Instruction: Generate impression based on medical findings.

Input: 64-year-old male with cachexia and bright red blood per rectum. Evaluate for malignancy and also for pancreatic pseudocyst; patient has experienced weight loss. ABDOMEN: LUNG BASES: New small bilateral pleural effusions with associated lower lobe volume loss bilaterally. Cachexia.LIVER, BILIARY TRACT: Hepatomegaly, the liver measures more than 20 cm craniocaudally. Diffuse fatty infiltration throughout the liver. The presence of fat limits the ability to see liver masses. If liver masses are of concern, MRI examination would be recommended. Heterogeneous soft tissue density is seen in the lateral segment of left lobe and in the right lobe described on the previous examination are most likely due to focal sparing from fat deposition due to lack of displacement of vessels.Gallstones and biliary sludge are present. No gallbladder wall thickening. No intrahepatic or extrahepatic biliary duct dilatation. Multiple subcentimeter hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: Punctate focal calcification in the head of the pancreas. These were not present on 2008 examination and may be the sequela of pancreatitis. Pancreatic parenchyma otherwise appears normal with no mass is identified. No pancreatic ductal dilatation is seen.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. Subcentimeter left lower pole renal cortical hypodensity is most likely due to a simple cyst..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osteopenia without focal mass. Degenerative changes throughout the lumbar spine.OTHER: Small amount of ascites is new.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A large soft tissue mass protrudes from the anus measuring 3 cm in diameter at coronal image 16/74. This may be due to rectal prolapse or prominent external hemorrhoids or both. The marked contrast enhancement most likely represents inflammatory change and possible bleeding focus in this mass.BONES, SOFT TISSUES: Bony ankylosis of the sacroiliac joints. Degenerative changes in the lumbosacral spine and pelvis.OTHER: Small amount of ascites is present.

Output: 1. Hepatomegaly. Diffuse fatty infiltration of the liver. 2. Gallstones and biliary sludge without acute cholecystitis. 3. New bilateral pleural effusions and small amount of ascites have developed since the prior exam. 4. Rectal prolapse and/or external hemorrhoids are probable source of melena. See above.


Instruction: Generate impression based on medical findings.

Input: Knee pain. Due to the patient's large body habitus, a knee coil could not be used. An alternative coil was used instead, resulting in suboptimal image quality.MENISCI: Mild intrasubstance signal intensity within both menisci suggests degeneration, but I see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is mild to moderate thinning of the articular cartilage of the lateral facet of the patella, with a near-full-thickness cartilage cleft noted in the median eminence. There is mild thinning of the articular cartilage of the medial facet of the femoral trochlea as well as focal near-full-thickness to full-thickness degeneration of the articular cartilage along the lateral facet. Small patellofemoral subchondral cysts are also noted. There is focal near-full-thickness to full-thickness cartilage degeneration along the weightbearing portion of the medial femoral condyle. There is also a small full-thickness cartilage defect along the weightbearing portion of the lateral femoral condyle. There are small tricompartmental osteophytesLIGAMENTS: Anterior cruciate ligament appears slightly thickened, suggesting mucoid degeneration. The posterior cruciate ligament appears normal. The medial collateral ligament and lateral collateral ligament complex appear normal. EXTENSOR MECHANISM: The extensor mechanism is intact. There is edema of the subcutaneous fat anterior to the patellar tendon extending along the lateral retinaculum that is nonspecific. ADDITIONAL

Output: 1.Tricompartment osteoarthritis.2.Mild edema of the subcutaneous fat anterior to the patellar tendon extending along the lateral retinaculum is nonspecific.3.Findings suggestive of an intra-articular lipoma anteriorly with extension into the patellofemoral articulation.4.Mucoid degeneration of the anterior cruciate ligament.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for TIA/stroke like symptoms History: transient paresthesias, dyscoordination, numbness MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a small T2 and flair signal hyperintensity present along the right pons.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 demonstrate mild mucosal thickening in the ethmoid air cells. 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 and the proximal anterior, middle and posterior cerebral arteries.The right vertebral artery demonstrates normal antegrade flow beyond the origin of the right posterior inferior cerebellar artery. The left vertebral artery is diminutive distally. The basilar artery appears to be occluded or near occluded beginning at the vertebrobasilar junction. The posterior communicating arteries appear to be the main supply to the posterior cerebral arteries and the P1 segments.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.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. The left common artery originates from the innominate artery. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is mild narrowing of the proximal right internal carotid artery with approximately 20% focal narrowing approximately 15 mm from the origin of the right internal carotid artery. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Findings are compatible with occlusion or near occlusion of the distal right vertebral artery intracranially as well as the basilar artery with reconstitution of posterior circulation flow via collaterals from the anterior circulation as well as the posterior inferior cerebellar arteries.2.There is no evidence for acute ischemic infarction appreciated.3.Findings suggest an old lacunar infarct in the right pons


Instruction: Generate impression based on medical findings.

Input: 68 year old with history of left mastectomy for ILC. There is scattered fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.Status post left mastectomy.No abnormal enhancement is seen in right breast or left mastectomy bed. No abnormal lymph nodes are identified in either axillary region.Stable bilateral thyroidal cysts, right larger than left.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with waxing and waning altered mental status. Please note that mild motion artifact limits evaluation. Focus of increased DWI signal in the left posterior frontal lobe likely represents artifact from susceptibility in this area. No definite evidence of diffusion restriction to suggest infarct. Severe enlargement of the ventricles and sulci likely reflects atrophy. Moderate to severe periventricular and subcortical T2 hyperintensities are nonspecific but likely represent chronic small vessel ischemic disease. Focus of susceptibility in the left high convexity is likely related to chronic hemosiderin deposition. A few additional punctate foci of susceptibility are present which are nonspecific. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. Mild mucosal thickening of the bilateral maxillary sinuses with a left maxillary mucous retention cyst/polyp.

Output: Moderate to severe chronic small vessel ischemic disease. No acute infarct.


Instruction: Generate impression based on medical findings.

Input: Lower left back pain, grossly reduced sensation in left lower back and left anterior thigh, 3/5 strength in left leg and left ankle Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the lumbar spinal curvature; alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Postcontrast images demonstrate no abnormal enhancement within the spine.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Cyst involving the inferior pole of the right kidney incidentally noted.

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


Instruction: Generate impression based on medical findings.

Input: 72-year-old male status post transphenoidal hypophysectomy. There is no evidence of intracranial hemorrhage or edema. Reidentified is a large, pituitary macroadenoma with extensive expansion of the sella and invasion of the sphenoid sinus and clivus which appears to be overall slightly smaller in size when compared to be presurgical MRI. There is no extension into the pre-pontine cistern There is bilateral involvement of the cavernous sinuses. There is significant extension of the tumor into the basal cistern.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. The paranasal sinuses and sphenoid sinus demonstrate opacification and air fluid levels which may be consistent with postsurgical blood and or packing material.

Output: Expected postsurgical changes as described above.


Instruction: Generate impression based on medical findings.

Input: Female 13 years old Reason: eval for loose body History: knee pain sports and history of synovial osteochondromatosis MENISCI: The lateral meniscus is intact. The medial meniscus is diminutive.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact.LIGAMENTS: Complete rupture of the ACL. Medial and lateral collateral ligaments are intact. PCL is intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Ossified loose body in the anterior joint space.2.Complete rupture of the ACL.3.Diminutive medial meniscus, raising question of chronic tearing.4.Moderate-sized joint effusion.5.Patella situated lateral to the trochlear groove suggesting patellar instability.


Instruction: Generate impression based on medical findings.

Input: acute mental status change, prior stroke history. Motion artifacts degraded exam quality.No evidence of acute ischemic or hemorrhagic lesion on this scan.High signal intensities on FLAIR images are seen on right frontal lobe, right temporal lobe, right basal ganglia,and right thalamus with volume loss indicating prior infarctions. The right cerebellar hemisphere also shows focal tissue loss indicating chronic infarction.Underlying brain shows patchy high signal intensity lesions on periventricular white matter on FLAIR images indicating non specific small vessel disease. No change since prior exam.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal chronic infarction with encephalomalacia involving right frontal lobe, right temporal lobe, right insular, right basal ganglia, right thalamus and right cerebellar hemisphere as described above.Non specific small vessel disease, no change since prior exam.


Instruction: Generate impression based on medical findings.

Input: 69 years Male (DOB:11/12/1947)Reason: pt with MS, concern for flare History: pt with MS, concern for flare PROVIDER/ATTENDING NAME: YASMIN H. KARIMI MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord is small and atrophic appearing but has normal signal characteristics. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.There are dorsally located subcutaneous cystic lesions present at the level of the the upper cervical spine and lumbar spine. One at the level of the upper cervical spine measures 13 x 24 mm sagittal dimensions whereas the one in the midthoracic spine level measures 30 x 19 mm sagittal dimensions. These are predominantly hyperintense on T2 and hypointense on T1 and have a thick wall most likely represent sebaceous cystsThere are small pleural effusions present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some facet and ligamentum flavum hypertrophy at this level. There is a disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some facet and ligamentum flavum hypertrophy at this level. There is a disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Findings are suggestive of spinal cord atrophy.2.There are some mild degenerative changes present lower lumbar spine without significant compromise spinal canal or neural foramina3.There are small pleural effusions present.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Mild cognitive impairment, so statedClinical question: Alzheimer vs alcoholic memory losses vs OSASigns and Symptoms: memory problems, name remembering difficulty The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 79x38mm coronal dimension cyst is centered in the right middle cranial fossa which is associated with remodeling of the adjacent bone. There is a 26x35mm coronal dimension cyst centered in the left middle cranial fossa.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is a punctate T2 and FLAIR hyperintense focus in the pons.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses and ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.There is a defect present along the odontoid process.

Output: 1.Bilateral middle cranial fossa arachnoid cysts. The one on the right is large.2.Periventricular and subcortical white matter changes of a mild degree and a punctate pontine lesions are nonspecific. At this age they are most likely vascular related. 3.There is a defect present along the odontoid process. A chronic fracture cannot be excluded. If clinically appropriate, CT of the cervical spine may help further evaluate this.4.An email was sent to Dr Mastrianni.


Instruction: Generate impression based on medical findings.

Input: Evaluate for progression of leptomeningeal carcinomatosis from breast cancer treated with WBRT. The abnormal leptomeningeal enhancement has markedly diminished and there is minimal residual T2-FLAIR hyperintensity in the left parietal sulci. There is no evidence of intraparenchymal abnormal enhancement. There is unchanged nonspecific patchy T2 hyperintensity in the periventricular white matter, particularly in the parietal regions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Interval improvement in the leptomeningeal carcinomatosis.2. No evidence of intraparenchymal metastases.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Malignant neoplasm of upper lobe, right bronchus or lungClinical question: vertigo; also history of lung cancer with non-specific vascular abnormality in brainstem on staging brain MRI from an outside institution; please evaluate for etiology of vertigoSigns and Symptoms: vertigo The CSF spaces are appropriate for the patient's stated age with no midline shift. A small ill-defined focus of enhancement is present along the right paramedian pons which is associated with loss of signal on the susceptibility weighted imaging. It is associated with minimal T2 and FLAIR signal hyperintensity and no evidence for diffusion restriction.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 demonstrate some minor opacities. The visualized portions of the orbits are intact.Incidental note is made of a a Thornwaldt cyst in the posterior nasopharyngeal mucosal space of the nasopharynx.

Output: 1.A small lesion in the pons is suspected to represent capillary telangiectasia rather than metastatic disease. If clinically appropriate, given the patient's clinical history for possible metastases, follow-up exams would help confirm this.


Instruction: Generate impression based on medical findings.

Input: History of relapsing polychondritis, limbic encephalitis, and left posterior scleritis. Evaluate for structural lesions Brain: There is mild increased T2/FLAIR signal in the hippocampi and bilateral medial and anterior temporal lobes which is less prominent than on the initial exam from 5/10/2014. There is no associated hemorrhage and the volume of the temporal lobe structures is unchanged.There is no intracranial mass or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are patchy areas of mucosal thickening within the ethmoid air cells. The skull and scalp soft tissues are grossly unremarkable.Orbits: The exam is limited by motion artifact.There is mild thickening of the posterior scleral wall with increased T2 signal and mild enhancement in the mid to lateral retrobulbar fat on the left. The optic nerves are normal in size and signal intensity and are symmetric bilaterally. The extraocular muscles appear normal. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen.

Output: 1.Mild residual T2/FLAIR signal in the bilateral temporal lobes is slightly less prominent then on the initial exam from 5/10/2014.2.Mild thickening and enhancement of the posterior left sclera and retrobulbar fat is nonspecific but compatible with the history of recent posterior scleritis.


Instruction: Generate impression based on medical findings.

Input: Right parietal anaplastic astrocytoma, status post RT and surgery 2012. There are stable post-treatment findings in the right temporo-occipital region with confluent T2 hyperintensity surrounding the resection cavity and an area of enhancement and susceptibility effect along the posterior margin of the resection cavity that measures up to 10 mm. There is no evidence of acute infarct. There is unchanged mild ex vacuo dilatation of the right lateral ventricle trigone. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Post-treatment findings in the right temporo-occipital region without evidence of tumor progression.


Instruction: Generate impression based on medical findings.

Input: Invasive squamous cell carcinoma of the supraciliary ridge treated with chemoradiation. There are stable post-treatment findings in the left supraciliary region, with a small amount of persistent mild patchy, ill-defined enhancement in the left supra-orbital subcutaneous tissues. Otherwise, there is no evidence of gross tumor. The right orbit is unremarkable. There is a small left maxillary sinus retention cyst. There is a right temporomandibular joint effusion. The imaged intracranial structures are grossly unremarkable.

Output: Stable post-treatment findings in the left supraciliary ridge region, without evidence of gross tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old, history of right MCA stroke, now with possible lacune and seizures. No restricted diffusion is seen to suggest the presence of acute ischemia. Encephalomalacia is again seen involving the right perirolandic cortex and the underlying white matter compatible with a chronic MCA distribution stroke. Patchy periventricular T2 hyperintensities are noted, a nonspecific finding but most likely representative of chronic microvascular ischemic disease. Mild chronic hemosiderin staining of the right MCA infarct region is seen. Otherwise, no significant intracranial hemorrhage is detected. No abnormal collections are seen. The ventricles are mildly prominent but stable in size and morphology.

Output: 1.No acute ischemia or other acute intracranial process.2.Chronic right MCA distribution stroke involving the perirolandic gyri and underlying white matter.3.No additional findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Cholestasis and pruritus. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. The patient is status post cholecystectomy.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: Status post cholecystectomy without biliary ductal dilatation or other hepatic abnormality.


Instruction: Generate impression based on medical findings.

Input: Developmental disorder of speech and language, unspecified [F80.9], Reason for Study: ^Reason: evaluate for atrophy, concern for primary progressive aphasia History: effortful speech, paraphasic errors, paucity of speech There is no evidence of acute ischemic or hemorrhagic lesion.There are localized encephalomalacia at both middle and inferior temporal gyri of the left temporal lobe.Multifocal scattered FLAIR/T2 high signal intensities on bilateral periventricular white matter and the centrum semiovale indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cysts are seen on the right maxillary sinus.There is well circumscribed scalp mass lesion [22.9mm(CC)x20.8mm(RL)x8.3mm(AP)] indicating lipoma.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Encephalomalacia on the left middle and inferior temporal gyri.3. Minimal non specific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Fibromyalgia with burning pain in neck and arms. 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 spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of degenerative spondylosis or spinal cord lesions in the cervical spine.


Instruction: Generate impression based on medical findings.

Input: 47 years, Male, evaluate for tumor resection, word finding difficulty. There are postsurgical changes of left-sided craniotomy for resection of left temporal mass. There is a rind of restricted diffusion surrounding the resection cavity compatible with cytotoxic edema. No large infarct is evident. There are blood products within the resection cavity. There appears to be near total resection of the enhancing tumor with small residual enhancement suspected along the superior aspect of the resection cavity abutting the left temporal horn.Extensive surrounding T2/FLAIR hyperintensity in the left temporal lobe extending medially into the left thalamus and basal ganglia region as well as superiorly into the left parietal white matter is again seen. Mass effect including effacement of the left lateral ventricle is slightly improved. Uncal herniation with deformity of the midbrain and rightward displacement of the brainstem is slightly improved. Rightward midline shift measured at the foramen of Monro measures approximately 6 mm compared to 8 mm on the preoperative study. No hydrocephalus. Major flow-voids are maintained. There is diffuse opacification of the left mastoid air cell. Remainder of the brain parenchyma demonstrates few scattered nonspecific T2/FLAIR hyperintense foci but otherwise unremarkable.

Output: Expected postsurgical changes of left temporal tumor resection. There is near total resection of the enhancing tumor with minimal residual enhancement suspected along the superior aspect of the resection cavity along the left temporal horn.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Syncope and collapseClinical question: r/o acute ischemiaSigns and Symptoms: dysarthria, right sided weakness There is diffusion restriction involving the right inferior parietal lobule, portions of the precentral gyrus, the midportion and posterior aspect of the right superior and middle temporal gyri as well as the posterior half of the right insular cortex and a small patchy area of the right frontal lobe centered in the precentral gyrus in an area measuring 24x74mm axial dimensions.There is encephalomalacia present in the left middle frontal gyrus.There is encephalomalacia involving the central portions of the right SCA territory of the right cerebellar hemisphere.There is cerebellar atrophy presentThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are foci of T2 hyperintensity in the pons and thalami.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. The eye lenses are thin.Images are degraded due to artifacts related to patient motion.

Output: 1.Acute infarction involving the right MCA territory as detailed above.2.Encephalomalacia is present in the left frontal lobe and right cerebellar hemisphere as detailed above.3.Cerebellar atrophy.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Lesions in the pons and thalami of a moderate degree are likely related to old lacunar infarcts.6.Images are degraded due to artifacts related to patient motion. This may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male presents with right shoulder pain. ROTATOR CUFF: The rotator cuff muscles and tendons appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. No fluid or gadolinium in the subdeltoid or subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. The labrum appears normal. A band of low signal intensity along the inferior margin of the glenoid may represent a prominent capsular fold. There is infiltration of gadolinium along the margins of the subscapularis which not uncommonly occurs with these injections.BICEPS TENDON: Long head of the biceps tendon is intact. ADDITIONAL

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


Instruction: Generate impression based on medical findings.

Input: Pain with weightbearing and hip flexion. Evaluate for labral tear or hip flexor injury. ACETABULAR LABRUM: Best seen on sagittal image 21 of series 701 and oblique sagittal image 14 of series 801 is a thin band of intermediate signal intensity traversing the anterior superior labrum at approximately the 2:00 position, indicating a tear. The posterior labrum appears intact.ARTICULAR CARTILAGE AND BONE: I see no fluid-filled articular cartilage defects. There is slight subjective prominence of the anterosuperior aspect of the femoral head-neck junction, with a borderline alpha angle of 55 degrees. There is a small, mild focus of edema along the medial aspect of the femoral neck that could represent a small focal stress reaction, but I see no fracture line or signal abnormality in the adjacent cortex. There appears to be transitional lumbosacral morphology, with a slightly hyperkyphotic lumbosacral junction. Small foci of fluid signal intensity arising from the facet joints of the lower lumbar spine suggest synovial cysts and osteoarthritis. These findings are not adequately optimally assessed on this hip MRI study, and would be better evaluated with lumbar spine radiographs and perhaps lumbar spine MRI. There is a small focus of edema-type signal within the inferior aspect of the right sacral wing adjacent to the sacroiliac joint which I suspect is degenerative in etiology. The remaining visualized bone marrow is unremarkable.SOFT TISSUES: There is edema-type signal within the anterior soft tissues of the hip left hip that I suspect is iatrogenic related to the injection portion of the procedure. The ligamentum teres appears intact. I see no muscle or tendon tear/disruption. Thin bandlike low signal intensity traversing the lateral subcutaneous fat of the left hip likely reflects prior surgery.

Output: 1.Tear of the left anterior superior labrum at the 2:00 position.2.Small focus of mild edema within the medial aspect of the base of the left femoral neck which could conceivably represent a mild stress reaction, but I see no discrete fracture line or signal abnormality in the cortex.3.Transitional lumbosacral morphology with facet joint osteoarthritis and possible synovial cysts. These findings would be better assessed with lumbosacral spine radiography and/or lumbar spine MRI, if clinically warranted.4.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 5-year-old male status post trauma rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Within the posterior occipital bone there is a 1 mm of displacement without adjacent hemorrhage. The fracture line extends from the skull base through the occipital bone just above the transverse sinus. MRI/MRV may be considered as clinically indicated to determine involvement of the adjacent vascular structures.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Right posterior occipital bone fracture, displaced by approximately 1 cortex width with extension cranial to the transverse sinus. MRI/MRV may be considered as clinically indicated to determine involvement of the adjacent vascular structures.2. No acute intracranial abnormalities.


Instruction: Generate impression based on medical findings.

Input: 45-year-old with history of right breast cancer on neoadjuvant chemotherapy. Please assess response. The patient also palpates a superficial mass in the left outer breast for which ultrasound is requested. A targeted bilateral ultrasound was performed for the known cancer and also the patient's area of concern. In the right breast 9 o'clock position at the site of the Hydromark biopsy clip, there is a residual hypoechoic area measuring 0.6 x 0.5 x 0.5 cm. This has no significant Doppler vascularity. Previously this measured 0.8 x 0.7 x 0.8 cm on 1/6/2015, 1.1 x 1.0 x 0.7 cm on 12/1/2014, and 2.5 x 1.2 x 1.6 cm before therapy. In the left breast at the site of patient concern, a 5-mm simple cyst was seen. This correlates with the MRI which showed cysts scattered in the left breast.

Output: 1. Minimal remaining soft tissue density adjacent to the Hydromark biopsy clip could represent a small focus of residual tumor versus fibrosis/scarring.2. Left breast simple cyst.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Pancreatic IPMN. ABDOMEN:LIVER, BILIARY TRACT: Unchanged small right lobe simple cyst. No focal suspicious lesion. No biliary ductal dilatation or vascular abnormality.SPLEEN: Stable small splenic cyst.PANCREAS: Fatty atrophy of the pancreas. Multiple pancreatic cystic lesions.The largest is in the mid body measuring 1.6 x 1.1 cm (series 11/23), unchanged. The numerous additional subcentimeter cystic foci are not significantly changed in size dating back to 7/8/2011. No enhancing nodularity. The main pancreatic duct is normal in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal superior pole simple cyst.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: No significant interval change in the size or number of multiple pancreatic cystic lesions compatible with side branch IPMNs.


Instruction: Generate impression based on medical findings.

Input: 24-year-old woman, 16 weeks pregnant and with history of lupus, now with severe headache. There are a few, scattered foci of punctate diffusion restriction and increased T2/FLAIR signal in the bilateral cerebral and cerebellar hemispheres at the gray-white junction (601/19 and 21). There is no intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several additional foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The brain parenchyma is otherwise unremarkable for age. The major flow voids are preserved.Sella and orbits are grossly within normal limits. The paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRV BRAIN

Output: 1.Scattered punctate white matter foci of diffusion and T2 signal abnormality which are nonspecific but likely represent bihemispheric subacute small vessel ischemia.2.Additional nonspecific punctate foci of increased T2 signal in the centrum semiovale, probably prior small vessel ischemic disease.3. No evidence of venous congestive encephalopathy.4. Poor visualization of the inferior sagittal sinus, likely technical. No evidence of venous infarct or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with left leg weakness. There is metallic susceptibility artifact related to the patient's history of orthopedic fixation of the lumbosacral spine with associated postoperative changes in the adjacent soft tissues. There is grade 2 anterolisthesis of L5 on S1 with severe degenerative disc disease at this level. Please see the dedicated lumbar spine MRI report for additional details. There are small lobulated foci of signal abnormality within the intertrochanteric region of the left femur with minimal enhancement likely representing enchondromas. The bone marrow signal intensity of the pelvis is otherwise normal. Mild osteoarthritis affects both hip joints, which otherwise appear normal for the patient's age. There is bony bridging along the anterior aspect of the sacroiliac joints which is likely degenerative in etiology. Mild degenerative arthritic changes affect the pubic symphysis. We see no focal mass lesions within the pelvis. The musculature of the hips is symmetric without evidence of edema. Other than the soft tissues posterior to the aforementioned lumbosacral spine we see no abnormal enhancement. Although this examination was not protocoled for detailed evaluation of the prostate, there is decreased signal abnormality within the body and apex of the right peripheral zone of the prostate gland, which is incompletely characterized. There may be post surgical changes of prior TURP.

Output: 1. Postoperative and degenerative changes of the lumbosacral spine. Please refer to the lumbar spine MRI report for additional details.2. Mild osteoarthritis of the hips, sacroiliac joints, and pubic symphysis but no findings within the pelvis to account for the patient's left leg weakness.3. Signal abnormality within the prostate gland which is incompletely characterized on this non dedicated MRI examination. Correlation with PSA levels is recommended as we cannot exclude the possibility of prostate carcinoma on this examination.


Instruction: Generate impression based on medical findings.

Input: Evaluate for CVA or hemorrhage. Examination demonstrates infarcts in the left parietal lobe. Since prior brain MRI, the infarcts have increased in size. No intracranial hemorrhage, mass, midline shift or abnormal extraaxial fluid collection is identified. The periventricular small vessel ischemic disease and right cerebellar encephalomalacia are again identified. The ventricles are normal in volume and are symmetric.The visualized paranasal sinuses mastoid air cells are normally pneumatized.

Output: 1.Interval increase in size of the left parietal stroke with no evidence of intracranial hemorrhage.2.Small vessel ischemic disease and right cerebellar encephalomalacia.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female patient with chronic neck pain. Vertebral body heights are maintained. Anterior osteophyte formation is noted at C2-C3, C4-C5, C5-C6, and C6-C7. There is mild multilevel disc space narrowing. There is no significant neuroforaminal narrowing.

Output: Multilevel osteoarthritis in the cervical spine, as above.


Instruction: Generate impression based on medical findings.

Input: History of gait balance, tinnitus, lightheadedness with recently discovered cavernous malformation; please compare to June 2016 examination. There is redemonstration of a small left temporal lobe lesion with signal characteristics compatible with a small congenital cavernous malformation measuring up to 7 mm on the T1 weighted sequences, not significant changed. There is no associated significant perilesional edema or mass effect. A small adjacent curvilinear area of enhancement compatible with a developmental venous anomaly also appears unchanged.There is a mildly prominent curvilinear area of increased susceptibility along a left occipital sulcus (802/10) without associated asymmetric vessel prominence on postcontrast images or associated parenchymal abnormality and which is favored to reflect a prominent vessel.Patchy areas of increased T2/FLAIR signal within the periventricular and subcortical white matter are nonspecific but compatible with moderate chronic small vessel ischemic changes, not significantly changed. There is no restricted diffusion to suggest acute ischemic infarction. The ventricles are stable in size and configuration. The basal cisterns remain patent. There is no midline shift or herniation. The major cerebral flow voids are intact. There is persistent mild, patchy opacification of the right mastoid air cells. There is mild patchy opacification of the ethmoid air cells.

Output: Subcentimeter left temporal lobe cavernous malformation with associated developmental venous anomaly, not significantly changed compared to 6/6/2016 and without associated perilesional edema or mass effect.


Instruction: Generate impression based on medical findings.

Input: Intracranial hemorrhage with altered mental status. There are postoperative findings related to right PCOM aneurysm coiling and stenting. There is a small amount of scattered subarachnoid hemorrhage and hemorrhage within the ventricular system with evidence of superficial siderosis. There is a predominantly T1 and T2 hyperintense hematoma in the right frontal lobe surrounding the path of the prior right transfrontal ventricular catheter that measures up to approximately 25 mm with surrounding vasogenic edema. There is also a small amount of hemorrhage along the left transfrontal shunt catheter path. The ventricular system appears to be stable to minimally more distended. There are small areas of recent infarction in the corpus callosum, posterior left insular cortex, and bilateral frontal lobe white matter. There is also mild scattered cerebral white matter T2 hyperintensity and more confluent T2 hyperintensity in the periventricular regions. There appears to be a small amount of encephalomalacia in the right cerebellar hemisphere. There is no midline shift or herniation. There is fluid signal within the bilateral mastoid air cells and middle ears.

Output: 1. Small amounts of residual scattered subarachnoid hemorrhage and hemorrhage within the ventricular system, with evidence of superficial siderosis. 2. Subacute hemorrhage along the bilateral transfrontal ventricular catheter paths, right larger than left. 3. The shunted ventricular system appears to be stable to minimally more distended.4. Small areas of recent infarction in the corpus callosum, posterior left insular cortex, and bilateral frontal lobe white matter.


Instruction: Generate impression based on medical findings.

Input: 57 year-old female with ataxia and cerebellar mass. Evaluate for evolution of cerebellar mass. Again noted is a posterior fossa space-occupying hypodense lesion measuring 3.5 x 2.6 cm and appears minimally decreased in size since the previous examination (Image 10; series 4). This previously measured 3.8 x 2.7 cm. There is an adjacent focus of hyperdensity in the right cerebellum measuring 1.9 x 0.8 cm which appears unchanged compared to previous study (Image 7; series 4). This previously measured 1.7 x 0.8 cm. Differential considerations include hematoma versus mass lesion with petechial hemorrhage. Contrast enhanced MRI could be considered for further evaluation of this finding. Again noted is effacement of the fourth ventricle associated with moderate supratentorial ventriculomegaly and transependymal edema which appears unchanged when compared to the previous study. These findings are likely related to obstructive noncommunicating hydrocephalus. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized. There is opacification of the left mastoid air cells and thickening of the left external auditory canal which appears unchanged compared to previous study. Incidental noted is made of bilateral lens prosthesis. There is calcification within the left globe.

Output: There is no significant interval change since the previous examination. 3.5 cm space-occupying mass lesion within the left cerebellum with an associated hyperdensity which could represent blood product or mass lesion with mineralization. There is associated effacement of the fourth ventricle and moderate noncommunicating hydrocephalus unchanged since the previous examination. MRI examination for further characterization is recommended.


Instruction: Generate impression based on medical findings.

Input: Metastatic lung cancer, C7 and T1 symptoms. Cervical Spine:Again seen is metastatic lesion involving the C7 vertebral body with diffuse marrow infiltration. There is associated lytic changes which are better appreciated on CT. Noted is expansion and extension into the left pedicle, transverse process, facets as well as the spinous process. There is mild diffuse loss of height of the C7 vertebral body similar to prior. There is moderate to severe narrowing of the left C7-T1 neural foramen which was present previously but appears slightly worse. Abnormal signal involving the inferior articular facet of C6 on the left is again seen.Craniovertebral junction appears within normal limits. There is mild diffuse loss of C7 height, vertebral body heights are otherwise maintained. Alignment remains unchanged since 4/6/2015 with loss of normal cervical lordosis. No abnormal signal seen within the cervical cord.Individual levels as below:C2-3: Small central disk osteophyte complex with no spinal canal or neural foraminal stenosis.C3-4: Disk osteophyte complex and uncovertebral hypertrophy with mild facet arthropathy with no significant spinal canal or neural foraminal stenosisC4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing mild to moderate spinal canal stenosis. There is minimal left neural foraminal narrowing. No significant right foraminal stenosis.C5-6: Disk osteophyte complex eccentric to the left causing focal indentation of the ventral cord surface on the left. There is mild to moderate spinal canal stenosis particularly on the left. Mild left neural foraminal stenosis.C6-7: Disk osteophyte complex causing mild spinal canal stenosis. There is moderate to severe left neural foraminal stenosis which appears worse since 4/6/2015.C7-T1: Vertebral body metastasis extending into the posterior elements left greater than right causing moderate to severe left neural foraminal stenosis. There is mild right foraminal narrowing on a degenerative basis.There is minimal epidural soft tissue thickening and enhancement at the left ventral C7-T1 level suspected to represent minimal epidural tumor. There is no significant spinal canal stenosis associated with the epidural tumor. Thoracic Spine:Multiple metastatic lesions are seen in the thoracic spine. Small lesion is noted in the right posterior aspect of the T2 vertebral body. There is a lesion noted within the dorsal T3 vertebral body extending into the posterior elements. Small lesion is seen at T6. There is a lesion at T8 on the right which extends into the posterior elements. Small lesions are seen at T9 and T10. There is a larger lesion involving the T11 vertebral body extending into the posterior elements with expansion of the right pedicle and transverse process and infiltration of the adjacent rib. Small lesion is seen involving the inferior right T12 vertebral body.Vertebral body heights are maintained. No evidence of compression fractures. No significant spinal canal stenosis is demonstrated. Moderate right T10-T11 and mild right T11-T12 neural foraminal stenosis is seen related to tumor involving the posterior elements at T11. There is also mild right T8-T9 neural foraminal stenosis. Minimal epidural enhancement along the dorsal aspect of the lower thoracic spine is favored to be vascular. No convincing evidence of epidural tumor is appreciated. No cord signal abnormality. Abnormal marrow signal involving the ribs at multiple levels is also noted.

Output: 1. Vertebral body metastasis at C7 extending into the posterior elements on the left and to a lesser degree on the right is not significantly changed in size since 4/6/2015. There is minimal ventral epidural enhancement dorsal to the C7 level which is suspected to represent minimal epidural tumor. There is moderate to severe left C6-7 and C7-T1 neural foraminal stenosis which appears slightly worse in the interval.2. Multiple metastatic lesions throughout the thoracic spine without evidence of compression fracture. Several lesions extend into the posterior elements and narrow the neural foramina as detailed above particularly on the lesions at T8 and T11. No significant spinal canal stenosis in the thoracic spine. No definite evidence of epidural tumor in the thoracic spine.3. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at C4-C5, C5-C6, and C6-C7.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with squamous cell carcinoma found on biopsy of urethra. Need MRI of pelvis. Multiple sequences are limited due to patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No intra or extrahepatic biliary ductal dilatation. Patent vasculature.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing punctate T2 hyperintensity of the right lower renal pole is too small to characterize. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Ectasia of the infrarenal abdominal aorta measuring 2.6 cm in AP diameter.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Right-sided pelvic lymphadenopathy in the pelvic sidewall, external iliac and inguinal regions (series 24 images 88, 102, 104, 111). The largest pelvic lymph node is in the right external iliac station measuring 1.9 x 3.8 cm (series 27 image 33).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is nonspecific heterogenous T2 signal intensity of the distalmost penile urethra (series 27 image 34). Periurethral or urethral wall hyperintense T2 signal and postcontrast enhancement are also noted of the corpus spongiosum /anterior urethra (series 27 image 45, series 26 image 94).

Output: 1. Right-sided lymphadenopathy involving the pelvic sidewall, external iliac and inguinal regions.2. Periurethral or urethral wall enhancement involving anterior urethra, most pronounced at the level of the bulbar urethra. May reflect prior inflammation, neoplastic extension not excluded. Correlation with patient's procedural history and pathology is needed.3. There is ovoid heterogenous T2 intermediate signal intensity of the distalmost penile urethra seen with indistinct margins, nonspecific, again correlation with patient's history required to exclude site of patient's known malignancy.4. No acute abnormality of the abdomen.


Instruction: Generate impression based on medical findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Localizing CT examination demonstrates a homogeneous 2 cm soft tissue mass along the posterior aspect of the greater trochanter corresponding to the findings seen on recent MRI examination. Using CT guidance, a 14-gauge Achieve core biopsy needle was advanced into the lesion. Four 14-gauge core biopsy specimens were obtained and placed in 10% formalin. Touch preparations were performed and handed to cytopathology to confirm specimen adequacy.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT-guided biopsy of right hip soft tissue mass.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is mild diffuse volume loss without a specific lobar predominant atrophy pattern, unchanged in appearance. There are no findings of ventricular obstruction or hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Redemonstrated is mild diffuse volume loss without a specific lobar predominant atrophy pattern, unchanged in appearance. Otherwise, negative contrast-enhanced brain MRI.


Instruction: Generate impression based on medical findings.

Input: Possible right L5 herniated disc Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Low T1 and T2 signal focus at the right S2 level may represent a sclerotic lesion such as bone island. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation and mild bulge. No significant spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and mild bulge, eccentric to the left. There is mild narrowing of the neural foramina, left relatively greater than right. There is contact of the extraforaminal left L3 nerve root. No spinal canal stenosis.L4-L5: There is a disc bulge with a central protrusion. There is no significant spinal canal or neural foraminal stenosis.L5-S1: There is a relatively large right paracentral disc protrusion which contacts the descending right S1 nerve root. The neural foramina and central canal remain patent. Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine. There is a right paracentral disc protrusion at the L5-S1 level which may be impinging on the right S1 nerve root. Additional levels of degenerative disease as described above.


Instruction: Generate impression based on medical findings.

Input: 43-year-old male with pain. Evaluate for extensor carpi radialis brevis degeneration. LIGAMENTS: Although this examination was not protocoled for detailed evaluation of the intrinsic ligaments of the elbow, the ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral collateral ligament appears intact.TENDONS: There is intermediate signal intensity within the common extensor tendon indicating moderate tendinosis. There is linear fluid signal abnormality within the common extensor tendon at the level of its insertion on the lateral epicondyle, indicating a tear, measuring approximately 6 mm in the craniocaudal dimension (image 11; series 601). There is intermediate signal intensity within the common flexor tendon indicating moderate tendinosis. The triceps tendon appears intact. The biceps and brachialis muscles and tendons appear intact.ARTICULAR SURFACES AND BONE: There is near full-thickness articular cartilage degeneration affecting the radiocapitellar joint. No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: The imaged musculature is normal in appearanceADDITIONAL

Output: Tendinosis and partial-thickness insertional tearing of the common extensor tendon as described above. Tendinosis of the common flexor tendon. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: There is an ill-defined focus of signal abnormality involving the right temporooccipital junction demonstrating gyral thickening, gyral and sulcal enhancement, with associated vasogenic edema and mild mass effect upon the adjacent right lateral ventricle. It does not demonstrate restricted diffusion and has no susceptibility abnormality.Elsewhere there are foci of T2 hyperintensity within the white matter without associated mass effect, restricted diffusion, or enhancement representing chronic small vessel ischemic disease.A single punctate focus of susceptibility hypointensity is noted within the right paramedian pons, without other signal abnormality, most likely representing a remote microhemorrhage.The ventricles and sulci are unremarkable for age. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: There is an ill-defined focus of signal abnormality involving the right temporooccipital junction demonstrating gyral thickening, gyral and sulcal enhancement, with associated vasogenic edema and mild mass effect upon the adjacent right lateral ventricle. It does not demonstrate restricted diffusion and has no susceptibility abnormality. This appearance is most suggestive of involvement by lymphoma or less likely metastasis from other primary cancer. However, a portion of the described enhancement pattern can also be seen in the setting of seizure activity, which may be superimposed. This does not have the imaging appearance of a contusion.


Instruction: Generate impression based on medical findings.

Input: H/o strokes. The previously seen right occipital hypoattenuation appears less when compared to prior exam. There appears hypoattenuation in the right cerebellum, which is compatible with findings on the prior MRI. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: Stable right posterior cerebral artery territory subacute stroke. Otherwise unremarkable CT head.


Instruction: Generate impression based on medical findings.

Input: Migraines headache, well controlled asthma, ADHD, OSA, gait instability, and some on/off jerking movements in the hands over the last over a month. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: 85 year-old male with fall and loss of consciousness. CT of brain without infusion.Large vessel intracondylar vascular calcification is noted.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Patchy areas of periventricular lucencies are concerning for small vessel disease considering patient's age. Small area of cortical encephalomalacia in the high convexity left parietal is believed to represent an old small cortical stroke. No evidence of post traumatic findings. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.CT of the cervical spine.Extensive degenerative changes of the cervical spine with significant loss of intervertebral disk height at multiple levels are noted. The alignment of cervical spine remains within normal limits. The facets are aligned and demonstrate no subluxation. A linear defect bilaterally across the pedicles of C6 is noted. There is however no evidence of any malalignment of these pedicles. Considering the patient's history I cannot entirely rule out nondisplaced bilateral pedicular fracture.These findings are best appreciated on sagittal image 15 for the right pedicle of C6 and sagittal images 24 and 25 for the left. Both of these findings are also appreciated on axial images 41 and 42. Follow-up with a repeat thin cuts CT and or an MRI is recommended.Dr. Watts from the emergency service was notified of the findings at the time of interpretation.

Output: 1.Unremarkable CT of brain without infusion.2.Suspected bilateral C6 pedicular fracture as detailed.3.Extensive degenerative changes of cervical spine.4.No malalignment of the cervical spine.


Instruction: Generate impression based on medical findings.

Input: There is a homogeneously enhancing mass within the right internal auditory canal without expansion or extension into the adjacent cerebellopontine angle. The left internal auditory canal is clear. The visualized brain parenchyma demonstrates punctate foci of T2 hyperintensity within the white matter. Mucosal thickening is noted within ethmoid air cells and the left maxillary sinus.

Output: 1.MRI evidence for right internal auditory canal acoustic schwannoma.2.Partially imaged chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The thoracic vertebral body and disk heights are well-maintained. There is a compression deformity at the L1 vertebral body, similar to the prior study. The spinal cord is of normal caliber and signal. Again noted is an enhancing lesion in the left lateral side of the T10 vertebral body overlying the T10-T11 neural foramen, measuring 16 x 12 mm, (series 1201, image 17), similar to 5/10/2016 allowing for measurement technique differences and 10 x 11 mm on 9/2/2013. There is no clear extension into the neural foramen. There are lesions within the T3, T8, T9, and T11 vertebral bodies demonstrating high T1 and T2 signal, compatible with hemangiomas and unchanged from the prior study. No worrisome focal marrow signal abnormality is appreciated. There are nonenhancing cystic lesions within the neural foramina of T10-T11 bilaterally, the right neural foramen at T8-T9 and T9-T10, and the left neural foramen at T1-2, appearing similar to the prior study and likely representing perineural cysts.There is effacement of the dorsal thecal sac at the T10-T11 level related to facet arthropathy and ligamentum flavum thickening. There is otherwise no significant spinal canal stenosis at any level.

Output: 1. Enhancing paraspinous lesion adjacent to the left T10-T11 neural foramen is unchanged since 5/10/2016 and gradually enlarged since more remote studies. Differential includes neurogenic tumors such as schwannoma.2. Chronic L1 compression fracture is also unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 4 years old. Reason: eval for mass, trauma History: AMS There is mild to moderate enlargement of the lateral ventricles with a wavy configuration consistent with periventricular infarction. Findings correlate with prior MRI examination. There is evidence of cavum vergae which is stable from the previous exam. There is no evidence of intracranial hemorrhage, mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Findings compatible with periventricular leukomalacia, no acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history HNC and CRT, compare to previous measurements. History of RT to the left orbit. There is susceptibility artifact related to patient dental hardware which somewhat limits examination. Posttreatment findings are again seen in the left supraciliary region. There is persistent enhancement along the left superolateral orbital wall and extraconal space extending superiorly through the frontal bone coursing medially adjacent to the left frontal sinus, not appreciably changed when compared to 1/5/2016 and 10/7/2015. Enhancing tissue also extends to the left frontal dura margin as before. No new mass lesions or areas of abnormal enhancement are noted to suggest tumor progression. Lytic osseous defect is better seen on recent CT. The right orbit is unremarkable. There is partial opacification of the bilateral ethmoid sinuses as well as a mucus retention cyst in the left maxillary sinus.

Output: Posttreatment changes in the left supraciliary region with unchanged nonspecific enhancing tissue at the site of the treated squamous cell carcinoma.


Instruction: Generate impression based on medical findings.

Input: Continued episodes of back pain and some discomfort and limited mobility in her back starting from a car accident in January of this year. There is mild anterior wedging of the T12 and L1 vertebral bodies with what may represent trace clefts, but no substantial bone marrow edema. The vertebral body heights are preserved at the other levels. There is no significant loss of disc space height. The vertebral column alignment is within normal limits. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable. There is a small amount of pelvic free fluid, which is likely physiological.

Output: Mild anterior wedge compression fractures of the T12 and L1 vertebral bodies without spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old, with intractable temporal lobe epilepsy. Sensorimotor and cortex mapping for epilepsy presurgical evaluation. Sensorimotor cortical activation observed during the hand, foot and face/tongue motor tasks maps to its expected locations along the pre- and post-central gyri.All tested language paradigms produced reliable language related cortical activation. Language is left dominant with task-dependent minor contributions from the right hemisphere.There is robust cortical activity in the pars orbitalis of the left inferior frontal lobe and modest activity on certain paradigms in the pars opercularis, either or both of which could reflect Broca's area. Fairly robust cortical activity in Wernicke's area is identified along the posterior aspect of the left superior temporal sulcus.

Output: Sensorimotor cortical activity maps as expected along the pre- and post-central gyri.Language is left dominant. Broca's area is identified as expected in the pars orbitalis and/or opercularis of the left inferior frontal lobe. Wernicke's area is identified as expected along the posterior aspect of the superior temporal sulcus.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: history of T4b rectal cancer with rectovaginal fistula. Now s/p chemoradiation. History: rectal cancer PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Near imperceptible residual linear focus of T2 hyperintense signal and diffusion signal abnormality extending from the 12:00 position of the anus and extending anteriorly towards the posterior wall of the vagina (series 4, image 60). This is significantly decreased compared to prior study. Again seen is asymmetry of the external sphincter along its left posterior inferior margin and asymmetric thickening of the left anal wall anteriorly measuring up to 9 mm (series 4, image 60). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant interval decrease in size of previously described anovaginal fistula extending from the 12:00 position of the anal canal.2.Unchanged thickening and asymmetry of the left-sided anal wall and external sphincter.


Instruction: Generate impression based on medical findings.

Input: Reason: RUE/RLE weakness, eval for CVA History: RUE/RLE weakness, eval for CVA. Brain: There is no restricted diffusion to suggest acute infarct. Again noted are changes compatible with prior suboccipital craniectomy and resection of posterior arch of C1 for posterior fossa decompression, with low-lying cerebellar tonsils which extend to the inferior margin of the anterior arch of C1 not significantly changed since the prior study. The ventricles are normal in size without hydrocephalus. There is prominent volume loss involving the superior cerebellar vermis similar to prior. There is no mass, mass effect, or midline shift. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as the pons, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Postcontrast images demonstrate no abnormal parenchymal or meningeal enhancement. Cervical spine: Again seen is T2 signal abnormality involving the right central and dorsal cervical cord from C2 to the C7 level. There is also a associated prominence of the central canal which extends to the lower T1 level on the axial T2 sequence. Overall appearance of the signal abnormality is unchanged. No abnormal enhancement in the cervical spine.Cervical spine alignment is unchanged with reversal of cervical lordosis and mild retrolisthesis of C4 on C5. Bone marrow signal is benign. The vertebral body heights are preserved. No abnormal enhancement. Degenerative changes are specified by the intervertebral level as follows: C2-C3: Minimal disc osteophyte complex without spinal canal stenosis or neural foraminal compromise is identified. C3-C4: Small disk osteophyte complex with mild narrowing of the spinal canal and effacement of the ventral thecal sac. No significant neural foraminal stenosis.C4-C5: Small disk osteophyte complex with effacement of the ventral thecal sac. Minimal right foraminal narrowing, otherwise no significant neural foramina stenosis. C5-C6: Disk-osteophyte complex without significant spinal canal or neural foramina stenosis.C6-C7: Small disk osteophyte complex without significant spinal canal or neural foramina stenosis.C7-T1: No spinal canal stenosis or neural foraminal compromise.

Output: 1.No evidence of acute infarct. No intracranial mass or mass effect. Postsurgical changes of prior Chiari I decompression without significant interval change in position of the low-lying cerebellar tonsils. 2.No significant change in extensive right cervical cord myelomalacia with small adjacent syrinx.3.Mild multilevel degenerative changes as detailed above with mild spinal canal stenosis at C3-C4 and C4-C5. No high-grade spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: The liver has a cirrhotic morphology. 13 mm arterially enhancing lesion in segment VII without definitive washout on delayed phases. Trace ascites. CholelithiasisThe hepatic and portal veins are patent.SPLEEN: Splenomegaly with collateral vessels. 1 cm T2 hyperintense enhancing nodule in the spleen most consistent with a hemangioma.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.

Output: Segment VII arterially enhancing lesion without washout is slightly increased in size compared to the prior exam possibly due to technical factors, but does not meet the criteria for HCC. Continued surveillance is recommended.


Instruction: Generate impression based on medical findings.

Input: 48-year-old woman with history of abdominal pain, altered bowel habits, and elevated inflammatory markers. ABDOMEN:LIVER, BILIARY TRACT: The dome of the liver is not included within the field-of-view. The visualized liver is unremarkable. There is no intrahepatic biliary duct dilatation. The patient is status post cholecystectomy. The common bile duct appears normal.SPLEEN: There is a 54 x 51 mm, lobulated, septated T2 intense, nonenhancing lesion in the spleen (series 4, image 8). The splenic vein is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The small bowel including the terminal ileum appears normal without wall thickening, dilation, or abnormal enhancement. The colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus and adnexa appear normal and there is a right ovarian cyst.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small Tarlov cysts are noted.OTHER: No significant abnormality noted.

Output: 1.No abnormality of the small bowel or colon. Specifically, normal terminal ileum.2.Benign-appearing cystic lesion in the spleen, probably a lymphangioma.


Instruction: Generate impression based on medical findings.

Input: 63 year old with history of right lumpectomy at an outside hospital in 2005 for IDC and right simple mastectomy in February 2013 for recurrent IDC. Status post right mastectomy.There is heterogeneous amount of fibroglandular tissue in the left breast.Minimal parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right mastectomy bed. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Numbness in hands and feet. There is trace prominence of the cervical spinal cord central canal. The spinal cord otherwise appears unremarkable. The vertebral column alignment is mildly straightened in the sagittal plane. There is a small eccentric left posterior disc-osteophyte complex at C5-6 without significant spinal canal stenosis. There is no evidence of mass lesions within the spinal canal. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Trace prominence of the cervical spinal cord central canal. The spinal cord otherwise appears unremarkable. 2. Small eccentric left posterior disc-osteophyte complex at C5-6 without significant spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Breast cancer. Left shoulder pain. No recent trauma. The rotator cuff tendons and muscles appear normal. The acromioclavicular joint appears normal. I see no frank fluid within the subacromial/subdeltoid bursa. Minimal enhancement of the bursa following gadolinium administration could conceivably represent a very mild bursitis, but this is equivocal. Glenohumeral joint alignment is within normal limits. Intermediate signal intensity traversing the anterior superior labrum may represent a tear or simply a normal variant, and may not be of any current clinical significance. The remainder of the labrum appears normal. There is trace fluid within the right glenohumeral joint extending into the subscapular recess, within normal limits. The tendon of the long head of the biceps appears normal. I see no soft tissue masses or bone lesions.

Output: Minimal enhancement of the subacromial/subdeltoid bursa is of uncertain clinical significance, but could conceivably represent a very mild bursitis. I see no frank fluid within the bursa nor do I see any other specific findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with a 30 year history of IV heroin abuse here with severe low back pain. Tender to palpation along L4-L5 with mild weakness in left leg. Evaluate for cord compression; suspect epidural abscess. Multilevel mild degenerative changes in the cervical and lumbar spine without high-grade spinal canal stenosis. 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. At L5-S1 there is a disc bulge and disc desiccation present.There are degenerative changes present in the cervical spine with the right-sided uncovertebral osteophytes and disc material at C5-6 and C6-7 and some encroachment of the right-sided exiting nerve roots at C6-7.

Output: 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. There are some degenerative changes present in the lower cervical spine and lower lumbar spine with suggestion of encroachment of right-sided exiting nerve roots at C6-7.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: Reason: evaluate for gallstone in duct History: epigastric pain, N/V Examination mildly limited by motion.ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly prominent in size measuring up to 22 cm in the craniocaudal dimension with an otherwise normal morphology. There is a mildly T2 hyperintense structure within hepatic segment 5 with reference measurements below which is nonspecific but lacks suspicious enhancement characteristics and which is most likely benign. There are a few additional scattered subcentimeter structures which are too small to characterize but likely represent cysts. The hepatic vasculature appears patent.The gallbladder demonstrates normal distention. Cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. No intra or extrahepatic biliary ductal dilatation. No choledocholithiasis is identified.SPLEEN: There is diffuse mildly decreased parenchymal signal suggestive of hemosiderin deposition. Scattered areas of increased T2 signal and enhancement within the spleen are nonspecific but may reflect hemangiomas.PANCREAS: The pancreas demonstrates diffusely decreased T1 signal, restricted diffusion, and mildly heterogeneous enhancement without evidence of focal necrosis. Mild fat stranding surrounds the pancreatic tail without discrete fluid collection. The pancreatic duct is not dilated. The main pancreatic duct crosses the common bile duct anteriorly and terminates in the minor papilla consistent with pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole simple cyst. No hydronephrosis.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: 9/20/2016 04:00:00)HEPATIC SEGMENT 5 LESION: 0.9 x 0.8 cm (Image 23, Series 6).

Output: 1.Findings compatible with pancreatitis without evidence of complication.2.Pancreas divisum.3.Cholelithiasis without evidence of cholecystitis or choledocholithiasis.4.Mild hepatomegaly. Hemosiderin deposition within the spleen which may be related to sickle cell disease.


Instruction: Generate impression based on medical findings.

Input: Relapsed neuroblastoma, pre-NANT 11-01. Orbits: There has been near resolution of the anterior and central skull base tumor with mild residual enhancement along the left lesser wing of the sphenoid and sphenoid roof, without appreciable mass effect upon surrounding structures. There is persistent focal T2 hyperintensity in the canalicular and posterior orbital portions of the left optic nerve. The right orbit is unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The previously described right occipital bone region finding is unchanged and may be related to the lambdoid suture. There is a small amount of residual scattered paranasal sinus mucosal thickening.

Output: 1. Near resolution of the anterior and central skull base tumor with mild residual enhancement along the left lesser wing of the sphenoid and sphenoid roof, without appreciable mass effect upon surrounding structures.2. Persistent focal T2 hyperintensity in the canalicular and posterior orbital portions of the left optic nerve may be related to prior compressive neuropathy. 3. Decreased pansinus mucosal inflammation.


Instruction: Generate impression based on medical findings.

Input: 45 years Female (DOB:12/10/1970)Reason: please do dr javed MS protocol compare to prior History: weakness and fatiguePROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD There is a marked degree of periventricular , subcortical, corpus callosum and to a lesser degree cerebellar white matter lesions which are hyperintense on T2 and FLAIR MRI but not associated with contrast enhancement and not significantly changed since the prior exam.An ill defined 6mm focus of enhancement adjacent and anterior to the right putamen is present and unchanged since the previous exam..A10 mm extra axial mass adjacent to the right occipital lobe is stable since May but measured 8 mm in 2011.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is nasopharyngeal soft tissue thickening present. This was also present on the prior exam.

Output: 1.Extensive white matter lesions are stable since the prior exam.2.An enhancing lesion adjacent to the right putamen is not associated with T2/FLAIR signal abnormality and is thus of uncertain significance. It is unchanged since the prior exam.3.An extra-axial mass adjacent to the right occipital lobe is stable since May but has slightly enlarged wince 2011. Presumably this represents a small meningioma.4.There is nasopharyngeal soft tissue thickening present. This is non-specific. Please correlate with clinical exam findings. It is stable compared to the prior exam


Instruction: Generate impression based on medical findings.

Input: 45-year-old female. Status post Whipple 3/13/14 for IPMN, pancreatic divisum and chronic pancreatitis. Needs surveillance MRCP in March 2015. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic mass. No biliary ductal dilatation. Cholecystectomy clips. Fatty infiltration of the liver. Portal vein and hepatic veins are patent.SPLEEN: Subcentimeter T2 hyperintense focus in the spleen without appreciable enhancement, likely a cyst.PANCREAS: Post surgical findings of Whipple procedure. No evidence of local recurrence. Fatty atrophy of the pancreas, which has normal T1 signal intensity. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post-surgical changes in the midline abdomen.OTHER: No significant abnormality noted.

Output: Post-surgical findings of Whipple procedure without evidence of recurrence.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Multiple sclerosis; follow-up progression. Signs and symptoms: Anesthesia. Pre and post enhanced brain MRI:Examination is performed utilizing multiple sclerosis protocol. Precise comparison is hindered secondary to difference in technique between the 2 exams (multiple sclerosis protocol on current study and routine brain MRI on prior exam) and lack of sagittal FLAIR on prior study. Images through posterior fossa are also limited due to extensive pulsation artifact.There is a suspected lesion in the right aspect of pons and axial FLAIR series (series 601 image 16) which cannot be confirmed with certainty on sagittal FLAIR sequence and could be artifactual.Few tiny demyelinating plaques in supratentorial subcortical and periventricular white matter are present. There is subtle interval increase in the number of lesions since prior study however note should be made that this observation can be at least partially secondary to difference in technique.No detectable abnormal enhancement on post infused images. Cortical sulci and ventricular system as well as the CSF spaces remain within normal for patient of stated age of 24.

Output: Minimal findings of chronic demyelinating disease in the supratentorial space with suggestion of subtle interval progression since prior exam from 2013 as detailed. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 6.7 x 4.4 x 6.4 cm.Peripheral Zone: T2 hypointense lesion with mild corresponding ADC signal in the left apical peripheral zone measuring approximately 1.3 x 1.2 cm. No corresponding early enhancement.Central Gland: Moderate to marked degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Focal enhancement in the right L5 endplate consistent with degenerative change. OTHER: No significant abnormality noted.

Output: 1.Indeterminate lesion in the left apical peripheral zone may represent a prostate malignancy.


Instruction: Generate impression based on medical findings.

Input: Female 80 years old Reason: 79 yo F with HCC, please evaluate for interval change compared to outside MRI dated 12/2/14. History: none Study is significantly limited due to motion artifact and lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. The liver parenchyma is diffusely heterogeneous and there is a nodular contour, caudate lobe hypertrophy and prominence of the hepatic fissures, consistent with cirrhosis. There is signal dropout on in phase images suggestive of iron deposition. T2 iso-/hypo-intense hepatic lesion measures 4.6 x 3.8 cm (series 8, image 10). The lesion is remeasured on prior study at 5.7 x 4.6 cm. Central T2 hyperintense signal /diffusion signal within the lesion is nonspecific and not significantly changed compared to prior study. Evaluation of this lesion is significantly limited in the absence of contrast.Evaluation for hepatocellular carcinoma is significantly limited in the absence of intravenous contrast however there are no additional areas of T2 signal hyperintensity or diffusion restriction to suggest new lesions.SPLEEN: Splenomegaly measuring 14.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace abdominal ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable position of a cholecystotomy tube. Left upper quadrant collateral vessels are noted.

Output: 1.Limited study due to motion and the absence of intravenous contrast. Comparison with outside images demonstrates decrease in size of treated hepatic lesion. No new lesions are identified given the limitations.2.Cirrhotic liver morphology with splenomegaly and splenic varices.


Instruction: Generate impression based on medical findings.

Input: Reason: Evalute suspected mid thoracic meningioma seen on non contrast MRI History: Mid thoracic pain The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: There is no evidence for a thoracic meningioma.


Instruction: Generate impression based on medical findings.

Input: Assess for osteochondroma. Again seen is the small bony excrescence from the posterior margin of the proximal humerus that has decreased in size in comparison from study obtained 2/4/2014. We see no associated soft tissue mass and suspect that this represents spontaneous resolution of the osteochondroma, however if the patient complains of pain or there is a palpable mass, MRI can be considered.

Output: Osteochondroma as described above.


Instruction: Generate impression based on medical findings.

Input: 74-year-old male with history of metastatic lung cancer, right hip pain and unsteady gait. Note is made of multiple foci of abnormal marrow signal and enhancement within the right ischium, right and left iliac wings, sacrum, left lesser trochanter, and right proximal femoral diaphysis. For reference purposes, a lesion within the posterior/medial right ilium measures 3 cm in greatest dimension. We see no fracture.Mild osteoarthritis affects the right hip. There is increased signal intensity traversing the superior labrum compatible with tear with adjacent lobulated fluid signal intensity lesion likely representing a para-labral cyst. Increased signal intensity within the anterior labrum likely represents a combination of degeneration and tearing. There is a 1 cm ossicle anterior to the superior aspect of the femoral head, perhaps representing an old fractured osteophyte. There is minimal enhancement of the hip joint suggesting mild synovitis, although we see no frank joint effusion.Mild osteoarthritis affects the left hip with adjacent para-labral cysts suggesting an underlying labral tear. Moderate multilevel degenerative disk disease affects the lower lumbar spine. There is mild muscular atrophy of the gluteus minimus bilaterally.

Output: 1.Multiple metastatic lesions as described above.2.Osteoarthritis of the right hip with superior labral tear.3.Other degenerative changes as above.


Instruction: Generate impression based on medical findings.

Input: Evaluate ventricle size. Hydrocephalus. There is a large infratentorial cystic mass posterior and superior to the cerebellar hemispheres causing mass effect on the cerebellum and the frontal lobes. The fourth ventricle is enlarged with altered configuration. The lateral and third ventricles appear normal in size. An MRI is recommended for further evaluation.There is no evidence of intracranial hemorrhage. There are questionable foci of hypodensity in the left cerebellar hemisphere of unclear clinical significance.A shunt catheter traverses the right parietal bone and with its tip located in the large cystic infratentorial mass.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Large cystic mass posterior and superior to the cerebellar hemispheres causing mass effect with enlargement of the fourth ventricle. Shunt catheter tip is within the cystic mass. An MRI is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: There are many motion artifact that degrades the study. During the study the patient was confused and unable to cooperate. Interpretation is limited. Diffusion images demonstrates high signal in the left posterior limb of internal capsule nucleus that extends to the left cerebral peduncle with no convincing evidence of restricted diffusion in ADC map.There is increased T2/FLAIR signal with corresponding low signal in T1 seen in the right insular cortex extending to the lateral aspect of the precentral gyrus and to the right middle frontal gyrus, and the subcentral lobule, in the distribution of the superior division of the right cerebral artery.There is cortical-based T2/FLAIR high signal in the left occipital pole.There is no evidence of midline shift. Ventricular size is prominent, age related.There is mild to moderate prevascular T2/FLAIR lesions, age related. The sella appears empty.The right eyeball lens is thin. The paranasal sinuses are clear. Mastoid air cells are clear.

Output: 1.No convincing evidence of acute cerebral infarction. 2.There is evidence for old infarctions in the left occipital pole and in the distribution of the superior division of the right middle cerebral artery.


Instruction: Generate impression based on medical findings.

Input: 5 year old female with subdural fluid collection. Postoperative exam. Right-sided shunt ventriculostomy catheter is unchanged in position. Right frontal catheter terminating in subdural collection unchanged. There is a new right parietal catheter terminating in subdural collection. The left frontal catheter terminating in subdural collection unchanged in position.There is new air in the right subdural collection. The right subdural collection is not significantly changed in size, measuring approximately 3.9 cm and greatest thickness, previously measured 4.1 cm (series 80498, image 43).The left subdural collection with internal air is not significantly changed, measuring 1.7 cm in greatest thickness, previously measured 1.8 cm (series 80498 on image 29). No evidence of acute hemorrhage.The common lateral ventricular chamber is unchanged in morphology or size, measuring approximately 8.0 cm in maximal transverse dimension, previously measured 8.2 cm (series 8 stroke 498, image 30).There is stable displacement of cerebellar tonsils below foramen magnum by 9 mm, previously this measured 9 mm.There is persistent abnormal morphology of the brain parenchyma and sulci, consistent with severe periventricular leukomalacia and areas of porencephaly in superior frontal and right occipital lobes, as described on recent MRI and unchanged. Abnormal morphology of calvarium, with bilateral burr holes unchanged.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Stable ventricular size.2.Stable size of bilateral subdural collections, with new air and new catheter in right subdural collection.3.Abnormal brain parenchyma, calvarium, and ventricular configuration; findings are unchanged and most consistent with severe periventricular leukomalacia and porencephaly, as described on recent MRI. 4.Stable inferior displacement of cerebellar tonsils, consistent with Chiari I malformation.


Instruction: Generate impression based on medical findings.

Input: 11-month-old female with infantile spasms. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. No abnormal mass lesions are appreciated intracranially. The pattern of myelination is within acceptable limits for patient's age. The CSF spaces are appropriate for the patient's stated age with no midline shift. Major vascular flow voids are maintained. 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: MRI of the brain is within normal limits.