Instruction: Generate impression based on medical findings.

Input: Clinical question: Assess brain lesions. Signs and symptoms: seizure. Non-enhanced CT brain:Examination demonstrate a well demarcated low attenuation lesion in the inferior right frontal lobe. There is effacement of adjacent cortical sulci and minimal indentation of right frontal horn. There is no interval change since prior examination of 5 -- 11 -- 2010.Additional small foci of low attenuation adjacent to the trigone of right lateral ventricle is also again identified and read no interval change. There are two additional apparent cortical based low attenuation in the left mid temporal lobes with no evidence of interval change. Subcortical low-attenuation in the right frontal lobe along to its interhemispheric aspect extends inferiorly to the level of previously described right frontal lobe lesion.These findings on MRI examination of brain on the same date do not have the appearance of stroke.There is bony thickening and new bone formation along the floor of anterior cranial fossa with possibly some internal lytic changes. This finding may represent fibrous dysplasia. This finding is immediately at the level of large right frontal lobe lesion and I can't be certain whether this finding is related to intracranial findings.CTA of intracranial circulation:Carotid system.Right internal carotid. Normal interval carotid artery across the cavernous sinus and in its supraclinoid portion. There is normal appearing right anterior and middle cerebral arteries and their branches. Review of coronal, sagittal and axial 2-D MIP images demonstrate no definitive evidence of any detectable abnormality in the distal branches of anterior and middle cerebral arteries that are not well visualized on the 3-D reformatted images.Left carotid.The left internal carotid artery across the cavernous sinus and its supraclinoid portion remains within normal. There is also normal visualization of the left anterior annular cerebral arteries and their branches. To evaluate the distal branches of left anterior and middle cerebral arteries which are not visualized on 3-D reformatted images the 2-D MIP images in coronal, sagittal and axial sequences were reviewed. These 2-D images fail to demonstrate any detectable abnormality of distal branches.Vertebral basilar system.There is normal visualization of bilateral vertebral arteries and their intracranial component. Basilar artery and all of its branches are well visualized and unremarkable.65 cc of Omnipaque 350 was administered for above study.

Output: 1.Stable unenhanced CT examination of brain since prior exam. Multiple intracranial findings are highly suspect for masses and unlikely to represent strokes.2.Expansile bony lesion of right frontal bone along the floor of the right anterior cranial fossa may represent fibrous dysplasia, however the large right frontal lobe lesion that abuts the inner table of the skull in the right frontal lobe may represent a combined osseous and intracranial pathology like a neoplasm. Patient had a nonenhanced MRI of brain however an enhanced MRI is highly recommended to further evaluate multiple unusual intracranial lesions. Please reviewed report of an enhanced MRI of brain.3.Negative CTA of intracranial vasculature.4.CTA is not in the appropriate test for detection of intracranial enhancement.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer treated with RT, now with rising PSA, prostate biopsy negative. This study is limited the to patient's inability to complete the study at one session and lack of intravenous contrast.PELVIS:PROSTATE:Prostate Size: 4.6 by 3.2 by 3.3-cm.Peripheral Zone: Prostate gland is atrophic due to radiation therapy. There are multiple radiotherapy seeds throughout the prostate. In the right basal the prostate there is a 1.3 x 1.1 cm hypointense mass involving both the right transition zone and peripheral zone anteriorly.Central Gland: Hypointense focus involving the right transition zone near the base as described above.Seminal Vesicles: Unremarkable.Extracapsular Extension: Not seen.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Changes secondary to radiation therapy. Right anterior basal lesion involving the peripheral and transition zones compatible with prostate cancer.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: Ms. Flores is a 37 year old female with known right breast cancer undergoing neoadjuvant chemotherapy. She presents today for MRI evaluation to assess for response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.A vascular port is present in the left medial chest wall.There has been an interval decrease in enhancement of known malignancy in the right breast, 3:00 location. At present, there are a few faint enhancing foci seen in this area, spanning approximately 2.1 x 0.5 x 1.4 cm (AP x ML x SI), previously measuring 1.8 x 2.0 x 2.1 cm. Susceptibility artifact from biopsy marker clip is seen centrally within these foci.No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Few residual enhancing foci in the right central breast, spanning approximately 2.1 cm in the AP dimension. Biopsy marker clip is located centrally within these foci.If breast conservation therapy is desired, a bracketed wire localization targeting the mammographically seen biopsy marker clip/density/calcifications can be performed. The span of density/calcifications approximates the MR findings, measuring approximately 2.3 cm in the AP dimension.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Dizziness, unilateral right tinnitus and sensorineural hearing loss. There is a vascular structure that courses adjacent to the proximal cisternal segments of the right cranial nerve 7 and 8 complex. The bilateral cranial nerve 7 and 8 complexes are otherwise intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There are scattered foci of T2 hyperintensity in the imaged portions of the cerebral white matter. There are bilateral lens implants.

Output: 1. A vascular structure that courses adjacent to the proximal cisternal segments of the right cranial nerve 7 and 8 complex is of indeterminate significance. 2. Scattered foci of T2 hyperintensity in the imaged portions of the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Inflammatory arthritis LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: There is increased fluid signal surrounding the fourth flexor tendons, as well as the adductor pollicis and opponens pollicis tendons. There is a mild amount of subcutaneous edema surrounding the soft tissues of the thumb but the underlying marrow signal is normal. BONES: No significant abnormality noted. ADDITIONAL

Output: Tenosynovitis of multiple flexor tendons described above with nonspecific subcutaneous edema of the thumb. There are no osseous erosions or joint effusions identified.


Instruction: Generate impression based on medical findings.

Input: Male 75 years old Reason: 75 yo male with hx of pancreas lesion; please eval for changes History: pancreas lesion ABDOMEN:LIVER, BILIARY TRACT: Status-post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Clustered cystic lesions again noted in the region of the pancreatic head and uncinate process. The largest measures 1.3 x 1.5 cm (series 3, image 31) and contains a solid focus on the nondependent wall. While this may represent debris a solid nodule cannot be excluded, particularly in the absence of intravenous contrast.Cranial to this there is a second 1.7 x 1.4 cm lobulated cystic lesion without evidence of internal nodule. Both lesions demonstrate interval decrease in size of the cystic component compared to prior study. The solid component in the more caudally located lesion is unchanged in size.Additional tiny cystic lesions are not significantly changed compared to prior study.The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable appearance on renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Clustered cystic lesions predominantly in the pancreatic head and uncinate process. There has been an interval decrease in size of the cysts compared to prior study. One of the lesions contains a solid component. While this may represent a complex IPMN, the possibility of malignant degeneration cannot be excluded, particularly in the absence of intravenous contrast. Correlation with results of endoscopic sonography recommended.


Instruction: Generate impression based on medical findings.

Input: 80 year-old male postop day number 1 status post ex lap with distal subtotal gastrectomy now with delay status post fall with altered mental status and hit head. Negative LOC. Evaluate for acute process/bleed. There is no evidence of intracranial hemorrhage, mass or edema. MRI of the brain could be obtained if there remains clinical concern for acute ischemic disease. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute findings to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: The craniocervical junction is unremarkable. Vertebral body heights are normal. Alignment is grossly maintained. Bone marrow signal is benign. No abnormal signal in the cervical or upper thoracic cord.There are multilevel degenerative changes throughout the cervical spine, as described below:C2/3: There is a mild posterior disc bulge without significant spinal canal stenosis. No neural foraminal stenosis. C3/4: There is a mild posterior disc bulge with minimal spinal canal stenosis. No significant neural foraminal stenosis. C4/5: There is a small disc osteophyte complex which effaces the ventral thecal sac and results in mild spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis related to uncovertebral hypertrophy. C5/6: There is small disc osteophyte complex without significant spinal canal stenosis. There is minimal bilateral neural foraminal stenosis.C6/7: There is small disc osteophyte complex with minimal spinal canal stenosis. There is minimal bilateral neural foraminal stenosis.C7/T1: No significant spinal canal or neural foraminal stenosis. There is mild bilateral facet arthropathy.

Output: Mild multilevel degenerative changes in the cervical spine without high-grade spinal canal or high-grade neural foraminal stenosis at any level. Specifically, no significant neural foraminal narrowing at the C7-T1 level is appreciated. Please see additional levels as above.


Instruction: Generate impression based on medical findings.

Input: Metastatic prostate cancer needs reevaluation and comparison to prior examinations with measurements, IRB 09 -- 267 ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No biliary ductal dilation. The hepatic vasculature is patent. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild cortical atrophy bilaterally. Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Right lower quadrant ostomy. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. Fluid collection in the surgical bed measures 5.1 x 4.1 cm in oblique transaxial dimensions (series 4, image 31), near stable.BLADDER: Status post cystectomy.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fatty bone marrow replacement in the pelvis without suspicious lesions.

Output: 1.Postsurgical findings related to prior cystoprostatectomy with a fluid collection in the surgical bed, near stable.2.No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: History of peritoneal mesothelioma. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again is a subcapsular T2 weighted hyperintense lesion in segment 6 of the liver (series 4/20) measuring approximately 1.6 x 0.7 cm without associated restricted diffusion or enhancement, compared to 1.9 x 1.0 cm previously. No additional focal liver lesion. No intra or extrahepatic biliary ductal dilatation.Mild bulging of the right hepatic dome is unchanged and is isointense to the remainder of the liver.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: Pancreatic tail focus matches the spleen on all imaging sequences, compatible with a benign intrapancreatic accessory spleen. 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: No significant change in the segment 6 benign appearing hepatic cyst.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old. Reason: thyroid cyst, pls assess for changes History: thyroid cyst RIGHT LOBE MEASUREMENTS: 1.5 x 1.4 x 4.3 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.4 x 5.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous echotexture, without focal lesion.LEFT LOBE: The previously described lower pole cystic nodule has significantly decreased in size, now only with residual solid component measuring 0.6 x 0.5 x 0.7 cm, hypoechoic, without significant internal vascularity. An additional small well marginated upper pole nodule measures 0.3 x 0.2 x 0.4 cm, hypoechoic, noncalcified, without significant internal vascularity.ISTHMUS: Homogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant interval decrease in size of the left lower pole cystic nodule, with residual subcentimeter solid component.


Instruction: Generate impression based on medical findings.

Input: 46 year old female, with a history of cervical cancer s/p LEEP, DLBC lymphoma on chemotherapy EPOCH-R, was noted with severe RV dilatation on echocardiogram. She is referred for cardiac MRI for further evaluate RV function. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), the LVEDV is 181 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 119 g (normal range 114+/-24). No LV hypertrophy was noted. Basal anterior interventricular septum is measured as 11 mm. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is moderately to severely enlarged (46 mm). Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 226 ml (normal range 110+/-24), the RV end systolic volume index is 59 ml/m2 (normal range 22+/-8), and the RVESV is 122 ml (normal range 35+/-13). No aneurysm or enhancement.Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is aortic regurgitation, visually estimated to be trace.Mitral ValveThe mitral valve opens widely and there is mitral regurgitation with the jet directed posteriorly.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe valve opens normally. Dedicated valvular imaging was not performed. However, tricuspid regurgitation is present. The jet is eccentric and is directed anteriorly toward right AV groove. AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (47 mm). Proximal left pulmonary artery is measured at 28 mm and proximal right pulmonary artery is measured at 33 mm. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsLeft scapular mass reduced in size with residual thoracic lymphadenopathy. For reference, there is a left axillary lymph node which is 22 mm short axis. Left supraclavicular lymph node is 15mm. The osseous structures of the left shoulder girdle, including the scapula, are not well visualized. Previous right axillary lymphadenopathy is not visualized. Right port catheter terminates at the superior cavoatrial junction.

Output: 1. The left ventricle is normal in size and function. 2. The right ventricle is severely dilated with mildly reduced systolic function. 3. The main pulmonary artery is severely dilated, suggestive of pulmonary artery hypertension.4. Left scapular mass reduced in size with residual thoracic lymphadenopathy.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: planning for SRS, history of NSCLC and brain mets. Multiple enhancing lesions indicating brain metastasis were again demonstrated.In particular, three supratentorial lesions including bilateral paracentral lobule lesions and left occipital lobe lesions, and bilateral cerebellar hemispheric lesions do not show any interval change since prior exam.There is no evidence of acute intracranial hemorrhage or acute ischemic infarct. There is no midline shift or herniation. The ventricles and basal cisterns are unchanged in size and configuration. The skull, orbits, and scalp soft tissues are unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: 1. No change of multiple enhancing metastatic lesions supra and infratentorially as described above since prior exam.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Eye pain, vision loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of T2 hyperintensity in the cerebral white matter, which appear to be similar to the exam from 2010. There is no abnormal intracranial enhancement. There appears to be a partially empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The slight swelling of the bilateral eyelids is better depicted on the recent orbit MRI.

Output: 1. Suggestion of a partially empty sella, which may be a manifestation of pseudotumor cerebri, along with mild prominence of the optic nerve sheath cerebrospinal fluid depicted on the recent orbit MRI, versus an normal variant. 2. A few punctate foci of T2 hyperintensity in the cerebral white matter, which appear to be similar to the exam from 2010, are nonspecific, but are not particularly reminiscent of multiple sclerosis. 3. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Reason: eval of lumbo-sacral plexus 2/2 b/l LE weakness History: b/l LE weakness, falls. Metallic artifact from bilateral hip orthopedic hardware limit evaluation.BONE MARROW: No significant abnormality noted. No bony abnormality. SOFT TISSUES: Fatty atrophy of the gluteal musculature. No abnormal mass. JOINTS: Limited evaluation due to metallic artifact. ADDITIONAL

Output: No abnormal mass or bony abnormality identified.


Instruction: Generate impression based on medical findings.

Input: History of NF 1. New right thigh/buttock pain and twitching. Evaluate for hamartomas and neurofibromas. Brain: Examination is slightly motion degraded. No intracranial mass or mass effect is appreciated. No abnormal parenchymal signal abnormality is seen. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No extra-axial collections. Cerebellar tonsils are borderline low-lying measuring up to 3.5 mm below the foramen magnum without clear evidence of Chiari I malformation.Sella and orbits are grossly within normal limits. There is minimal mucosal thickening involving the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits. There is a small cervical syrinx which is noted at the C5 level and extends inferior, outside the field-of-view, (sagittal STIR series 25 image 16).Lumbar spine:Examination is motion degraded. The lumbar spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1level. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. Incidentally seen is a small focus of CSF intensity measuring 9 x 8 mm at the L4-L5 level which may represent a small arachnoid cyst or diverticulum, and of doubtful clinical significance. Specifically no masses within the lumbar spinal canal or neural foramina are appreciated within the limits of noncontrast study. Please refer to separate report for findings in the pelvis. Small subcutaneous nodules are noted in the posterior paraspinous soft tissues compatible with superficial neurofibromas.

Output: 1. MRI of the brain without contrast is within normal limits. Cerebellar tonsils are borderline low-lying without clear evidence of Chiari I malformation.2. Incidentally seen on the brain MRI study is a small cervical syrinx at the C5 level which extends inferiorly, outside the field-of-view. Prior cervical spine MRI from 8/24/2012 also demonstrates a small cervical syrinx. Follow-up dedicated cervical and thoracic spine MRI can be considered for further evaluation as clinically indicated.3. No masses within the lumbar spinal canal or neural foramina are appreciated within the limits of noncontrast study. Please refer to separate report for findings in the pelvis.


Instruction: Generate impression based on medical findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: vertigo, history of CVA, please eval History: vertigo, history of CVA, please eval There is no evidence of acute ischemic or hemorrhagic lesion.There are multifocal tissue losses involving bilateral basal ganglia and thalami indicating chronic lacunar infarctions.Multifocal patchy scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease. Unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on bilateral maxillary sinuses and a retention cyst in the right maxillary sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion.Mild to moderate non specific small vessel ischemic disease, no change since prior scan.


Instruction: Generate impression based on medical findings.

Input: History of invasive breast carcinoma progressed after aromatase inhibitor status post right radical mastectomy 12/14/2015 at outside hospital with bulky tumor left behind close margins positive nodes and direct skin extension. Evaluate for distant metastases. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules compatible with metastatic disease, see reference left apical nodule and right apical nodule measurements below. Left lung base paramedial mass, see measurements below.Right hilar mass/conglomerate lymphadenopathy and extensive soft tissue paramediastinal soft tissue thickening. The dominant right hilar/mediastinal mass measurement is provided below.There is nodular soft tissue pleural thickening and enhancement of the right hemi-thorax, suspicious for pleural metastatic disease.Small left pleural effusion.MEDIASTINUM AND HILA: Right hilar/mediastinal mass. Paratracheal lymphadenopathy measuring approximately. The right hilar/mediastinal lesion partially encases the SVC which is mildly narrowed. Small pericardial effusion.CHEST WALL: Postsurgical changes from right mastectomy. Abnormal restricted diffusion in the right axillary region may represent residual tumor. There is abnormal postcontrast enhancement which appears to involve several right lateral ribs such as on image 51 of series 100 which reflect metastatic osseous disease and less likely healing fractures.ABDOMEN:LIVER, BILIARY TRACT: Numerous liver metastases. Reference right hepatic dome segment 8 lesion measurement is provided below. No biliary ductal dilatation. The vessels are patent. Porta hepatis lymphadenopathy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing and minimally complex cysts.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.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 2/2/2016 13:00:00)LEFT APICAL NODULE: 1.5 x 1.1 cm (Image 15, Series 7).RIGHT APICAL NODULE: 1.4 x 1.3 cm (Image 14, Series 7).LEFT LUNG BASE PARAMEDIAL MASS: 5.2 x 3.9 cm (Image 38, Series 7).RIGHT HILAR MASS/CONGLOMERATE LYMPHADENOPATHY: 5.5 x 4.4 cm (Image 17, Series 10).PARATRACHEAL LYMPH NODE: 2.5 x 1.6 cm (Image 12, Series 10).RIGHT HEPATIC DOME SEGMENT 8 LESION: 1.6 x 1.3 cm (Image 8, Series 20).

Output: Multiple bilateral pulmonary metastatic nodules/mass, right hilar mass/conglomerate lymphadenopathy and numerous liver metastases. Suspected metastatic right hemi-thorax pleural disease. Suspected right lateral rib metastases; consider bone scan for a more sensitive evaluation of bone metastases. Right axillary signal abnormality may be post-surgical or residual tumor.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with multiple sclerosis,experiencing paresthesias, evaluate for progression. Again seen are multiple FLAIR hyperintense lesions in the periventricular and subcortical white matter with distribution and morphology consistent with known chronic demyelinating disease. Compared to 3/18/2013, no new lesions are appreciated. A few of these lesions demonstrate T1 hypointensity. Brain parenchymal volume is grossly preserved. No intracranial mass or mass effect. Ventricles are normal in size. Normal vascular flow voids are present. Calvarium and extracranial soft tissues are unremarkable.

Output: Multiple FLAIR hyperintense lesions consistent with known demyelinating disease. No new lesion compared to 3/18/2013 to suggest progression.


Instruction: Generate impression based on medical findings.

Input: Male 58 years old PELVIS:PROSTATE:Prostate Size: The prostate measures 5.3 x 4.0 x 6.2 cmPeripheral Zone: There is a dominant focus of T2 signal abnormality posteriorly in the midline within the mid gland/apex. This is dark on ADC map. This measures approximately 0.9 x 0.6 cm (series 703, image 124). A second focus of signal abnormality is identified in the right paracentral mid gland/base posteriorly measuring 1.2 x 0.6 cm (series 703, image 264). These are suspicious for foci of prostatic adenocarcinoma.Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No seminal vesicle invasion.Extracapsular Extension: No convincing extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two foci of signal abnormality within the peripheral zone suspicious for foci of prostatic adenocarcinoma. The largest measures 1.2 cm in maximum dimension. No extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on medical findings.

Input: Back pain wrapping around to sternum. Evaluate for acute changes, myelopathy, foraminal stenosis, known thoracic disc bulge with mild canal stenosis previously. At T5/6, there is mild right paracentral disc bulge with mild flattening of the right spinal cord. At T7/8, there is right paracentral disc bulge with mild flattening of the right spinal cord. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild loss of disc height at multiple levels from T2/3 through T7/8. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or foraminal stenosis. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.

Output: Right paracentral disc bulges at T5/6 and T7/8 with mild flattening of the right spinal cord at these levels. 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: 20 year-old female with knee pain for one to two years MENISCI: The medial and lateral menisci are within normal limits.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal. Bone marrow signal is within normal limits throughout.LIGAMENTS: The cruciate and collateral ligaments are intact. Specifically, the lateral collateral ligament proper and iliotibial band appear normal.EXTENSOR MECHANISM: The quadriceps and patella tendons appear intact.

Output: Normal knee without specific findings to explain the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old, with history of a left cerebellopontine angle meningioma status post resection, surveillance imaging. Findings are again seen compatible with left retrosigmoid craniotomy for resection of a left CP angle meningioma. Enhancing tissue within the left pontine cistern is unchanged measuring up to 7 mm in overall thickness. As before, this tissue exerts mild mass effect upon the left aspect of the pons but there is no evidence of pontine edema. Also similar to prior, there appears to be an enhancing dural tail which extends from this tissue into the left internal auditory canal.No new or concerning lesions are seen. A vague focus of enhancement within the midline pons is unchanged and favored to represent a capillary telangiectasia. Brain parenchymal morphology is otherwise unremarkable. No new areas of signal abnormally are seen. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.Redemonstration of postoperative findings related to prior left CP angle meningioma resection.2.Enhancing tissue within the left prepontine cistern, favored to represent residual meningioma, is unchanged.3.No new or concerning intracranial lesions are seen.


Instruction: Generate impression based on medical findings.

Input: Female, 11 years old, with arachnoid cyst, presenting with recurrence of dizziness, assess for changes. A nonenhancing extra-axial cystic lesion is demonstrated interposed between the left frontal lobe and calvarium. This lesion continues to measure approximately 32 x 27 mm and shows no significant change in size.Newly seen on this examination is a vague, 5 mm focus of soft tissue which appears to be situated at the most dependent portion of the cyst given supine positioning of the patient (see image 11 series 10 and image 11 series 8). This structure is not discretely visualized on the prior examinations, though this could reflect differences in technique.As before, no part of the cystic lesion enhances. The cyst exerts mass effect upon the adjacent left frontal lobe parenchyma but without pathologic parenchymal signal abnormality. The remainder of the examination is within normal limits.

Output: 1.No significant change in the overall size of an extra-axial cystic lesion along the left frontal lobe.2.Newly visualized on this examination is a small quantity of nonenhancing ill-defined soft tissue which appears to be layering in the most dependent portion of the cyst given supine positioning. Although this tissue was not clearly evident on prior exams, differences in technique may have prevented its identification. 3.Given that this tissue is nonenhancing and located dependently, it may simply represent a small quantity of layering debris. The possibility of a growing nodule is considered less likely at this point. If further imaging evaluation is warranted, repeat imaging could be considered with sequences obtained in prone or lateral decubitus positions in an attempt to demonstrate mobility of this tissue within the cyst.


Instruction: Generate impression based on medical findings.

Input: Female 76 years old Reason: solid pelvic mass suggestive of a pedunculated fibroid but left ovary not seen raising possibility of solid ovarian tumor History: intermittent abdominal pelvic pain PELVIS:UTERUS, ADNEXA: Uterus measures 4.2 x 2.6 x 5.9 cm. There is a T1 hyperintense lesion in the fundus of the uterus measuring 11 mm and may represent a endometrioma.Right adnexa measures 2.4 x 1.3 cm and is located adjacent to the right pelvic sidewall vessels. There is a T2 hyperintense mass is inseparable from the left ovary measuring 4.8 x 3.6 cm. Lesion has foci of T1 hyperintensity within it indicating areas of hemorrhage.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of a 4.8 cm left adnexal mass. The lesion has some foci of hemorrhage within it and may have subtle enhancement.2.No ovarian fibroids as clinically suggested.3.Probable small endometrioma at the fundus of the uterus.


Instruction: Generate impression based on medical findings.

Input: 51 years Male (DOB:12/6/1965)Reason: low back pain History: low back painPROVIDER/ATTENDING NAME: KIMBERLY MARTIN KIMBERLY MARTIN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present.At L4-5 there is a broad-based central disc protrusion present which is associated with partial effacement of the fat at the lateral recess bilaterally. As well as some encroachment of the left-sided exiting nerve roots within the neural foramen. There is disc desiccation and loss of disc space height at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is a diffuse disc bulge present associated loss of disc space height this desiccation and endplate reactive change. There is ventral impression on the thecal sac at this level associated with crowding of the nerve roots within the thecal sac and mild narrowing of the neural foramina. There is displacement of the exiting nerve roots as the exit the neural foramina due to this disc bulge worse on the right side compared to the left. The endplate reactive changes are high signal on T2 STIR. Overall there is moderate spinal stenosis at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a T1 hyperintense mass which is well-circumscribed and suppresses on the inversion recovery images. It measures 49 x 29 mm sagittal dimensions and is located immediately behind the left-sided perivertebral musculature. This represents a lipoma.

Output: 1.There are multilevel degenerative changes in the lumbar spine with moderate spinal stenosis at L2-3 where there are subacute endplate reactive changes and encroachment of exiting nerve roots due to the lateral disc components bilaterally at L2-3. In addition there is a mild encroachment of nerve roots at the lateral recesses at L4-5 and encroachment of the left-sided exiting nerve roots at L4-5.


Instruction: Generate impression based on medical findings.

Input: Amputation of the right foot, swelling of the lower extremity There has been resection of the distal tibia and fibula at the level of the talocalcaneal articulation.There is cortical thinning and irregularity of the distal tibia and fibula. There is increased T2 signal within the marrow distally without definite corresponding low T1 signal. These findings are thought to reflect a combination of postsurgical change and reactive osteitis without definite osteomyelitis. The remaining marrow signal of the more proximal tibia and fibula is normal.There is diffuse soft tissue and muscular edema and inflammation of the lower leg. Following contrast administration, there is an irregular peripherally enhancing thick-walled fluid collection in the distalmost soft tissues overlying the amputation. Scattered areas of susceptibility artifact are noted relating to prior surgical intervention.

Output: 1. Surgical resection of the distal tibia and fibula with cortical thinning and irregularity of the remaining cortex. There is abnormal T2 signal without definite corresponding abnormal T1 signal in these findings are thought to represent a combination of postsurgical change and reactive osteitis without definite osteomyelitis.2. Irregular enhancing fluid collection within the distalmost soft tissues concerning for abscess.These findings were discussed with the ordering physician Dr. R. Krishnamoorthi at the time of interpretation.


Instruction: Generate impression based on medical findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: Assess for stroke History: L face/arm/leg weakness, gaze deviation to L There is a focal restricted diffusion at mid Pons especially on the right side without evidence of hemorrhagic transformation indicating mid basilar pleural prior type of ischemic infarct.Underlying brain shows scattered minimal FLAIR/T2 high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. 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.There is a small retention cyst in the right side sphenoid sinus.There is about 14.8 mm x 16.3 mm sized Thornwaldt cyst.

Output: 1. Acute ischemic infarct at mid Pons especially on the right side from the midline likely represent basilar artery perforator territory. No hemorrhagic transformation.2. Non specific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old, with rapidly growing left neck mass. Dog bite one month ago. Extensive edema is evident within the left neck involving the parotid space, masticator space, submandibular space, sublingual space and floor of mouth, retropharyngeal and pharyngeal spaces. The left-sided submandibular gland is particularly edematous. There is mass effect on the airway with mild effacement and slight rightward deviation. Inflammation appears to track through the submental soft tissues to involve the right neck to a lesser degree than the left.Although there may be tracking fluid within the retropharyngeal space, no definite evidence of a discrete or loculated fluid collection is seen allowing for the absence of IV contrast. On diffusion-weighted images, multiple diffusion restricting lymph nodes are seen which is compatible with inflammation, but no discrete fluid collections are demonstrated.Mild edema is seen within the left ventricular body. Elsewhere, marrow signal characteristics are unremarkable.A right pleural effusion is partially visualized. The vascular flow voids of the visualized neck vessels appear to be preserved compatible with patency.

Output: Extensive cellulitis involving the left neck more than the right including superficial and deep spaces. There is mass effect with partial effacement and rightward deviation of the airway.There may be tracking fluid within the retropharyngeal space, but no definite evidence of a discrete or loculated abscess collection is seen. Although the absence of IV contrast does limit evaluation for abscess, diffusion-weighted imaging at least partially makes up for this shortcoming, and there is no diffusion evidence of an abscess at this time.Marrow edema is seen within the left mandibular body which could represent contiguous inflammation or infection.


Instruction: Generate impression based on medical findings.

Input: 78-year-old man with history of prostate cancer. Additional history as per chart: PSV of 4 ng/mL in 2013, status post biopsy demonstrating Gleason 6 prostate cancer. PELVIS:PROSTATE:Prostate Size: 52 x 33 mmPeripheral Zone: Two areas of low T2 and ADC signal are seen: A 9 x 9 mm focus in the midline anterior apical transition zone (series 901, image 8) and a 6 x 6 mm focus in the left mid-gland posterior peripheral zone (series 901, image 17).Central Gland: Hypertrophied with BPH nodules.Seminal Vesicles: The seminal vesicles are not invaded.Extracapsular Extension: There is questionable extraprostatic spread of the apical lesion.BLADDER: The bladder appears thick-walled and trabeculated.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two suspicious foci in the prostate gland as described above.


Instruction: Generate impression based on medical findings.

Input: Dorsal foot ulcer There is diffuse skin thickening, edema and inflammation within the dorsal soft tissues of the foot with areas of ulceration overlying the metatarsals. There is no underlying marrow abnormalities to suggest osteomyelitis. Mild nonspecific edema and fatty atrophy affects the plantar musculature which is nonspecific but may relate to diabetic myopathy.Following contrast administration, there is no focal fluid collection to suggest abscess.

Output: Diffuse soft tissue inflammation and edema without evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Developmental delay, porencephaly, 4 month history of progressive hearing loss, gait decline, change in speech, and multifocal pains, intracranial bleeding, new-onset seizure like episodes and 50pound weight loss. Brain: There are bifrontal porencephalic cysts and deficiency of much of the septum pellucidum. There is layering intermediate T1 and low T2 signal hemorrhage in the occipital horns of the bilateral lateral ventricles. There is extensive supratentorial and infratentorial superificial siderosis. There are bilateral cerebral convexity subdural fluid collections, measuring 16 mm on the left and 6 mm on the right, with compression of the underlying brain. The ventricular system is unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is staphylomatous deformity of the right globe. There is a left maxillary retention cyst and mild right maxillary sinus mucosal thickening.Lumbar Spine: There is diffuse T2 hypointensity along the surface of the imaged spinal cord. There is also a small amount of high T1 and low T2 signal material within the inferior spinal canal. 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 paravertebral soft tissues are unremarkable.

Output: 1. Bifrontal porencephalic cysts.2. Layering subacute hemorrhage in the occipital horns of the bilateral lateral ventricles and subacute hemorrhage in the inferior spinal canal. 3. Bilateral cerebral convexity subdural effusions, left larger than right.4. Extensive superficial siderosis involving the intracranial contents and imaged potions of the spinal cord.


Instruction: Generate impression based on medical findings.

Input: Back pain and sciatica, evaluate for herniated disc or spinal stenosis 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. There is minimal fibrofatty infiltration of the filum terminale measuring less than 2 mm. The conus medullaris is normal in position. Limited evaluation of the lower thoracic spine demonstrates a disc bulge at the T11-T12 level without significant spinal canal or neural foraminal stenosis.Multilevel degenerative changes are seen in the lumbar spine, 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: There is a disc bulge with small right paracentral protrusion. There is also mild ligamentum flavum thickening, mild facet arthropathy, and prominence of the epidural fat which all contribute to mild to moderate spinal canal stenosis at this level. There is mild bilateral neural foraminal narrowing L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L5-S1: Evidence of remote left-sided laminotomy. Significant loss of disc height and degenerative fatty endplate marrow signal changes. There is a disc bulge with left foraminal disc protrusion. There is prominent facet arthropathy on the left. There is moderate narrowing of the left neural foramen related to a disc material, endplate osteophyte, and facet arthropathy. There is minimal narrowing of the right neural foramen. No significant central canal stenosis. Paraspinous soft tissues are within normal limits.

Output: Degenerative changes in the lumbar spine. There is mild to moderate spinal canal stenosis at the L3-L4 level. There is also moderate left L5-S1 neural foraminal stenosis with possible impingement of the left L5 nerve root. Please see details above.


Instruction: Generate impression based on medical findings.

Input: Incontinence, weakness. Metastatic prostate cancer. There are multiple vertebral body osseous lesions related to known sclerotic metastases, particularly the L2, L3, and L4 levels with the L3 lesion demonstrating extension involving the posterior elements on the left. Additional small scattered lesions are present more superiorly including T3, T8, and T11 levels as well as inferiorly involving the left iliac bone which is partially imaged. Lesion involving the left-sided posterior elements at the T2 level is also noted. Large left femoral metastases also noted on the coronal survey sequence. There is corresponding sclerosis on recent CT. Burden of osseous metastases is better assessed on recent bone scan. Vertebral body heights are maintained. Alignment is maintained. There is mild developmental narrowing of the spinal canal without high-grade stenosis in the cervical, thoracic, or lumbar spine. No gross evidence of epidural tumor.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2. Multiple scattered osseous metastases, particularly in the lumbar spine. No gross evidence of epidural tumor or pathologic fracture.3. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on medical findings.

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

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


Instruction: Generate impression based on medical findings.

Input: Radiculopathy, lumbar region [M54.16], Reason for Study: ^Reason: lumbar radiculopathy History: lower back pain with radiation down right leg For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: There is broad based disc protrusion toward right side lateral recess with extension to the proximal part of the neuroforamen.

Output: L5S1 disc herniation toward right lateral recess which extends to the right side proximal neuroforamen.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for worsening of cervical spinal stenosis, impingement upon the canal. Signs and symptoms: Neck pain, left hand first 3 digits with decreased strength. Nonenhanced cervical MRI:Examination demonstrates normal anatomical alignment of the vertebral column however with reversal of cervical lordosis likely secondary to extensive degenerative disease.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes with resultant mild central spinal stenosis without neural foraminal compromise.C3-C4 demonstrate moderate disc disease and loss of disc height, there is a broad-based central and left lateral disc protrusion which results in mass effect, flattening and posterior displacement of the cord. There is resultant moderate central spinal stenosis, significant bilateral neural foraminal compromise (left greater than right). There is no detectable cord signal abnormality.C4-C5 demonstrate moderate disc disease and loss of disc height with mild hypertrophic changes of posterior elements. Degenerative changes results in flattening and posterior displacement of the cord and with resultant moderate central spinal stenosis and significant bilateral (right greater than left) neural foraminal compromise.C5-C6 demonstrates moderate disc disease and loss of disc height, mild (left greater than right) facet hypertrophic changes. There is shallow broad-based bulging disc which results in flattening and posterior displacement of the cord and resultant moderate central spinal stenosis. Significant left and moderate right neural foraminal compromise is also present.C6-C7 demonstrate moderate disc disease and loss of disc height and mild hypertrophic changes of posterior elements. Changes at this level results in mild to moderate central spinal stenosis and significant left neural foraminal compromise.C7-T1 through T2-T4 levels are unremarkable.

Output: 1.Extensive degenerative changes of the disc and minimally of the posterior elements in the cervical spine as detailed.2.There is resultant multilevel mass effect and posterior displacement of the cord and moderate central spinal stenosis at C3-C4, C4-C5 and C5-C6 levels without detectable cord signal abnormality. A left lateral broad-based disc protrusion at C3-C4 contributes to mass effect on the cord and central spinal stenosis.3.There is mild reversal of cervical lordosis and multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above.4.No detectable cord signal abnormality.5.Unremarkable upper most visualized thoracic spine to T3-T4 level.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with history of primary CNS lymphoma, status post chemotherapy and transplant. There are otherwise unchanged post-treatment and post-biopsy findings with patchy T2 hyperintensity and associated susceptibility effect in the right cerebellar hemisphere and left anterior cingulate gyrus. There is also unchanged focal susceptibility effect in the right globus pallidus. There are unchanged areas of high T2 signal in the cerebral white matter. There is no evidence of acute 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 skull, orbits, and scalp soft tissues are unchanged. There is mild mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of recurrent central nervous system lymphoma with stable post-treatment findings in the right cerebellar hemisphere and left cingulate gyrus.2. Unchanged areas of cerebral white matter signal abnormality in the cerebral white matter are otherwise nonspecific.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: Left temporal/insular anaplastic astrocytoma, status post surgery, radiation therapy/TMZ and 12 cycles of TMZ. There is a new punctate focus of diffusion hyperintensity in the left parietal subcortical white matter with associated FLAIR hyperintensity and mild enhancement. Redemonstrated is nonenhancing high T2 signal abnormality with gyral thickening in the left medial and anterior temporal lobe, amygdala and insular cortex. There is no new mass effect. There is an unchanged left thalamic developmental venous anomaly and adjacent T1 shortening and enhancement. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is diffuse low T1 marrow signal in the calvarium which is unchanged.

Output: 1. Stable lesion in the left medial anterior temporal lobe and insular cortex without evidence of tumor progression.2. New punctate focus of diffusion hyperintensity in the left parietal subcortical white matter with associated FLAIR hyperintensity and enhancement likely representing a tiny subacute infarct. Findings conveyed to Dr. Lukas by EPIC mail at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: scaphoid fracture History: pain LIGAMENTS: Give the limitations of a non-arthrogram study, the scapholunate and lunotriquetral ligaments appear intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The articular disc of the triangular fibrocartilage complex appears intact, although there is increased signal intensity within the lamina of the triangular ligament at their ulnar styloid attachments which may reflect degeneration or degenerative tearing.TENDONS: There is mild thickening and increased signal intensity within the extensor carpi ulnaris tendon as it courses along the ulnar styloid suggesting mild tendinosis. The flexor and extensor tendons appear intact. BONES: There are small cysts within the dorsal portion of the lunate bone as well as within the capitate, likely degenerative in etiology.ADDITIONAL

Output: 1. No evidence of scaphoid fracture.2. Ganglion volar to the radioscaphoid articulation as described above.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Sphenoethmoidal encephalocele and cleft palate. Reassessment. Compared to the postoperative September 2015 CT scan, the large midline sphenoethmoidal encephalocele has recurred. The encephalocele has reexpanded and now has a component that bulges into the upper aspect of the posterior nasal cavity. This component measures 14 mm at the base and 13 mm in height and is slightly smaller than on the preoperative MRI from April 28, 2015 where it measured 16 mm x 13 mm and was abutting the tongue. There is unchanged relative thickening of the posterior wall of this component of the encephalocele which may represent the floor of the third ventricle. The optic chiasm is probably part of this thickening laterally. The sphenoid bone is deformed. Soft tissue thickening along the anterior aspect of the deformed sphenoid body probably represents deformed pituitary tissue, with a stretched infundibulum. The acute postoperative changes in the frontal region have evolved. There is cystic encephalomalacia in the right frontal lobe anteriorly. The brain shows complete agenesis of the corpus callosum and associated colpocephaly, which remain unchanged. There is no acute infarct. Small foci of susceptibility effect are present deep to the frontal craniotomy flap. Otherwise, there is no acute intracranial hemorrhage. The major intracranial vascular flow voids are preserved. There is unchanged large palatal cleft , which also involves the maxillary alveolar ridge. There is hypertelorism and suggestion of midface hypoplasia. There is poor tissue contrast enhancement but there is no definite abnormal intracranial contrast enhancement.While the mastoid effusions have resolved, new fluid intensity is now present in the maxillary sinuses, worse on the left.

Output: 1.There is recurrence of the sphenoethmoidal midline encephalocele with herniation into the posterior nasal cavity.2.Multiple other structural abnormalities are described above, including a large palatal cleft, hypertelorism and midface hypoplasia, as well as agenesis of the corpus callosum.


Instruction: Generate impression based on medical findings.

Input: Right leg pain (buttocks to behind the right knee), numbness and tingling. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is about 13 mm sized well-circumscribed vertebral body lesion, showing high signal intensity on both T1 and T2 weighted images indicating possible vertebral body hemangioma, this lesion wasn't seen on prior scan and demonstrate no interval change in terms of shape, size and MR characteristics.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc with disc desiccation. Minimal spinal canal stenosis.L3-L4: Diffuse bulging of disc with disc desiccation. There is associated central to slightly left focal protrusion of disc which indents anterior thecal sac. There is no interval change since prior scan about this finding.L4-L5: Diffuse bulging of disc with bilateral ligamentum flavum thickening at this level creating mild to moderate spinal canal stenosis. There is associated central focal protrusion of disc which indents the thecal sac. Again no change since prior scan.L5-S1: Diffuse bulging of disc with disc desiccation. There is a focal central to right disc protrusion. Again no significant interval change since prior scan.

Output: 1. Multifocal disc degeneration with the herniation as described above (L3-4: Central to left, L4-5: Central, L5-S1: Central to right). No change since prior scan.2, multifocal various degree spinal canal stenosis from L2-3 to L4-5, no significant interval change since prior scan.3. Vertebral body hemangioma, T12.


Instruction: Generate impression based on medical findings.

Input: Reason: 11 year old female with chronic abdominal pain and nausea. May 23, 2015, abdominal ultrasound findings: subtle contour deformity and questionable 9mm nodule along the anterior pancreatic body. History: abdominal pain, nauseaEXAMINATION: Pancreas MRI and MRCP without and with IV contrast 06/15/15 at 13:19 ABDOMEN:LIVER, BILIARY TRACT: The liver enhances homogeneously without focal lesions. No intra or extrahepatic biliary dilatation. The gallbladder is within normal limits.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously without focal lesions. No pancreatic ductal dilatation is identified. No surrounding inflammatory changes to suggest pancreatitis. A normal variant accessory pancreatic duct is noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelvis sees are noted. No focal lesions or hydronephrosis. Mild prominence of the bilateral ureters, which is likely of no clinical significance.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: Normal examination.


Instruction: Generate impression based on medical findings.

Input: Check for ligamentous tear. Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Mild thinning largely observed in the lateral femoral compartment with associated more moderate an irregular changes involving the undersurface of the patella. The patellar compartment also demonstrates associated subchondral cysts and focal full-thickness tear near the apex. Underlying patellar edema and more focal degenerative and edematous marrow changes are otherwise observed involving the tibial spines and mid plateau.LIGAMENTS: Collateral ligaments are intact as well as the PCL. The ACL however demonstrates diffuse increased signal and thickening representing a severe sprain given intact fibers are observed throughout (best appreciated on axial projection). Small immediately adjacent posterior periligamentous small cyst is observed (image 8 series 8). Retinaculum appears intact EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Severe ACL sprain with otherwise scattered focal cartilaginous degenerative changes, see details provided.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old, with left thigh pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Small left foraminal disc protrusion. No significant spinal canal stenosis. Mild left foraminal narrowing. L3-4: Small right foraminal disc protrusion. No significant spinal canal stenosis. Mild right foraminal narrowing. L4-5: Mild facet arthropathy. The intervertebral disc is preserved. No significant spinal canal or foraminal stenosis. L5-S1: Mild facet arthropathy. Minimal left foraminal protrusion/annular fissuring. No significant spinal canal stenosis. Minimal left foraminal narrowing.

Output: Mild disc degeneration is seen with small foraminal protrusions at L2-3, L3-4 and questionably at L5-S1. No high-grade spinal canal or foraminal stenosis is detected.


Instruction: Generate impression based on medical findings.

Input: Meningioma status post CyberKnife in May 2014 and orbital pseudotumor. There are postoperative findings related to left suboccipital craniotomy for resection of a meningioma with encephalomalacia in the left cerebellar hemisphere. There is perhaps slight interval decrease in size of the tumor, which now measures up to 16 mm in thickness, previously 20 mm. However, the signal characteristics of the mass have changed somewhat, with apparent increased enhancement. There is an unchanged nodular extra-axial lesion that is markedly T2 hypointense with susceptibility effect and mild peripheral enhancement along the floor of the left posterior fossa, adjacent to the craniotomy defect that measures up to 15 mm. There is unchanged mild nonspecific periventricular T2 hyperintensity. There is no evidence of acute infarct or hemorrhage. The ventricular system is stable in size and configuration. There are postoperative findings related to orbitozygomatic craniotomy with persistent diffuse enhancement of the right orbital fat and multiple extra-ocular muscles with associated impingement upon the optic nerve and proptosis, which is not significantly changed, accounting for differences in technique.

Output: 1.Perhaps slight interval decrease in size of the treated left posterior fossa meningioma, with evolution of the enhancement characteristics.2. An unchanged nodular extra-axial lesion min left posterior fossa adjacent to the craniotomy margin may represent an organizing hematoma. 3. Persistent inflammatory process in the right orbit with impingement upon the optic nerve.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old, with history of ganglioneurocytoma of the left frontal lobe status post resection and radiation. Redemonstrated is a left frontal lobe resection cavity which is stable in size and morphology. The degree of T2 hyperintensity surrounding this cavity, and to a lesser extent, along the frontal horn of the right lateral ventricle, is also unchanged. No pathologic enhancement is seen within or around the resection cavity.Elsewhere in the brain, no new areas of signal abnormality or pathologic enhancement are detected. No restricted diffusion is seen. There is no evidence of mass effect or parenchymal edema. Ex vacuo dilatation of the left lateral ventricle is unchanged.

Output: Stable examination with no evidence of recurrent disease.


Instruction: Generate impression based on medical findings.

Input: A 64 year old female with history of hypertension, hyperlipidemia and lung sarcoidosis. She has evidence of supraventricular tachycardia. A cardiac MRI in 2009 showed no evidence of cardiac sarcoid. Referred now to cardiac MRI for follow up. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 120 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 50 ml (normal range 31+/-10), the LV mass index is 32 g/m2 (normal range 67+/-11), and the LV mass is 61 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 125 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in sizeAortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMediastinal lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 58%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 57%).3. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old, with assess for compulsive disorder, preoperative planning exam for laser fiber placement. Bilateral T2 hyperintense foci are redemonstrated adjacent to the frontal horns of the lateral ventricles representing sequelae of prior laser ablation. As before, the focus on the right is more conspicuous than the focus on the left. However, there has been no significant interval change in the size or morphology of these lesions. On postcontrast images, there is minimal enhancement at the left focus but no convincing enhancement on the right. Brain parenchymal morphology is otherwise unremarkable. No abnormal fluid collections are seen. Ventricular size and morphology are unchanged.

Output: Expected findings are seen compatible with prior laser ablation adjacent to the bilateral frontal horns.


Instruction: Generate impression based on medical findings.

Input: H/o porencephalic cyst . S/p Ommaya shunt. Evaluate for interval change. Examination demonstrates further enlargement of the right porencephalic cyst and the supratentorial ventricular system. There have been large areas of encephalomalacia in the bilateral cerebral hemispheres since prior exams. There has been an interval placement of a right frontal catheter, and the tip appears to be approximately within the confluence of the sinus. No hemorrhage is identified. The cerebellar hemispheres remain unchanged from prior exam.

Output: 1. Diffuse cerebral encephalomalacia which has further evolved since prior exam. Findings are compatible with ischemic injury. 2. Further enlargement of the right porencephalic cyst and the supratentorial ventricular system, which is secondary to underlying brain volume loss related to diffuse encephalomalacia versus increased intraventricular pressure.


Instruction: Generate impression based on medical findings.

Input: 67 years, Female, preoperative planning for craniotomy for cavernous malformation resection. Examination is obtained for operative planning and intraoperative navigation with limited sequences. Fiducial markers are in place. Again seen are numerous foci of predominantly T2 hypointensity and susceptibility effect throughout the supratentorial and infratentorial brain. The largest of these involves the fourth ventricle and posterior aspect of the midbrain/pons measuring 16 mm AP x 20 mm transverse x 22 mm craniocaudal (as measured on T2 sequences previously). A relatively more prominent lesion involving the lateral aspect of the right postcentral gyrus measuring approximately 11 mm in the longitudinal axial plane is also again seen. Few of these lesions demonstrate areas of T1 hyperintensity, better assessed on the precontrast T1 sequence on prior study, as well as lobulated T2 hyperintensity. None demonstrate perilesional edema nor associated development of venous anomaly. The ventricles and sulci are normal in size. No midline shift or herniation. There is no abnormal enhancement within the brain. Major vascular structures are patent. Diffuse left mastoid opacification and mild to moderate scattered opacification of the paranasal sinuses again evident. Note is made of a small, fat-containing focus within the right parietal/occipital bone, which may represent small hemangioma or focus of fat.

Output: Examination for operative planning again demonstrating multiple supra and infratentorial cavernous malformations.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with erythema, pain, drainage of prior right great toe amputation site, concern for osteomyelitis. Evaluate for osteomyelitis of the right great toe. There is diffuse soft tissue edema particularly along the dorsum of the forefoot which extends into the toes. Patient has undergone amputation of the great toe through the base of the proximal phalanx. Small foci of signal void in the adjacent soft tissues likely reflects suture material. There is a small thin linear focus of increased signal intensity on T2 weighted images that extends from the distal skin surface of the amputation margin to the medial aspect of the proximal phalanx which may represent a small sinus tract, but the remaining base of the proximal phalanx maintains its normal fat signal intensity on T1-weighted images arguing against osteomyelitis. There is increased signal intensity on T2-weighted images circumferentially within the outer margin of the outer head of the first metatarsal with corresponding enhancement on postcontrast images, however on T1 weighted images the fat signal is maintained again arguing against osteomyelitis. There is also increased signal intensity on T2-weighted images and enhancement on postcontrast images concentrated within the medial aspects of both sesamoid bones; there is associated mild decreased signal intensity on T1 weighted images in an ill-defined hazy pattern, and while it is impossible to exclude osteomyelitis, we favor reactive osteitis based on the signal intensity pattern and lack of definite adjacent ulceration. Note is made of a mildly retracted flexor hallucis longus tendon. Mild degenerative arthritic changes affect the forefoot.

Output: Soft tissue edema and postoperative changes as described above. Signal abnormality and enhancement of the first metatarsal head and sesamoid bones is favored to represent reactive osteitis rather than osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old. Reason: re-evaluate osseous lesions seen on prior study, hx osseous sarcoid History: re-evaluate osseous lesions seen on prior study, hx osseous sarcoid Again seen are multiple round lesions within the sacrum, innominate bones, and proximal femora, many of which appear slightly smaller and less confluent on the current study than on the prior study. For example, a right intertrochanteric lesion measured 2.3 cm in craniocaudal dimension on the prior study, and now measures 2 cm. These lesions are of similar intensity to skeletal muscle on T1WI, hyperintense on T2WI, and enhance following contrast administration.Osteonecrosis of the femoral heads appears similar to the prior study, with osteoarthritis affecting both hips, left greater than right. Degenerative disc disease at L4-5 appears similar to the prior study.Lymphadenopathy seen on the prior study is again noted, although many of the lymph nodes appear slightly smaller in size. A uterine fibroid and nabothian cysts appear similar to the prior study accounting for slight positional differences.

Output: 1.Findings compatible with sarcoidosis as described above with lesions appearing smaller and less confluent on the current study than on the prior study.2.Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Patient with two days history of headaches with frontal neurologic signs, vertigo, sensory deficit, bilateral hand tingling, right cranial nerves 6 palsy, vertical nystagmus. CT of brain without and with infusion:No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Subtle foci of low-attenuation in the periventricular white matter of bilateral hemispheres are not specific and non-enhancing. The findings considering patient's age are concerning for demyelinating disease. Possibility of stroke cannot be entirely ruled out. Follow up with a dedicated MRI of brain is recommended. There is no evidence of parenchyma volume loss. Cortical sulci and ventricular system remain within normal. No evidence of any abnormality of cortex is detected.On post infusion images no abnormal enhancement of brain parenchyma or leptomeninges is detected.Calvarium is intact. Mastoid air cells and limited view of paranasal sinuses are unremarkable.100 cc of Omnipaque 350 was utilized for the above study.

Output: 1.Periventricular foci of low attenuation without enhancement is concerning for demyelinating disease considering patient's age. Ischemic stroke or other etiologies cannot be entirely ruled out and further follow-up with an MRI is recommended.2.There is no abnormal enhancement on post infusion images.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on medical findings.

Input: Headache [R51], Reason for Study: ^Reason: evaluate for ischemic etiology of intractable headache in patient with HgbSS History: persistent headache No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

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


Instruction: Generate impression based on medical findings.

Input: 79-year-old female with history of pancreas divisum and a pancreatic IPMN. Previous MRI/MRCP in 2013. Surveillance. ABDOMEN:LIVER, BILIARY TRACT: 11 mm non-enhancing T1 hypointense lesion in the right hepatic lobe is unchanged, only evident on T1-weighted imaging, uncertain whether artifactual or a benign lesion such as a cyst, stable from prior MRI exam. This is not seen on T2 or diffusion weighted images, may be due to slice thickness. Punctate arterially enhancing focus in hepatic segment 7, most likely a perfusional defect. Otherwise, no focal hepatic lesions.No intrahepatic biliary ductal dilation. The extrahepatic bile duct measures 8 mm, unchanged. Cholelithiasis without choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum is again noted, with normal pancreatic parenchymal signal. The mildly dilated main pancreatic duct measures 7 mm, unchanged, and drains via the minor papilla. The ovoid T2 hyperintense lesion in the uncinate process measures 9 x 9 mm on MRCP images, previously 8 x 7 mm, and again appears to communicate with the ventral pancreatic duct. Additional punctate T2 hyperintense foci are seen in the pancreas, likely representing sidebranch IPMNs. No solid pancreatic lesions are noted. No ampullary lesion identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are again noted, with a hemorrhagic cyst in the left kidney upper pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 2.6 cm cystic lesion in the right hemipelvis appears similar to prior, though is incompletely characterized.

Output: 1. Pancreas divisum, with unchanged mildly dilated main pancreatic duct draining via the minor papilla.2. Minimally increased size of the subcentimeter pancreatic intraductal papillary mucinous neoplasm (IPMN).


Instruction: Generate impression based on medical findings.

Input: Male 55 years old with Hx of new onset left arm weakness with extensor predominance and hand numbness, please evaluate for infarcts Mild periventricular and subcortical T2/FLAIR hyperintensities suggestive of chronic small vessel ischemic changes, several of which demonstrate focal volume loss within the bilateral frontal periventricular white matter, basal ganglia, and right pons. Some of these lesions are also associated with susceptibility, indicative of chronic microhemorrhages, and appear similar to prior exam. There is no evidence of acute intracranial hemorrhage, mass, or restricted diffusion to suggest ischemia. Stable mild global parenchymal volume loss. The ventricles and basal cisterns are patent. There is no midline shift or herniation. The major cerebral flow voids are intact. Right maxillary retention cyst appearing stable from prior exam. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute infarct or intracranial mass effect.2. Chronic small vessel ischemic disease with multiple chronic lacunar infarcts within the bilateral periventricular white matter, basal ganglia, and right pons appear similar to prior. Scattered chronic microhemorrhages also appear similar to prior.


Instruction: Generate impression based on medical findings.

Input: Pain, check for medial meniscal tear MENISCI: A complex tear observed in the posterior horn of the medial meniscus is identified with extension to the superior articular surface towards the apical aspect. A horizontal extension is also noted towards the body extending towards the inferior articular surface. The anterior aspect is otherwise intact as well as the lateral meniscus. Both menisci remain well anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Minimal osteoarthritic changes and small scattered bone islands within the femoral condyles, however no superimposed osseous or cartilaginous abnormality.LIGAMENTS: The ACL, PCL, MCL and LCL are all intact EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear of the medial meniscal posterior horn with a small effusion, as described


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with recurrent shoulder pain despite conservative therapy. Assess for labral tear. ROTATOR CUFF: There is supraspinatus and infraspinatus muscles and tendons appear intact. There is mild intermediate signal abnormality and thickening of the supraspinatus tendon consistent with mild tendinosis. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid is identified within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint with a slight impression on the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. No articular cartilage defects are identified. The glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Mild rotator cuff tendinosis without evidence of rotator cuff or labral tear.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other convulsionsClinical question: assess for ischemic changesSigns and Symptoms: seizure/altered mental status8 months old MRI of the brainNo diffusion weighted abnormalities are appreciated. Myelination pattern is appropriate for a months ageThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.No abnormal lesions are appreciated within the brain parenchyma to explain the patient's seizure. 2.There is no evidence for acute ischemic cerebral infarction.3.MR venogram of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with history of right upper extremity paresthesias. The cervical-thoracic junction is obscured by overlying anatomy on the lateral view. Small osteophytes project along the anterior aspect of C3 through C6. Intervertebral disc spaces and vertebral body heights are well-maintained. There is mild narrowing of the C3-4 and C4-5 neuroforamina on the right secondary to posterior osteophytes. There is perhaps mild narrowing of the C3-4 neuroforamina on the left as well. These abnormalities would be better evaluated on MRI. There is loss of the normal cervical lordosis.

Output: Findings compatible with mild neuroforaminal narrowing as above. If patient care warrants further imaging, MRI may be obtained.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Metastatic thyroid cancer to bone, brain and lung. Pre-chemotherapy. Signs and symptoms: metastatic thyroid cancer. Enhanced CT of soft tissues of neck:Limited view of intracranial content demonstrates small enhancing metastatic lesion in the left frontal lobe measuring 7-mm times 10-mm. This could be further evaluated on dedicated CT of brain.Images through the skull base demonstrate a lytic lesion in the clivus with no change since prior exam. This lesion has a sclerotic rim. This is believed to represent postoperative changes of the sphenoid sinus with packing material.Cavernous sinuses and bilateral Petrus bones remain within normal limits.Images through the neck and demonstrate no evidence of a mass or pathologic adenopathy. No evidence of residual enhancing thyroid tissue. The esophagus appears dilated and contains air. This may represent reflux. Trachea appears ectatic.CT of brain with enhancement: Lytic changes of clivus with a sclerotic rim and internal calcific fragments remains stable since prior CT of head and neck study and MRI of brain. This lesion believed to represent non-pneumatized sphenoid sinus or may be result of prior surgical inflammation (transphenoidal hypophysectomy) and with packing of the sinus. There is no interval change since prior exams and there is no abnormal enhancement of this finding on MRI examination. Please correlate with patient's past history.Images through the posterior fossa demonstrate a well demarcated low-attenuation within the vermis with no enhancement at the site of previously noted metastatic lesion. Surrounding vasogenic edema still is present. The finding may represent post treated metastatic lesion. This lesion measures approximately 16.2 mm in transverse axis and 14.4-mm in AP axis. This is a smaller than prior measurements of the enhancing mass in this location which measured 21 mm times 18-mm.At enhancing tumor measuring approximately 9 mm times 7-mm in the inferior left frontal lobe with surrounding vasogenic edema is again identified. This mass on prior MRI examination measured 5-mm x 4.5-mm. there is no evidence of any new additional metastatic lesions to the brain or leptomeninges.Calvarium is intact. 65 cc of Omnipaque 350 was utilized for the above studies.

Output: 1.Stable CT of soft tissues of neck with no evidence of recurrence of tumor or pathologic adenopathy in neck.2.Minimally larger left inferior frontal metastatic focus with surrounding vasogenic edema. This lesion measures 7 mm times 9-mm on current exam.3.Patient is known enhancing metastatic lesion in the vermis demonstrates no enhancement on the current exam and measures smaller than prior exam.4.No evidence of new additional metastatic lesion to the brain or calvarium.


Instruction: Generate impression based on medical findings.

Input: Migraine without aura, intractable, without status migrainosus [G43.019] / Obesity, unspecified [E66.9], Reason for Study: ^Reason: 46 y.o,. with worsening headaches c/w migraine but hx of cancer - tumor, other mass lesion? History: worsening headache, Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Right parieto-temporal lobe high signal focus on FLAIR images is non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. 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. A small left maxillary sinus retention cyst.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral PCAs are fetal origin.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA.


Instruction: Generate impression based on medical findings.

Input: 56 year old woman with history of peripheral arterial disease, diabetes who is referred for cardiac stress MRI for further evaluation of chest pain.MEDICATIONS: ASA, Lipitor, HCTZ, Xarelto, Metformin. First Pass PerfusionDuring hyperemia, there is a moderate severity perfusion defect involving the basal inferolateral wall. A subtle perfusion defect in the mid to apical inferior and inferoseptal walls can not be excluded.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), the LVEDV is 128 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 63 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 61 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall axillary (<1mm) lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a moderate severity perfusion defect/ "ischemia" in the basal inferolateral wall. A second subtle perfusion defect involving the mid to apical inferior and inferoseptal walls can not be excluded.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%5. See extra-cardiac findings. 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: History of pancreatic mass. Increasing abdominal distention. ABDOMEN:LIVER, BILIARY TRACT: Several scattered cysts. The common bile duct measures 6 mm and tapers smoothly at the ampulla. This is within normal limits given the patient's age and post cholecystectomy state. No suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: Several punctate pancreatic cystic foci appear to communicate with a normal caliber main pancreatic duct compatible with sidebranch IPMNs without suspicious imaging characteristics (series 11/5). No suspicious solid pancreatic lesion.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: Scoliosis.OTHER: No significant abnormality noted.

Output: 1.Small pancreatic IPMNs without suspicious imaging characteristics.2.No suspicious liver lesion.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate intracranial hemorrhage, cerebral edema. Signs and symptoms: Worsening hepatic encephalopathy. Unenhanced CT of brain:Patchy areas of periventricular and subcortical low attenuation although nonspecific could represent small vessel disease of indeterminate age. Considering provided clinical data all hepatic encephalopathy these findings may represent edematous changes from hepatic encephalopathy. There is no evidence of any associated mass-effect with his findings. Prior examination from 6 -- 2 -- 2010 was performed with a helical CT and imaging quality was not as good as the current exam and precise comparison is difficult.There is no evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Follow up would and MRI can significantly improved the assessment.

Output: Diffuse patchy areas of subcortical and periventricular low attenuation with no associated hemorrhage, mass-effect or midline shift as detailed. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: 40 year-old male, distention, right lower quadrant pain, flank pain evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable bilateral adrenal mass lesions. Right adrenal mass measures 4.6 x 4 .1-cm on image number 34. Left adrenal mass measures 9.9 x 5.1 cm image number 36.KIDNEYS, URETERS: Right nephrectomy site is clear. Irregular left kidney is unchanged. Possible photocell carcinoma cannot be excluded. Left renal vein is again distended suspicious for tumor thrombus. If there is a clinical concern to evaluate the left renal vein and the left kidney MRI may be helpful.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No change in the right paracolic cutter metastases measuring 5.8 x 2.6 cm image number 71.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Inflammatory changes and small fluid Colette since adjacent to the sigmoid colon consistent with diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Metastatic renal cell cancer. New diverticulitis with small fluid collections in the pelvis.