is slightly increased narrowing of the left lateral recess and proximal neural foramen. Otherwise no significant spinal canal or neural foraminal stenosis. Linear T2 hyperintensity involving the posterior aspect of the disc, mainly to the left of midline, may represent an annular fissure.The metastatic involvement of the iliac bones is slightly more discretely T1-hypointense compared to the previous examination.Extensive liver metastatic involvement is only partly imaged.Again seen is epidural enhancement dorsal to the L5 vertebral body which may represent small amount of epidural tumor, although some of this enhancement likely represents epidural venous plexus. No significant associated stenosis.

Output: 1.Diffuse osseous metastatic disease with slight differences in associated signal abnormalities compared to 2/9/2015 including decrease in enhancement, findings overall representing treatment response. Please note however given the extensive osseous metastatic disease, follow-up bone scan may be helpful to assess for changes in the overall burden of osseous metastatic disease. 2.Pathologic compression fractures at T12, L4 and L5 are worse in the interval. There is also increased osseous retropulsion particularly at T12, where there is mild spinal canal stenosis without frank cord compression.3.Minimal ventral epidural tumor is suspected at the L5 level which is slightly more prominent than before but without significant spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with chronic history of sinusitis. Patient has history of complex pituitary surgery there is a moderate. Small amount of soft tissue and air density within the sphenoid sinus is noted. There is also presence of air within the sella and a defect across the floor of the sella and across the floor of the sphenoid sinus. All these findings are believed to be secondary to transsphenoidal hypophysectomy. No clinical information regarding the date of the procedure is provided. The amount of Bob soft tissue/fluid density within the sphenoid sinus is more than what was noted on prior study of 9 -- 24 -- 07.Very minimal mucoperiosteal thickening within the dependent portion of bilateral maxillary sinuses is again identified. These were noted on prior MRI examination from 2/27/08 and prior CT examination of the sinuses dated 9 -- 24 -- 07. TheOMUs of maxillary sinuses remain patent.

Output: 1.Postoperative changes of the sphenoid sinus and sella as detailed above.2.Very minimal residual mucoperiosteal thickening in the dependent portion of maxillary sinuses as detailed.3.4.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old, with altered mental status, history of AML in blast crisis, evaluate for ischemia versus hemorrhage versus leukostasis. MRI brain:Restricted diffusion compatible with acute ischemia is seen within the right MCA distribution affecting the posterior frontal lobe, much of the parietal lobe, part of the insula, and part of the temporal and occipital lobes.Restricted diffusion is also seen within the left MCA territory involving a moderately sized portion of the left posterior frontal lobe and frontal operculum. Numerous small foci of restricted diffusion are evident elsewhere in both cerebral hemispheres and in the cerebellum. The affected tissue demonstrates T2 hyperintensity and mild edema but no significant generalized mass effect, midline shift or brain herniation is seen. No hemorrhagic conversion is suspected as of yet. There are small foci of susceptibility scattered through the brain but these may represent chronic microhemorrhages.Extensive patchy periventricular T2 hyperintensity is seen, a nonspecific finding which may reflect chronic microvascular ischemic disease. There is mild effacement of the right lateral ventricle. Elsewhere, the ventricular system is unremarkable.MRA brain:Abrupt cessation of flow related signal is seen within one of the proximal M2 branches of the right MCA. A paucity of MCA vessels is visualized in the right cerebral hemisphere. Scattered areas of narrowing are seen within the M2 and M3 branches of the left MCA as well. The intradural right vertebral artery is not well visualized.MRA neck:The origins of the great vessels are not well visualized due to technical limitations. The common carotid and internal carotid arteries are free of significant vascular stenosis. The left vertebral artery is free of significant vascular stenosis. The right vertebral artery is not visualized.

Output: 1. A large acute infarct is evident within the right MCA distribution with a moderately sized acute infarct seen in the left MCA distribution. Scattered small ischemic lesions are demonstrated elsewhere throughout the cerebrum and cerebellum. The pattern of disease is largely territorial and therefore a thromboembolic process or possibly in situ cerebral vessel thrombosis would be the favored etiology.2. Correlating with the large right MCA infarct, there is abrupt occlusion of one of the proximal M2 branches of the right MCA. Scattered vascular stenoses are also seen within the left MCA distribution.3. The right vertebral artery is not identified in the neck or intradurally. This may reflect a proximal occlusion or severe atherosclerosis or a congenitally diminutive vessel. The cervical carotid vessels are unremarkable.


Instruction: Generate impression based on medical findings.

Input: 50 years, Female, Reason: h/o right DBS; planning for left side DBS placement. Examination is obtained for operative planning. There is a right transfrontal DBS lead in place with the lead tip in the region of the subthalamic nucleus on the right. There is T2 hyperintensity involving the proximal aspect of the lead which is nonspecific and may represent gliosis or inflammatory response. No significant edema, intracranial mass, or mass effect. No masses or vascular abnormalities are evident along the expected trajectory of a planned left-sided DBS lead. No hydrocephalus. No extra-axial collections. Major arterial and venous structures are patent.

Output: Examination for operative planning. Right-sided DBS lead as above.