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.There is mild congenital narrowing of the spinal canal. Individual levels 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: Minimal disc bulge. No compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. No compromise to the spinal canal or neural foramina.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: Examination of the cervical spine is essentially unremarkable for age. No significant spinal canal or neural foraminal stenosis is evident at any level.


Instruction: Generate impression based on medical findings.

Input: 5-week-old male with apparent life threatening episode and reported cyanosis. Rule out bleed or skull fracture. There is no evidence of intracranial hemorrhage, mass or midline shift. Hypodensity in the subcortical white matter along the convexities and in the frontal and parietal regions bilaterally is slightly lower T1 signal than expected for unmyelinated parenchyma and could represent gliosis from prior ischemia. An MRI is recommended for better visualization of these areas, if clinically indicated.The ventricles and basal cisterns are normal in size and configuration for the patient's age.The calvaria and skull base are radiographically normal without evidence of fracture.

Output: Subcortical white matter hypodensity in the frontal and parietal regions bilaterally shows lower T1 signal than expected for unmyelinated parenchyma. An MRI is recommended for better visualization of these areas, as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Preop (biopsy) planning brain MRI. Redemonstration of abnormal high FLAIR signal intensity lesions involving left insular cortex, left temporal lobe pole, left temporal lobe superior and anterior transverse temporal gyrus, left side parahippocampal gyrus and left fusiform gyrus anterior aspect. No change since prior exam. The ventricles, sulci and cisterns are symmetric and unremarkable.There is midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No change of left side high signal intensity lesions on FLAIR images since prior exam.


Instruction: Generate impression based on medical findings.

Input: 27-year-old male with chronic weakness. Assess for muscle disease. The imaged musculature of the right thigh is within normal limits. There is no increased signal abnormality or fatty atrophy of the imaged musculature of the right thigh. Heterogeneous bone marrow signal abnormality appears most consistent with residual islands of red marrow. There is a small amount of fluid within the right hip, which is within normal limits.

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


Instruction: Generate impression based on medical findings.

Input: Oscillopsia, eye pain, and headaches. Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a persistent left trigeminal artery. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on medical findings.

Input: 44 year old man with heart block and exercise intolerance referred to evaluate for infiltrative cardiomyopathy. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 165 ml (normal range 142+/-34), the LV end systolic volume index is 89 ml/m2 (normal range 25+/-9), the LVESV is 198 ml (normal range 47+/-19), the LV mass index is 74 g/m2 (normal range 85+/-15), and the LV mass is 165 g (normal range 164+/-36). 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 dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 91 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsHilar and mediastinal lymphadenopathy is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 51%).3. Mild biatrial dilation.4. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with nausea and emesis with a previously noted biliary mass. Evaluate the mass. ABDOMEN:LUNG BASES: Stable right subpleural atelectasis with adjacent pleural thickening/small effusion, probably round atelectasis. Small left pleural effusion.LIVER, BILIARY TRACT: At the junction of segment 4A and segment IVb, again seen is intrahepatic periductal mild T2 hyperintensity (series 6, image 19) and diffusion restriction which is not measurable; however, this finding is unchanged from the previous examination. Intrahepatic biliary ductal dilatation has improved compared to the previous exam.No evidence of extrahepatic biliary ductal dilatation; the common bile duct tapers to the level of the ampulla without evidence of a stone, significant stricture, or lesion.SPLEEN: Splenomegaly persists.PANCREAS: Subcentimeter pancreatic head T2 hyperintense nonenhancing focus has slightly increased in size compared to the 2014 examination. This is favored to be side branch type IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter scattered renal cysts. Mild perinephric fluid bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.

Output: 1.Intrahepatic periductal mild T2 hyperintensity and diffusion restriction is not measurable; however, unchanged compared to the prior examination. Differential considerations include inflammatory sequelae related to patient's sarcoidosis.2.Persistent right basilar segmental consolidation/atelectasis.3.Anasarca.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Removal of cystic lesion at L3 -- L4 and L4 -- L5 levels in September of 2012. Follow-up for any recurrence. Signs and symptoms: As above. Pre-and post-enhanced lumbar MRI:Examination demonstrates an ill-defined increased T2 stir signal intensity in the left paraspinal soft tissues posterior to L4 and L5 level at the site of prior tumor resection. Post enhanced images also demonstrate a very faint subtle enhancement at the site. There is interval improvement (less conspicuous enhancement and signal abnormality) of the finding since prior exam highly suggestive of improvement of post operative changes. There is no convincing evidence of residual tumor. The alignment of the vertebral column remains anatomical and the signal intensity of vertebral column demonstrate changes related to degenerative disease. Post enhanced images demonstrate expected enhancement of degenerated/hypertrophied facet complexes at L3 -- L4 through L5 -- S1 levels of varying degree.T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise or interval change since prior exam.L2 -- L3 demonstrate mild degenerative disease a mild bilateral facet and ligamentum flavum hypertrophy without central spinal stenosis or neural foraminal compromise or interval change.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. Constellation of above changes results in moderate central spinal stenosis without convincing evidence of interval change since prior exam. No neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and loss of disk height, moderate to severe bilateral facet and mild bilateral ligamentum flavum hypertrophic changes are noted. Mild central spinal stenosis and mild right neural foraminal compromise similar to prior exam.L5 -- S1 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise or interval change since prior exam.

Output: 1.Post operative changes in the soft tissues of the posterior lower back at L3 -- L4 and L4 -- L5 levels at the site of previously resected tumor without evidence of residual tumor.2.Stable degenerative changes of the lower lumbar spine with evidence of moderate central spinal L3 -- L4 and mild at L4 -- L5 levels. No significant neural foraminal compromise. stenosis


Instruction: Generate impression based on medical findings.

Input: Chronic left sided headache with history of left pulsatile tinnitus. There is no acute infarct or intracranial hemorrhage. There are few punctate T2-hyperintense subcortical foci in the frontal lobes. The cerebellar tonsils reach up to 5 mm below the foramen magnum. Otherwise, the brain shows normal signal characteristics and normal morphology. There is no abnormal intracranial contrast enhancement. The ventricles and the other CSF-containing spaces are normal in size. There is no extra-axial fluid collection. There is no midline shift or brain herniation. The major intracranial vascular flow voids are preserved. Major venous sinuses are also patent. No mass within the cerebellopontine angles or internal auditory canals is appreciated. The internal auditory canals are symmetric as well as the seventh/eighth cranial complexes. There is a partially empty sella.There is trace mucosal thickening in the ethmoid sinuses. Mastoid air cells are clear. The orbits are unremarkable.

Output: 1.Few punctate T2-hyperintense lesions in the frontal subcortical white-matter are nonspecific and essentially within normal limits for age. These may be related to prior inflammation, infection or perhaps related to migraines.2.Partially empty sella is commonly an incidental finding, but can be seen with pseudotumor cerebri in the proper clinical setting.3.The cerebellar tonsils are borderline low-lying measuring up to 5 mm below the foramen magnum. This finding can also be seen with pseudotumor cerebri but may also be unrelated.


Instruction: Generate impression based on medical findings.

Input: History of renal transplant and disseminated nocardia, follow-up examination. Redemonstration of multiple lesions with surrounding edema throughout both cerebral hemispheres. Interval increase in edema involving the left occipital, left parietal and right temporal lesions. These lesions again demonstrate diffusion restriction. There is been interval resolution of multiple T2/FLAIR hyperintense foci involving the right thalamus, and the right cerebellum. The remainder of the lesions appear similar to prior exam. No new lesions are identified.Few of the lesions again demonstrate minimal susceptibility artifact, but no significant intracranial hemorrhage. T2 hyperintense signal in the posterior medulla and pons appear similar to prior exam and remains of uncertain etiology. Ventricles are normal in size and stable.

Output: Redemonstration of multiple lesions within both cerebral hemispheres, with a mixed response as described above.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with right sided weakness and paresthesia. MRI brain:Examination is somewhat limited by motion artifact. Within these limitations, there is no evidence of intracranial mass or acute infarct. There is scattered mild periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. 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 near complete opacification of the left maxillary sinus with mild mucosal thickening involving the right maxillary sinus. There is opacification of many of the ethmoid air cells and minimal mucosal thickening of the frontal sinus.MRI C-spine:This is a severely limited exam secondary to patient motion. There are degenerative changes involving the cervical spine with mild spinal canal stenosis involving the C4-5, C5-6 and C6-7 levels. A disc osteophyte complex and facet arthropathy contribute to severe bilateral neuroforaminal narrowing at C4-5. In addition, a disc-osteophyte complex and facet arthropathy at C5-6 contribute to severe left and moderate to severe right neuroforaminal stenosis at this level.There is straightening of the cervical spine which is nonspecific. The vertebral body heights are maintained. The cervical spinal cord normal signal cannot be adequately assessed secondary to patient motion. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Limited exam of the brain without acute abnormalities.2.Mild scattered chronic small vessel ischemic disease3.Severely limited examination of the cervical spine shows degenerative changes most prominent at the C4-5 and C5-6 level at most severe neuroforaminal narrowing involving the bilateral C4-5 and left C5-6 levels. There is at most mild spinal canal stenosis from C4-5 through C6-7.4.Note that the cervical spinal cord cannot be adequately assessed secondary to the limitations of motion.5.Paranasal sinus inflammation, greatest involving the left maxillary sinus, as described above.


Instruction: Generate impression based on medical findings.

Input: 58-year-old man with history of lymphoma and abnormality in liver enzymes. ABDOMEN:LIVER, BILIARY TRACT: Moderate intrahepatic biliary ductal dilatation is again seen to level of the hepatic hilum. There is diffuse infiltrative masslike T2 signal within the hepatic parenchyma distal to the biliary duct dilatation. The gallbladder wall is thickened.SPLEEN: The splenic capsule appears infiltrated with an ill-defined T2 hyperintense lesion which appears contiguous with the pancreatic tail and retroperitoneum.PANCREAS: The pancreatic duct is mildly dilated. The pancreatic tail is indistinguishable from the aforementioned lesion.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There are punctate renal cysts, otherwise the kidneys appear normal.RETROPERITONEUM, LYMPH NODES: The abdominal aorta is aneurysmal, better characterized on the recent CT. Additionally, there is T2 hypo and T1 hyperintense material in the lumen.BOWEL, MESENTERY: The stomach is distended as previously noted in the wall of the greater curvature appears infiltrated by this mass (series 4, image 20). An umbilical hernia containing fat is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Very limited study due to patient motion and lack of intravenous contrast.2.Infiltrative mass involving the greater curvature of the stomach, spleen, pancreas, and retroperitoneum. This finding is more likely to represent lymphoma than hematoma as previously questioned.3.Additional infiltrative mass within the liver causing biliary duct dilatation.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with weight loss, hyperbilirubinemia. Past medical history of metastatic pancreatic cancer with liver metastases. Concern for cholangitis. Elevated AST/ALT. Please characterize pancreatic primary, liver metastases, and biliary tree. Rule out obstruction. Exam limitations include extensive patient motion artifact and susceptibility artifact at the level of the central pancreas.ABDOMEN:LIVER, BILIARY TRACT: Marked hepatomegaly measuring 30 cm in craniocaudal length. The hepatic parenchyma demonstrates innumerable near confluent small lesions of abnormal signal intensity compatible with the history of hepatic metastatic disease. There is narrowing of the hepatic veins and portal veins. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Extensive cystic changes of the pancreatic body and tail, which is favored to represent pancreatic ductal and sidebranch dilatation. These findings extend to the proximal pancreatic body, however a discrete lesion is not clearly identified within the limitations of this exam. The proximal aspect of the SMA demonstrates a normal surrounding fat plane, however there is limited visualization of the midportion SMA due to motion artifact and susceptibility artifact.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal and upper abdominal lymphadenopathy is seen. For reference, there is a 1.9 x 1.5 cm left paraaortic lymph node (series 401 image 24).There are separate origins of the common hepatic artery and splenic artery from the aorta, normal variant. An IVC filter is noted.BOWEL, MESENTERY: Mild ascites.BONES, SOFT TISSUES: Multilevel degenerative changes of the spine.OTHER: Small right pleural effusion.

Output: 1.Extensive cystic changes of the pancreatic body and tail, which is favored to represent pancreatic ductal and sidebranch dilatation. These findings extend to the proximal pancreatic body. However, extensive motion and regional susceptibility artifacts limit the ability to accurately delineate the presumed pancreatic body mass lesion, and CT is recommended for more accurate staging. There is evidence of metastatic hepatic and nodal disease.2.Marked hepatomegaly measuring 30 cm in length. Extensive near confluent hepatic lesions compatible with history of metastases. No intra or extrahepatic biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 38 year-old female with history of breast cancer. ABDOMEN:LIVER, BILIARY TRACT: There is a T2 hyperintense lesion within segment 2 measuring 17 x 14 mm without contrast enhancement. There are several other subcentimeter cystic lesions with similar imaging characteristics noted throughout the liver parenchyma. No enhancing lesions are identified. No intrahepatic biliary ductal dilatation.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple bilobar hepatic lesions with imaging characteristics of benign cysts. No suspicious hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old. H/o dislocation R shoulder in 2012 with ongoing pain, acutely worse ROTATOR CUFF: There is a partial thickness articular surface tear of the supraspinatus tendon near its insertion, extending for approximately 15 mm in AP diameter and involving approximately 75% of the tendon thickness. No full-thickness tear is identified. There is no significant atrophy of the supraspinatus muscle. The infraspinatus, subscapularis, and teres minor tendons and muscles are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is unremarkable. No significant fluid is noted within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears intact. The articular cartilage is intact.BICEPS TENDON: The tendon of the long head of biceps is normal in course and morphology. ADDITIONAL

Output: 1.Partial thickness tear of the supraspinatus tendon as above.2.The glenoid labrum appears intact.


Instruction: Generate impression based on medical findings.

Input: 83-year-old man with right frontal contusion and left frontal epidural hematoma. Question extension of hematoma. There are bilateral, fluid-density subdural CSF collections. These appear slightly enlarged from previous studies, although the previous exam is suboptimal. The crescent shaped lesion in the left pterion region is isodense to the brain parenchyma and consistent with a meningioma -- this could be better evaluated with MRI. The lesion measures 1.5 x 0.8 cm (series 1430 image 12).There are periventricular regions of hypoattenuation consistent with age-indeterminate, small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The right frontal scalp hematoma is decreased in size from the prior study.

Output: 1. Bilateral subdural CSF collections with slight increase in size from previous study.2. Left pterion lesion consistent with meningioma.3. No CT evidence of epidural hematoma as questioned on requisition.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male with right-sided neck pain and right lower back pain. Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant disc bulge/herniation, spinal canal stenosis, or neuroforaminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a small right maxillary sinus retention cyst. There is a subcentimeter Thornwaldt cyst.Lumbar Spine: There is prominent lumbosacral epidural lipomatosis with substantial narrowing of the spinal canal at L4, L5, and throughout the sacrum. There are also disc bulges are noted at L4-5 and L5-S1, which contribute to the spinal canal narrowing. There is also mild bilateral neural foraminal narrowing at L4-5 and L5-S1. There is no significant spinal canal or neural foraminal narrowing at T12 through L4. There is no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged distal spinal cord and cauda equina are unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1.No spinal canal or neural foraminal stenosis in the cervical spine.2.Prominent lumbosacral epidural lipomatosis with substantial narrowing of the spinal canal at L4, L5, and throughout the sacrum. In addition, disc bulges are noted at L4-5 and L5-S1 contribute to the spinal canal narrowing and result in mild bilateral neural foraminal narrowing at L4-5 and L5-S1.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: 25 years, Female, headache. Also history of Legionnaire's disease. MRI BRAIN: There is extensive susceptibility effect involving multiple bilateral cortical veins as well as the superior sagittal sinus and bilateral transverse sinuses with areas of T1 hyperintensity consistent with venous thrombosis.There is no evidence of acute infarct. There are bilateral subdural fluid collections along the bilateral cerebral convexities as seen on recent CT with mild local mass effect, particularly along the right frontal convexity. Subdural fluid is also noted along the falx and tentorium. There is no midline shift or frank herniation, although there is mildly diminutive appearance of the ventricles and CSF cisterns which may be related to mild cerebral edema.No evidence of acute infarct. No intraparenchymal edema or hemorrhage. No parenchymal signal abnormality. There are minimal areas of apparent leptomeningeal enhancement such as at the left internal auditory canal which are nonspecific in this setting. No clear MRI evidence of intracranial infection.Paranasal sinuses and mastoid air cells are clear. Calvarium and intracranial soft tissues are grossly unremarkable.MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Patent anterior communicating and right posterior communicating artery. Left posterior communicating artery is not definitively seen which is normal variant.MRV HEAD: There is thrombosis involving the superior sagittal sinus as well as the proximal and mid aspects of the transverse sinus. The inferior sagittal sinus, very distal transverse sinuses, sigmoid sinuses, and visualized portions of the bilateral internal jugular veins appear patent. Internal cerebral veins, vein of Galen, basal veins of Rosenthal, and straight sinus are patent.

Output: 1. Extensive venous sinus thrombosis involving the entire superior sagittal sinus and majority of the bilateral transverse sinuses. The sigmoid sinuses and bilateral internal jugular veins are patent. There is also extensive thrombosis involving multiple cortical veins.2. There are bilateral subdural effusions which are nonspecific and are associated with mild local mass effect along the right frontal convexity. No findings to suggest empyema. There is mild dural enhancement which while may be related to the venous thrombosis, in association with the subdural effusions there is a possibility that this represents sequela of prior lumbar puncture. There are minimal apparent areas of leptomeningeal enhancement such as the left internal auditory canal which is nonspecific in the setting and may actually represent venous congestion. No definite MRI evidence of intracranial infection, but would suggest correlation with CSF analysis to better exclude infection.3. Suggestion of mildly diminished CSF spaces including the basilar cisterns and mildly diminished caliber of the ventricular system which may reflect mild cerebral edema. There is however no evidence of frank herniation.4. No evidence of parenchymal edema or parenchymal hemorrhage. Dr. Ali discussed findings with Dr. Thoburn at 1713 hrs on 8/3/2016.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Syncope and collapseClinical question: stenosisSigns and Symptoms: syncope MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate T2 and FLAIR hyperintense lesion is present in the right cerebellar hemisphere measuring approximately 7 mm in diameter. This could represent an old lacunar infarct.There are multiple punctate subcortical foci of susceptibility effect identified on susceptibility imaging. As a punctate focus of susceptibility present within the midbrain. Several foci of susceptibility effect are present in the cerebellar hemispheres.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the right posterior cerebral artery. The left posterior communicating artery is small. The right A1 segment is smaller than the left A1 segment. The pericallosal arteries are asymmetric in diameter. The left pericallosal artery is larger than the right pericallosal artery. The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery. The right vertebral artery is smaller than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is a mild degree of microhemorrhages distributed in predominantly subcortical white matter and also brainstem and cerebellum which do not have a specific pattern of distribution.4.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.5.Findings are compatible with old lacunar infarct in the right cerebellar hemisphere.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old, with history of non-small cell lung cancer with brain metastases, restaging examination. Faint punctate enhancing cortical foci are seen along the superior surface of the left superior temporal gyrus (see image 113 series 1202), and along the superior lateral right occipital lobe (see image 112 series 1202). These lesions were both larger and better visualized on the prior examination.No additional pathologic parenchymal enhancement is seen. However, there is a 12 mm homogeneously enhancing mass at the left cranial vertex which abuts the adjacent dura and the superior sagittal sinus with perhaps minimal ingrowth into the overlying calvarium. This lesion mildly displaces the underlying brain parenchyma but causes no edema. When compared to the prior examination, there has been no significant interval change.Scattered nonspecific foci of parenchymal T2 hyperintensity are unchanged. No evidence of significant parenchymal edema or mass effect is observed. Diffusion-weighted images are within normal limits. No intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits.

Output: 1.Two small foci of enhancement are vaguely perceived, one along the left superior temporal gyrus, and one in the superior lateral right occipital lobe. Both these lesions are smaller and more difficult to visualize than on the prior examination. This could reflect the effect of treatment and/or differences in technique.2.A homogeneously enhancing extra-axial mass at the left paramedian vertex is seen. The features of this lesion are most consistent with a meningioma. Metastatic disease would be much less likely, though continued attention on follow-up examinations is advised.3.No definite additional enhancing lesions are seen.


Instruction: Generate impression based on medical findings.

Input: History of HCV cirrhosis, HCC screening. ABDOMEN:LIVER, BILIARY TRACT: There is minimal enlargement of the caudate and left hepatic lobes as well as minimal nodular contour of the liver, suggestive of early cirrhosis.The liver demonstrates normal background parenchymal signal intensity and enhancement. The is redemonstration of T2 hyperintense lesions within hepatic segments 2 and 6, not significantly changed with reference measurements as below. The lesions demonstrate progressive filling in on more delayed images and most likely represent benign hemangiomas. There are couple peripheral areas of arterial enhancement within hepatic segment 7 without washout on more delayed images compatible with transient hepatic intensity differences. No suspicious focal hepatic lesions are identified.Status post cholecystectomy, metallic clips from which causes susceptibility artifact which somewhat obscures surrounding structures. There is mild intra and extra hepatic biliary ductal dilatation. The common bile duct measures up to 10 mm in diameter, slightly increased from prior. No bile duct stones or high-grade stenoses are identified.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal background parenchymal signal intensity and enhancement. There are several subcentimeter T2 hyperintense lesions within the pancreas which appear grossly similar to prior when accounting for differences in technique. The largest is in the uncinate process with reference measurements below.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/19/2016 13:00:00)HEPATIC SEGMENT 6 LESION: 1.1 x 0.6 cm (Image 14, Series 401); 1.1 x 0.7 cm on prior (8/19/2014) (Image 7, Series 5).HEPATIC SEGMENT 2 LESION: 1.1 x 0.9 cm (Image 33, Series 401); 1.1 x 0.9 cm on prior (8/19/2014) (Image 20, Series 5).PANCREAS UNCINATE PROCESS CYSTIC LESION: 0.4 cm (Image 10, Series 401); 0.4 cm on prior (8/19/2014) (Image 6, Series 5).

Output: 1.Mild cirrhotic liver morphology.2.Unchanged segment 2 and 6 hepatic lesion compatible with hemangiomas. No suspicious focal hepatic lesions are identified.3.Several subcentimeter cystic structures within the pancreas which most likely represent side branch IPMNs and can be followed on subsequent examinations.4.Status post cholecystectomy with associated mild dilation of the common bile duct.


Instruction: Generate impression based on medical findings.

Input: Reason: cuff tear; prior repair History: pain ROTATOR CUFF: 4 suture anchors are identified within the greater tuberosity presumably related to prior rotator cuff repair. There is a full-thickness tear of the supraspinatus with retraction to the level of the superior aspect of the humeral head, measuring approximately 1.4 cm in the AP dimension. There is associated delamination which extends proximally along the proximal tendon fragment. There is fatty atrophy of the supraspinatus.There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is mild fatty atrophy of the infraspinatus.The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small to moderate amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Linear increased signal abnormality traverses the anterior inferior labrum indicating degeneration with probable degenerative tearing. There is thinning of the articular cartilage along the humeral head.BICEPS TENDON: The intra-articular portion of the long head of the biceps tendon is poorly visualized indicating a full-thickness tear at the level of its transition from the bicipital groove to the rotator interval.ADDITIONAL

Output: 1. Postoperative changes of prior rotator cuff repair. There is a full-thickness tear of the supraspinatus with delamination as described above.2. Full-thickness tear of the tendon of the long head of the biceps at the level of its transition from the bicipital groove to the rotator interval.


Instruction: Generate impression based on medical findings.

Input: Right amydohippoampal laser ablation in January: 3 month follow up.. There is encephalomalacia and peripheral linear hemosiderin staining associated with the laser ablation zone involving the medial portions of the right hippocampus and posterior amygdala. There is also mild linear T2 hyperintensity along the right transfrontal prior probe track. The left hippocampus appears unremarkable. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Expected postoperative findings related to right amydohippoampal laser ablation.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old, with history of pituitary lesion, noted to be hypermetabolic on the prior PET scan. A mildly T2 hyperintense, mildly hypoenhancing lesion within the left aspect of the sella turcica is redemonstrated showing no significant interval change in size. The lesion measures up to 10 mm in diameter. No significant encroachment upon the suprasellar cistern is seen. The pituitary stalk deviates slightly towards the right. The cavernous sinuses and visualized optic apparatus are unremarkable. Mild paranasal sinus inflammation is seen.

Output: Stable lesion within the left sella turcica which could represent an adenoma.


Instruction: Generate impression based on medical findings.

Input: Neck pain, evaluate for myelopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis with mild kyphosis at the C5-C6 level. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine with multilevel disc desiccation and significant disc height loss at the C5-C6 and C6-C7 levels. Individual levels as 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: No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex and ligamentum flavum flavum thickening resulting in mild to moderate spinal canal stenosis at this level. There is prominent uncovertebral hypertrophy at this level resulting in severe left and moderate to severe right neural foraminal stenosis.C6-7: There is a disc osteophyte complex which effaces the ventral thecal sac and results in mild spinal canal stenosis. There is severe left and moderate to severe right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina. Bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative changes in the cervical spine particularly at the C5-C6 and C6-C7 levels. There is associated mild to moderate spinal canal stenosis. No cord signal abnormality. There is also prominent uncovertebral hypertrophy with significant neural foraminal stenoses bilaterally at these levels.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with metastatic prostate cancer and known thoracic involvement. Rule-out cord compression. Exam limited by motion.Within these limitations, the vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. There is diffuse abnormal bone marrow signal intensity throughout the spine and there is involvement of the vertebral bodies and pedicles. There is evidence of extra-osseous spread, worse from T3 to T8 which causes spinal canal narrowing and is described in more detail on the accompanying same day dedicated thoracic spine MRI.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Diffuse spinal osseous metastases and extraosseous spread, most severe in the thoracic spine, which is more fully characterized on the accompanying dedicated thoracic MRI.


Instruction: Generate impression based on medical findings.

Input: HCC screening. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There are numerous varices/collateral vessels. There is evidence of cavernous transformation of the portal vein and recanalization. No lesions suspicious for hepatocellular carcinoma. Cholelithiasis is again noted. There is also a stone in the distal common bile duct.SPLEEN: Severe splenomegaly.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No lesions suspicious for hepatocellular carcinoma.2.Choledocholithiasis.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other disorders of meninges, not elsewhere classifiedClinical question: biopsy of cervical massSigns and Symptoms: RUE weakness/numbness Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the prevertebral lesion. Following needle removal images were obtained that demonstrate no complications.

Output: 1.T4 prevertebral and paravertebral biopsy and aspiration. Purulent material was aspirated. Biopsies were also obtained. 2.Touch preps from each specimen were obtained and analyzed by cytopathologist who was present throughout the procedure. They suggested this represents inflammation with possible granuloma.


Instruction: Generate impression based on medical findings.

Input: 85 year old with history of atrial fibrillation, hypertension and heart failure presenting for evaluation of etiology of heart failure. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. There is basal septal hypertrophy and concentric left ventricular hypertrophy. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 157 ml (normal range 109+/-23), the LV end systolic volume index is 53 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10), the LV mass index is 60 g/m2 (normal range 67+/-11), and the LV mass is 99 g (normal range 114+/-24). The left ventricular systolic dysfunction is global.There is late gadolinium enhancement at the basal to mid septum (on right ventricular side), subendocardial basal lateral wall, subendocardial apical septum and transmural at the apex. The differential diagnosis includes prior myocarditis from inflammation or sarcoidosis. This distribution is atypical for amyloidosis. Although the majority of the enhancement is subendocardial, it does consistently follow a pattern for infarct. No intracardiac thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 114 ml/m2 (normal range 69+/-14), the RVEDV is 187 ml (normal range 110+/-24), the RV end systolic volume index is 78 ml/m2 (normal range 22+/-8), and the RVESV is 129 ml (normal range 35+/-13). No enhancement.Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation. There is mild thickening of anterior leaflet of the mitral valve. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no significant pericardial effusion.Extracardiac Findings:There is a trace right pleural effusion and small left pleural effusion.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%. Enhancement pattern that is suspicious for prior inflammation from myocarditis or infiltrative process such as sarcoidosis. It is atypical for amyloidosis or embolic infarcts.2. The right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 31%


Instruction: Generate impression based on medical findings.

Input: Reason: posterior fossa stroke History: left sided dysmetria, ataxia The CSF spaces are appropriate for the patient's stated age with no midline shift. On T2 and MRI there are subcentimeter in size foci of T2 and flair signal hyperintensity in the left centrum semiovale as well as the left inferior frontal gyrus subcortical white matter. Additionally there are several punctate subcortical and periventricular white matter lesions in the right and left hemispheres which are hyperintense on T2 and flair MRI.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. Findings suggest a bilateral fetal origins of the posterior cerebral arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no MRI evidence for acute ischemic cerebral infarction.2.A couple lesions present in the left centrum semiovale and subcortical white matter of the left frontal lobe which are nonspecific. Etiology cannot be established on this exam. Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. 3.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: 76 year old man with prior PCI to LCx and RCA, referred for evaluation of chest tightness.MEDICATIONS: ASA, Lipitor First Pass PerfusionDuring hyperemia, no perfusion defects were present. There is a prominent dark rim artifact noted.Viability/ Myocardial ScarThere is a small area of late gadolinium enhancement in the basal inferolateral wall. It is mid myocardial and not consistent with prior myocardial infarction. It may be due to a prior fibrotic, inflammatory, or infiltrative process. It appears similar to prior cardiac MRI on 7/8/14. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 63 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 45 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. The interatrial septum is aneurysmal. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 120 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 59 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 51%).5. There is a small area of late gadolinium enhancement in the basal inferolateral wall. It is not consistent with prior myocardial infarction and may be due to a prior fibrotic, inflammatory, or infiltrative process. 6. Compared to prior MRI on 7/8/14, there is no significant change.


Instruction: Generate impression based on medical findings.

Input: 56 year old man with asymmetric septal hypertrophy referred to evaluate for etiology. Left VentricleThe left ventricle is normal in size with normal systolic function. The is asymmetric hypertrophy of the interventricular septum. The maximum wall thickness is at the mid anteroseptum and is 19mm. The posterior wall thickness is 7mm. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 166 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 66 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a patch of endocardial non-transmural late gadolinium enhancement involving the basal anteroseptum. The pattern is somewhat atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. No evidence of systolic anterior motion of the mitral leaflets. 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 pseudobovine 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 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 asymmetric hypertrophy of the left ventricle with normal systolic function (LVEF 58%). The maximum wall thickness is 19mm. There is a small burden of atypical late gadolinium enhancement in the basal anteroseptum consistent with the presence of underlying myocardial fibrosis, inflammation, or infiltration. Taken together, these findings are most consistent with the diagnosis of hypertrophic cardiomyopathy. 2. Normal right ventricular size and systolic function (RVEF 60%).3. No evidence of systolic anterior mitral annular motion or left ventricular outflow obstruction.4. Mild biatrial dilation.


Instruction: Generate impression based on medical findings.

Input: Right hip pain ACETABULAR LABRUM: There is a defect along the undersurface of the anterior superior labrum indicating an undersurface tear, which on the radial sequence may extend through the width of the labrum. The defect is estimated to extend from the 1:00 to 4:00 position anteriorly.ARTICULAR CARTILAGE AND BONE: There are no articular cartilage defects and the bone marrow signal is normal with no evidence of stress fracture. There is slight prominence of the anterior superior aspect of the femoral head neck junction suggesting a mild cam deformity. The alpha angle is borderline at 55 degrees.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior labral tear as described above. There is no evidence of a stress fracture.


Instruction: Generate impression based on medical findings.

Input: 81 year old female patient with right-sided visual field deficit, visual hallucinations. Question of stroke. BRAIN: There is extensive encephalomalacia involving the right frontal, parietal, and temporal lobes as well as the right basal ganglia with associated ex-vacuo dilatation of the right lateral ventricle. Surrounding susceptibility artifact within this area likely represents chronic blood products. There is Wallerian degeneration of the right pons and right cerebral peduncle. There is a focus of diffusion restriction within the region of the motor cortex within the right precentral gyrus without definite evidence of ADC restriction; this could be artifactual or represent a small ischemic lesion. Otherwise, there is no diffusion-weighted abnormalities to suggest acute ischemia. There is extensive subcortical and periventricular abnormal T2 signal within the right cerebral hemisphere and mild T2 signal abnormality within the left cerebral hemisphere consistent with chronic small vessel ischemic disease. There is no midline shift or herniation. There is attenuation of the M1 segment of the right middle cerebral artery flow void. There is fluid in the left mastoid air cells. ORBITS: The bilateral globes and ocular adnexa are unremarkable, other than bilateral lens implants. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. Extensive right cerebral hemispheric encephalomalacia in the distribution of the right middle cerebral artery.2. A focus of diffusion restriction within the right precentral gyrus without definite evidence of ADC restriction; this could be artifactual or represent a small ischemic lesion.3. Chronic small vessel ischemic disease. 4. Unremarkable examination of the bilateral orbits.


Instruction: Generate impression based on medical findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: Pt with history of CVA and residual right sided deficits, evaluate for possible worsening History: as above Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is slit like tissue defect on the left basal ganglia in particular putamen with susceptibility artifacts indicate chronic hemorrhagic infarction, no change since prior scan.Non specific small vessel ischemic changes on bilateral periventricular white matter, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree intracranial and extracranial arterial luminal stenosis were seen.In particular, the left MCA proximal M1 segment just beyond the the left ICA bifurcation shows more than 70% luminal stenosis. The right ICA cavernous sinus segment and the right MCA proximal M1 segment also show about 50% luminal narrowing.Comparing to prior scan, the left MCA M1 segment luminal narrowing appears to be slightly progressed but the right ICA cavernous sinus segment showed slightly improved since prior scan. Due to inherent technical issue, the degree of luminal stenosis progression of internal carotid artery cannot be reliably compared especially with TOF MRA technique. Therefore, if clinically indicated CTA should be considered. Bilateral extracranial ICA at the junction of cervical segment and carotid canal segment shows more than 50% luminal stenosis. Vertebrobasilar system appears to be slightly ectatic in luminal diameter and irregular lumen without evidence of luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of chronic hemorrhagic infarction on the left basal ganglia and non specific small vessel disease since prior scan.3. More than 70% stenosis of the left MCA proximal M1 segment stenosis and about 50% stenosis of the right ICA cavernous sinus segment and bilateral extracranial ICA at the junction of cervical segment and carotid canal segment. CTA of head and neck can be considered for further evaluation if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Adenoid cystic carcinoma of the right pterygopalatine fossa with right V2 numbness treated with chemoradiation. There is unchanged enhancing tumor within the right cavernous sinus extending from the right foramen rotundum and pterygopalatine fossa, measuring up to 5 mm in width. The skull base and adjacent internal carotid artery flow voids are otherwise intact. Likewise, the Meckel caves and cisternal trigeminal nerves are intact. There is no evidence of acute infarction or midline shift. The ventricles are normal in size and configuration. There is moderate mucosal thickening and fluid in the right maxillary sinus, mild mucosal thickening in the left maxillary sinus, and secretions in the nasal cavity. There is fluid signal within the bilateral mastoid air cells. There are scattered foci of T2 hyperintensity in the cerebral white matter.

Output: 1. Unchanged treated perineural tumor involving the second division of the right trigeminal nerve with extension in the cavernous sinus.2. Findings suggestive of acute rhinosinusitis.


Instruction: Generate impression based on medical findings.

Input: Images are motion degraded. Given this caveat:There is slight reversal of normal upper cervical curvature.. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no abnormal enhancement.C2/3: UnremarkableC3/4: Mild posterior osteophyte disc complex and bilateral uncinate hypertrophy without significant resulting stenosis.C4/5: Posterior osteophyte disc complex and left uncinate hypertrophy results in moderate left neural foraminal stenosis.C5/6: Posterior osteophyte disc complex asymmetric to the right causes right anterior hemicord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy (right greater than left). Overall there is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe bilateral neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C4/5: Moderate left neural foraminal stenosis.2.C5/6: Mild central and severe bilateral neural foraminal stenosis.3.C6/7: Moderate to severe bilateral neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Backache, numbness in right leg and left shoulder pain. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column.Normal stimuli thoracic spine and thoracic cord is unremarkable. T11 -- T12 is unremarkable.T12 -- T11 demonstrate mild disk disease and unremarkable otherwise.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease and mild bilateral ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however moderate right neural foraminal compromise is noted.L4 -- 5 demonstrate advanced disk disease with significant loss of disk height, moderate to significant left and moderate right facet and ligamentum flavum hypertrophy is present. Constellation of changes results in mild central spinal stenosis and moderate bilateral (left greater than right) neural foraminal compromise.L5 -- S1 demonstrate mild degenerative changes and unremarkable otherwise.

Output: 1.Degenerative changes of disk and the posterior elements at L4 -- L5 with mild central spinal stenosis and moderate (L>R) neural foraminal compromise as detailed.2.Degenerative changes at the L3 -- L4 results in moderate right neural foraminal compromise.3.Minimal degenerative changes at other levels however without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with history of multiple sclerosis who presents with bilateral leg weakness. There are numerous, greater than 10, patchy T2 hyperintense white matter lesions scattered throughout the subcortical and deep cerebral periventricular white matter in addition to the basal ganglia, midbrain, peripheral pons, and cerebellar peduncles and hemispheres. There is no evidence of enhancing lesions or any areas of restricted diffusion. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. The major intracranial vascular flow voids appear to be intact. There is mild left maxillary sinus mucosal thickening. The mastoid air cells are unremarkable. The orbits are unremarkable.

Output: Findings compatible with multiple sclerosis in the supratentorial and infratentorial regions without evidence of enhancing lesions or restricted diffusion to suggest active demyelination.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: 57 years, Female, Reason: 57F with dilated pancreatic duct and side branches. Please evaluate for nodules, masses using secretin protocol History: dilated duct. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Right hepatic lobe T2 hyperintensity likely represents cysts. There is a 8mm lesion in the left hepatic lobe which is dark on all sequences and likely represents calcification. Bile duct is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: No suspicious pancreatic lesions.Pancreatic duct is ectatic and dilated within the body and tail to 1.7 cm, consistent with a main duct IPMN. No enhancing component is evident. No obstructing lesions are present. There is a blunted response to secretin. Attenuation within the pancreatic parenchyma is normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Debris within the bladder.

Output: Findings consistent with a main duct IPMN.


Instruction: Generate impression based on medical findings.

Input: Left renal complex cyst. ABDOMEN:LIVER, BILIARY TRACT: Normal morphology without a focal lesion or biliary ductal dilatation. Normally distended gallbladder.SPLEEN: T2 hyperintense splenic septated cystic nonenhancing lesion is unchanged, most likely benign.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst with minimal proteinaceous/hemorrhagic components. Exophytic left renal inferior pole intrinsically T1 hyperintense lobular lesion measures 2.1 x 1.4 cm, essentially unchanged in size. Accounting for subtraction misregistration artifact there is no significant postcontrast enhancement.There is a smaller likely proteinaceous/hemorrhagic cyst in the superior pole of the left kidney measuring 1.1 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable hemorrhagic/proteinaceous cysts in the left kidney.


Instruction: Generate impression based on medical findings.

Input: Sacral dimple with ultrasound showing possible tethered cord when she was a newborn. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved and there is no gross dysraphism. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There may be trace fluid within the inferior central canal of the spinal cord. The imaged portion of the spinal cord otherwise appears unremarkable and appears to shift anteriorly in the prone position. The conus medullaris is situated at the L1-2 level. There is no evidence of filar fibrolipoma. The paravertebral soft tissues are unremarkable.

Output: Possible trace partially imaged ventriculus terminalis. Otherwise, no evidence of gross lumbosacral spine anomalies.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old with right shoulder pain and limited range of motion. Evaluate for rotator cuff tear, labral tear, adhesive capsulitis. ROTATOR CUFF: There is thinning of the supraspinatus tendon just proximal to its insertion with irregularity of the undersurface fibers indicating partial thickness tearing involving less than 50% of the tendon thickness. Although we see no discrete full-thickness tear, there is mild diffuse increased signal intensity within the distal 1 cm supraspinatus tendon anteriorly with a small amount of gadolinium in the overlying subdeltoid bursa suggesting a full-thickness perforation of the tendon that is below the resolution of this study. We see no tendon retraction. The supraspinatus muscle appears normal. The infraspinatus, teres minor and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. Again seen is a small amount of gadolinium in the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There may be a tiny articular cartilage defect along the anterior glenoid but this is equivocal. We see no labral tear.BICEPS TENDON: The tendon of the long head of the biceps is perhaps slightly perched on the lesser tubercle but otherwise appears normal. ADDITIONAL

Output: 1.Although we see no discrete full-thickness rotator cuff tear, increased signal intensity in the distal supraspinatus tendon along with gadolinium in the subdeltoid bursa suggests a perforation that is beneath the resolution of this study. There is also partial-thickness tearing of the undersurface supraspinatus tendon fibers more proximally.2.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: NSCLC. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases. A few scattered cerebral white matter T2 hyperintense foci are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 33 years Female (DOB:9/1/1982)Reason: CCM yearly surveillance History: yearly surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. A small focus of signal loss is present in the left paracentral lobule adjacent to the marginal ramus of the cingulate sulcus measuring several millimeters in size. It appears be associated with a very small developmental venous anomaly. It is unchanged since the prior exam.Multiple foci of signal loss and susceptibility weighted imaging are present with the lesions identified in the subcortical white matter of the frontal lobes, parietal lobes and right cerebellar hemisphere. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A lesion in the left paracentral lobule suspicious for a cerebral cavernous malformation is stable compared to the prior exam.2.There are multiple punctate lesions in the subcortical white matter which were also present on the prior exam and are nonspecific and too small to characterize further. It is conceivable that these are related to cavernoma or microhemorrhages from other cause.


Instruction: Generate impression based on medical findings.

Input: 54 year old female with interstitial lung disease, rheumatoid arthritis, pre-lung transplant evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced global systolic function. The overall LV ejection fraction is 50%. The LVEDV is 113 ml (normal range 109+/-23), LV end diastolic volume index is 60 ml/m2 (normal range: 65+/-11), LVESV is 57 ml (normal range 31+/-10), and LV end systolic volume index is 30 ml/m2 (normal range 18+/-5). The LV mass is 95 g (normal range 114+/-24) and the LV mass index is 50 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 146 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild to moderate aortic regurgitation.Sinus of Valsalva: 28 x 28 x 27mm.Sinotubular Junction: 19mm Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.MPA 29.5mm.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 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.Mild to moderate aortic valve regurgitation2.Normal sized left ventricle with mildly reduced systolic function (LVEF 50%).3.Normal sized right ventricle with normal systolic function (RVEF 51%).4.Mild dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Epilepsy, depth electrode planning. There is possible focal volume loss and T2 hyperintensity in the medial right temporal lobe. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable, including a prominent right occipital arachnoid granulation. There is mucosal thickening in the right anterior ethmoid and frontal sinuses.

Output: Preoperative planning MRI demonstrates probable right medial temporal sclerosis.


Instruction: Generate impression based on medical findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 31 seconds

Output: Successful fluoroscopic left hip arthrogram injection.


Instruction: Generate impression based on medical findings.

Input: Ms. Strug is a 46 year old female with biopsy proven DCIS of the left breast. She presents for MR imaging for further evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Spanning the entire left upper outer breast are multiple enhancing masses/clumped non-mass enhancement with suspicious appearance and kinetics. The total span of enhancement measures approximately 5.1 x 2.0 x 4.9 cm (AP x ML x SI). The total AP extent on the sagittal view is approximately 6.3 cm. At the mid-depth of this enhancement is the area of biopsy proven DCIS with susceptibility artifact from biopsy marker clip. At the posterior most extent of this abnormal enhancement is a spiculated enhancing mass measuring 2.1 x 1.9 x 1.6 cm. At the anterior most extent of this abnormal enhancement is an area of clumped nonmass enhancement measuring 1.5 x 0.8 x 1.1 cm, approaching to within 1 cm of the left nipple base.In the right medial breast, there are two enhancing foci/masses identified measuring approximately 0.5 and 0.8 cm respectively. These two enhancing areas do have a more benign appearance with non-suspicious kinetics. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Abnormal enhancement spanning the entire left upper outer breast, suspicious for additional disease than what was initially mammographically detected. Additional workup, including MR-directed ultrasound, can be performed targeting the anterior and posterior most extent of suspected disease. If found, additional biopsies with clip placement can be performed as clinically warranted.(2) Two enhancing foci/masses with benign morphology in the right breast for which MR-directed ultrasound can be performed. If no corresponding sonographic correlate is identified, then a short term 6 month MRI follow-up can be performed to confirm stability of these findings.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Contrast rapidly opacified the radiocarpal joint. Upon flexion of the wrist, contrast also opacified the distal radioulnar joint via a tear in the articular disc of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for further information.Exposure time: One minute 33 seconds

Output: Tear of the articular disc of the triangular fibrocartilage complex


Instruction: Generate impression based on medical findings.

Input: MRI findings: Extensive areas of restricted diffusion in the bilateral medial temporal lobes, right more than the left occipital lobe, left more than the right cerebellum, midbrain and pons compatible with acute infarction. There is T2 hyperintensity and encephalomalacia in the left inferior cerebellum, left occipital lobe and pons compatible with chronic infarcts. There is mild periventricular white matter hyperintensity related to chronic small vessel ischemic disease. No evidence of susceptibility foci are evident.There is mild global parenchymal volume loss. No evidence of mass effect or midline shift. The basal cisterns remain patent. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. MRA head findings: Please note this is motion degraded exam as well as technically limited. The intracranial internal carotid arteries are normal in course and caliber. The anterior and middle cerebral arteries show flow related signal with some wall irregularity but without hemodynamically significant stenosis or occlusion. The left vertebral artery is not opacified. The right vertebral artery is diminutive beyond the proximal V4 segment. The basilar artery is not visualized. The posterior cerebral arteries are also not visualized. Bilateral PCOM arteries appear to be present but they do not apparently compensate for the vertebrobasilar abnormalities.MRA neck findings: The common carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. There is some narrowing at the carotid bifurcations but without high-grade stenosis or occlusion.Bilateral vertebral arteries are poorly visualized which may be technical or could be related to atherosclerotic disease.

Output: 1. Extensive areas of acute infarction involving the bilateral medial temporal lobes, right more than the left occipital lobe, left more than the right cerebellum, midbrain and pons.2. Lack of flow in the vertebrobasilar circulation compatible with severe stenosis or occlusion.3. No significant vaso-occlusive disease in the anterior circulation.Above findings were discussed with Dr Warnecke at 10:30 hours on 12/21/2015.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with elevated LFTs, ANA positive. Evaluate for biliary stricture, dilatation, or underlying hepatic etiology. ABDOMEN:LIVER, BILIARY TRACT: Suspected flash-filling hemangioma of hepatic segment 8/5 (series 10013 image 231). Otherwise, normal hepatic parenchyma. Patent vasculature. No intra or extrahepatic biliary ductal dilatation. The gallbladder is collapsed, and the 3 mm suspected polyp noted on the prior ultrasound is not clearly visualized.SPLEEN: No significant abnormality noted.PANCREAS: Normal parenchymal enhancement. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Normal caliber of the biliary tree. No evidence for biliary stricture.2.Flash-filling hemangioma of hepatic segment 8/5.


Instruction: Generate impression based on medical findings.

Input: 62 year od man referred for evaluation of infiltrative disease. Left VentricleThe left ventricle is severely hypertrophied and dilated with severely reduced systolic function. The IVSd=17mm. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 182 ml/m2 (normal range: 74+/-15), the LVEDV is 393 ml (normal range 142+/-34), the LV end systolic volume index is 129 ml/m2 (normal range 25+/-9), the LVESV is 278 ml (normal range 47+/-19), the LV mass index is 155 g/m2 (normal range 85+/-15), and the LV mass is 335 g (normal range 164+/-36). There is global hypokinesis which is most pronounced along the basal to mid inferior wall. The native myocardial T1 relaxation time is moderate to severely elevated along the basal anterior, mid anterior and anteroseptal, and apical anterior, septal, and lateral walls. No evidence of myocardial iron overload. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 197 ml/m2 (normal range 82+/-16), the RVEDV is 426 ml (normal range 142+/-31), the RV end systolic volume index is 140 ml/m2 (normal range 31+/-9), and the RVESV is 302 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. A catheter is noted in the SVC.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is significant thyromegaly. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LVH with severe LV dilation and severely reduced systolic function (LVEF 29%). 2. The native myocardial T1 relaxation time is moderate to severely elevated, which supports the presence of significant myocardial fibrosis or infiltration. 3. Severe RV dilation with severely reduced systolic function (RVEF 29%).4. Severe biatrial dilation.5. Mild to moderate mitral and tricuspid regurgitation.6. Moderate dilation of main pulmonary artery.7. Small pericardial effusion.8. Significant thyroid enlargement. 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: New tiny a lesion on MRI. Concern for arteriovenous malformation. Evaluate for arteriovenous malformation. Signs and symptoms: Neck pain/stiffness/headaches. Non-enhanced CT of brain:Examination demonstrate no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Previously noted mildly enhancing cranial mass is not identified on this exam. There was no evidence of arteriovenous malformation malformation on prior MRI exam or the current CT.Calvarium is intact.Mastoid air cells, middle ear cavities and limited view of the paranasal sinuses are within normal.CTA of intracranial circulation:Right internal carotid is well visualized across the skull base and through the cavernous sinus with no abnormality. Supraclinoid right internal carotid artery, right posterior communicating artery, right anterior and middle cerebral arteries and their branches are within normal limits.Left internal carotid is well visualized and unremarkable in its cavernous and supraclinoid portion. There is normal visualization of a small posterior communicating artery. The anterior and middle cerebral arteries are within normal limits. There is anatomical variation of hypoplastic left A1. There is no evidence of arteriovenous malformation.Vertebral basilar system, there is normal visualization of bilateral intracranial vertebral arteries. Normal appearing right pica is identified. There is no visualization of the left pica. Basilar artery, superior cerebellar arteries and posterior cerebral arteries are well visualized and within normal limits. There is no detectable arteriovenous malformation as clinically questioned. The findings in the pineal region noted on prior MRI is not consistent with an arteriovenous malformation and it represents a mass.65 cc of Omnipaque 350 is administered for above study.

Output: 1.Negative non-enhanced CT of brain. 2.Previously noted less than one CM mass in the pineal region is not identified on this non-infused head CT.3.No evidence of arteriovenous malformation on this CTA or prior MRI exam.4.Negative CTA of intracranial circulation.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. No arterially enhancing lesions with washout are identified. Transient hepatic intensity differences are noted on the arterial phase only. Cholelithiasis without evidence for acute cholecystitis.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Cirrhotic morphology.2. No suspicious hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Follow-up of post op meningitis and possible sellar abscess after transphenoidal hypophysectomy.. There are postoperative findings related to transsphenoidal surgery. There is no residual fluid collection in the sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no residual abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is scattered paranasal sinus mucosal thickening, particularly in the sphenoid sinuses.

Output: No evidence of residual fluid collection in the sella or stigmata of meningitis.


Instruction: Generate impression based on medical findings.

Input: Please note lack of contrast limits evaluation, especially for leptomeningeal metastatic disease. On the sagittal counter series, note is made of extensive, expansile T2 signal involving the brainstem, better characterized on MRI brain dated 1/30/2016.Thoracic spine:No discrete mass within the thoracic spinal canal is appreciated. Apparent region of low T1 signal in the dorsal epidural region of the thoracic spine is favored to represent artifact related to motion degradation. The alignment of the thoracic spine is anatomic. The vertebral body heights and intervertebral disc spaces are preserved. There is no abnormal bone marrow signal. There is no evidence of spinal canal stenosis or significant neural foraminal narrowing. The cord is normal in signal and caliber. There are multiple T2 hyperintense lesions involving several neural foramina, intercostal nerves, and posterior subcutaneous soft tissues most consistent with neurofibromas. No intraspinal extension. Lumbar spine:The alignment of the lumbar spine is anatomic. The vertebral body heights and intervertebral disc spaces are preserved. There is no abnormal bone marrow signal. There is no evidence of spinal canal stenosis or significant neural foraminal narrowing. The cord is normal in signal and caliber. There are multiple T2 hyperintense lesions involving the bilateral neural foramina and posterior subcutaneous tissues which are most consistent with neurofibromas. No intraspinal extension. Neurofibromas involving the lumbosacral plexus are also noted.

Output: 1. Please note patient could not tolerate the study including the post contrast sequences. Evaluation for leptomeningeal metastatic disease is severely limited by lack of intravenous contrast.2. No abnormal cord signal or intraspinal mass within the limits on noncontrast study.3. Numerous T2 hyperintense lesions involving several neural foramina in the thoracolumbar spine, intercostal spaces, and the posterior subcutaneous tissues compatible with multiple neurofibromas.


Instruction: Generate impression based on medical findings.

Input: 39-year-old female with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. There is focal low attenuation in the left basal ganglia, which may represent a prior lacunar infarction or perivascular space. Further evaluation with MRI may be considered if clinically indicated. There is diffuse parenchymal volume loss.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Focal low attenuation in the left basal ganglia may represent prior lacunar infarction or perivascular space. If stroke is clinically suspected, MRI may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 58 years Female (DOB:3/5/1958)Reason: primary CNS lymphoma s/p treatment History: please compare with previous MRI in the systemPROVIDER/ATTENDING NAME: CHADI NABHAN CHADI NABHAN The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post burr hole placement along the left parietal calvarium for a previous left parietal lobe stereotactic biopsy.There is confluent signal change present within the left periventricular subcortical white matter centered in the left parietal lobe which has extended further compared to the prior exam. The area involved canal measures 60 x 27 mm axial dimensions and previously measured 47 x 20 mm axial dimensions. There is no associated contrast enhancement. There is susceptibility effect within the left parietal lobe in the location where there was a ring-enhancing lesion on the 9/4/2015 exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR punctate hyperintense foci present in the range stem, internal capsules and deep gray nuclei.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam, white matter changes associated with a left parietal lesion have extended further. It is conceivable that this white matter change is related to posttreatment change.2.No enhancing mass lesion is appreciated intracranially to suggest recurrence of the lymphoma.3.Periventricular and subcortical white matter lesions as well as punctate lesions in the deep gray nuclei and brainstem are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with pain in thigh when walking. Assess for lumbar stenosis/radiculopathy There is grade 1 anterolisthesis of L4 on L5. Alignment of the lumbar spine is otherwise maintained. Small Schmorl's nodes are noted at the endplates at multiple levels. There are mild anterior wedging of T11 and T12 which may be physiologic. Vertebral body heights are otherwise maintained. There is no suspicious marrow signal. Conus is in normal position and demonstrates normal signal. There are multilevel degenerative changes, individual levels as below:At T11-T12, there is no significant narrowing of the spinal canal or neural foraminal narrowing. At T12-L1, there is no significant narrowing of the spinal canal or neural foraminal narrowing.At L1-L2, there is mild disc bulge, ligamentum flavum thickening, and mild facet arthropathy resulting in mild spinal canal stenosis. No significant neural foraminal stenosis. At L2-L3, there is no significant narrowing of the spinal canal or neural foraminal narrowing.At L3-L4, there is a mild spinal canal stenosis related to mild disc bulge, facet arthropathy, and prominence of the epidural fat. There is no significant right neural foraminal narrowing. There is mild left neural foraminal narrowing.At L4-L5, there is grade 1 anterolisthesis with disc uncovering and mild bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening resulting in moderate spinal canal stenosis. There is mild bilateral neural foraminal stenosis.At L5-S1, there is a minimal disc bulge with no significant narrowing of the spinal canal or neural foraminal narrowing.There are bilateral T2 hyperintense lesions involving the kidneys likely representing cysts.

Output: Moderate degenerative changes in the lumbar spine, worst at the L4-L5 level where there is advanced facet arthropathy, grade 1 anterolisthesis, and disc bulge with resulting moderate spinal canal stenosis. Relatively mild neural foraminal narrowing at L4-L5 bilaterally and on the left at L3-L4.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: Metastatic cervical cancer. Evaluate for brain metastases. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable without abnormal enhancement. 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: No evidence of abnormal intracranial enhancement to suggest metastases.


Instruction: Generate impression based on medical findings.

Input: Newly diagnosed polycythemia vera with new numbness/tingling on the right side of her face. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a small developmental venous anomaly in the right posterior cingulate gyrus, Otherwise, 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: No evidence of intracranial hemorrhage, mass, or acute infarct.