Instruction: Generate impression based on medical findings.

Input: A 24 year old female with known systemic lupus erythematosus, now hospitalized with chest pain and positive troponin, echocardiography showed normal left ventricular systolic function. Referred to cardiac MRI to evaluate for myocarditis/pericarditis secondary to lupus flare. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 155 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 85 g (normal range 114+/-24). There is mild global hypokinesis in the basal segments. There is subtle, focal myocardial late gadolinium enhancement involving the epicardial portion of the basal inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is additionally increased signal in that region on SSFP imaging suggesting edema vs inflammation. No evidence of myocardial infarction. Normal native myocardial T1-times. The global relative enhancement ratio, the T2-STIR edema ratio and the extracellular volume fraction are in the normal range. These findings suggest normal interstitial fibrosis burden.No intracavitary thrombus was seen.No myocardial iron overload.Left AtriumThe left atrium is normal in size. The LA volume is 75 ml.Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 168 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 84 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 mild to moderate mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion without evidence of significant pericardial inflammation or edema.Extracardiac FindingsSeveral large bilateral axillary 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. The left ventricle is normal in size with low normal systolic function, the LVEF is 52% with evidence of a small amount of subtle late gadolinium enhancement and edema in the basal inferior and inferolateral walls. These findings support the diagnosis of mild myocarditis without evidence of myocardial infarction. 2. The right ventricle is normal in size with low normal systolic function, the RVEF is 50%. 3. There is mild to moderate mitral regurgitation. 4. No evidence of pericarditis.5. Significant bilateral axillary lymph adenopathy.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: 59-year-old female with a history of left breast mastectomy with reconstruction in 2012 for IDC followed by chemoradiation and arimidex therapy. History of right breast reconstruction surgery. Three standard views of the right breast and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. An asymmetry in the right inferior outer breast disperses on spot compression views and is likely superimposed glandular tissue or related to her prior breast reconstruction procedure(s). A cyst in the right upper outer breast, confirmed by prior MRI is less discretely visible on today's exam. A few scattered benign calcifications are present.There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast.

Output: No mammographic evidence of malignancy. Benign asymmetries may relate to her reconstruction surgery. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Migraine for the last 6 months. Signs and symptoms: Migraine for the last 6 months. Pre-and post-enhanced brain MRI:Diffusion weighted series are unremarkable.The anatomical morphology as well as the signal intensity of brain parenchymal remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination of brain.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal.Post enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarial or the retro-orbital spaces.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal intensity.

Output: 1.Negative pre-and post enhanced brain MRI.2.Unremarkable calvarium, well pneumatized paranasal sinuses, mastoid air cells and middle ear cavities.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for medial meniscus and acl tears History: pain, effusion, clicking. Metallic artifact within the proximal tibia related to bullet fragments.MENISCI: Complete loss of the anterior body and horn of the lateral meniscus. The posterior horn of the lateral meniscus is intact.Globular intrasubstance signal involving the undersurface of the anterior body and the free edge of the anterior horn of the medial meniscus likely due to degeneration overlying the prior tibial plateau fracture.ARTICULAR CARTILAGE AND BONE: Thinning of the articular cartilage anteriorly along the medial tibiofemoral compartment. Near complete loss of articular cartilage anteriorly along the lateral tibiofemoral compartment. Deformity and postsurgical changes of the proximal tibia compatible with prior tibial plateau fracture.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complete loss of the anterior body and anterior horn of the lateral meniscus. Degeneration of the undersurface of the anterior body and anterior horn of the medial meniscus. Associated cartilage loss. These findings likely are related to patient's prior tibial plateau fracture.


Instruction: Generate impression based on medical findings.

Input: Left calf pain Note that the examination is limited by susceptibility artifact from the patient's knee arthroplasty. The examination is also markedly limited by motion artifact.There is diffuse subcutaneous edema of the lower extremity which is most prominent along the medial aspect inferiorly. There is also diffuse T2 signal hyperintensity of the calf musculature particularly of the medial head of the gastrocnemius reflecting nonspecific edema. There is mild fatty atrophy of the lower extremity musculature as well. A focus of scarring is identified medially just below the level of the tibial plateau. There is no evidence of a focal fluid collection.The marrow signal of the proximal tibia and fibula is normal aside from areas of poor fat saturation. There is an irregular focus of low T1/high T2 signal intensity within the distal tibia which appears to enhance. This was not evident on a radiograph dated 1/18/2016. There is no evidence of osteomyelitis.

Output: 1. Limited exam secondary to motion artifact and the patient's knee arthroplasty.2. Diffuse subcutaneous and muscular edema of the lower extremity predominantly involving the medial soft tissues and head of the gastrocnemius.3. Focus of signal abnormality in the distal tibia may reflect a small bone infarction.


Instruction: Generate impression based on medical findings.

Input: Altered mental status at church. Rule out stroke, acute process. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation. Calcifications are noted within the basal ganglia bilaterally which is probably dystrophic.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: Small vessel ischemic disease, age indeterminate. If there clinical concern for an acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, unspecified [R41.82] / Unspecified abnormalities of gait and mobility [R26.9], Reason for Study: ^Reason: r/o infection, structural lesion History: altered mental status, headaches No evidence of acute ischemic or hemorrhagic lesion.Patchy scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and pons are nonspecific, these are likely small vessel ischemic disease.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 paranasal sinuses and mastoid air cells are clear.

Output: 1. Nonspecific small vessel ischemic disease as described above.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Reason: HCV cirrhotic History of HCC s/p TACE/RFA with new lesion on follow up imaging. Reviewed at radiology conference instruction to f/u with surveillance imaging History: History of HCC s/p TACE/RFA with new lesion on follow up imaging. Reviewed at radiology conference instruction to f/u with surveillance imaging ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver.RFA defect in the inferior segment 6 is unchanged with no new arterial enhancement.RFA defect in segment 8 is unchanged. There is heterogeneous signal with intrinsic T1 hyperintense signal compatible with proteinaceous or blood products. No abnormal enhancement. Adjacent focal intrahepatic biliary ductal dilatation, likely related to fibrosis. Surrounding parenchymal perfusional abnormality.Small arterial phase enhancing lesion in the dome of the liver is not visualized.No new arterial enhancing lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal 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.

Output: 1.Segment 8 ablation defect with intrinsic T1 signal compatible with proteinaceous or hemorrhagic products. Stable segment 6 ablation defect. No evidence of residual or recurrent tumor.2.Small arterial enhancing lesion in segment 8 seen on CT is not identified on this examination.


Instruction: Generate impression based on medical findings.

Input: 67 years Female (DOB:8/14/1948)Reason: Mets small cell lung cancer, s/p 2 lines of therapy, now with disease progression, pls evaluate CNS status as restaging. History: mets small cell lung cancerPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate partial opacification of the left mastoid air cells. There appears to be some signal hyperintensity on FLAIR imaging within the left jugular vein and sigmoid sinus. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for brain metastases.2.There is fluid in left mastoid air cells. The possibility of mastoiditis cannot be excluded. Some adjacent signal hyperintensity involving the left jugular vein and sigmoid sinus is nonspecific and of uncertain significance however, in theory to could potentially represent inflammatory reaction.


Instruction: Generate impression based on medical findings.

Input: Contrast opacified the midcarpal joint, as well as the scapholunate and lunotriquetral intervals. No contrast entered the radiocarpal joint. Please refer to the subsequent MRI report for further information.Exposure time: Two minutes 8 seconds

Output: Successful injection of contrast into the midcarpal joint space. I see no findings to suggest a scapholunate ligament tear on this study.


Instruction: Generate impression based on medical findings.

Input: Cystic fibrosis c/b pancreatic exocrine insufficiency, recurrent pseudomonas pneumonia, and chronic hemoptysis s/p multiple bronchial embolizations with ongoing hemoptysis, adrenal insufficiency, and protein malnutrition on PEG tube who presents with AMS and witnessed seizure. There is diffuse gyriform restricted diffusion in the bilateral cerebral hemispheres in a watershed distribution, including the right frontal and parietal lobes and left frontal lobe, with underlying white matter vasogenic edema. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening and secretions.

Output: 1. Gyriform restricted diffusion in the bilateral cerebral hemispheres in a watershed distribution, right more than left, with underlying white matter vasogenic edema. These findings may represent recent watershed infarction or perhaps posterior reversible encephalopathy syndrome with associated infarction or cytotic edema related to seizure activity. 2. Pansinus disease likely related to cystic fibrosis.Discussed with Dr. Kress at 4:45 PM on 6/29/16.


Instruction: Generate impression based on medical findings.

Input: 75 years Female (DOB:7/28/1940)Reason: TIA workup History: TIAPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.There are a couple periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Given their small number they are likely of little clinical significance.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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. The right eye lens is thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very small.. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The origin of the left vertebral artery and the origin of the left subclavian artery were no included on this exam.

Output: 1.No evidence for intracranial or extracranial cerebrovascular occlusive disease.2.The origin of the left vertebral artery and the origin of the left subclavian artery were no included on this exam.3.No evidence for cerebral infarction or intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Reason: History of sacral chordoma with multiple lesions within the pelvis. Need MRI sacrum to evaluate extent of disease. Compare to prior imaging, which has been uploaded into PACS. History: History of surgical resection of a 15 cm sacral chordoma, now with multiple lesions with the pelvis and palpable mass in buttocks. There are postoperative changes of a partial sacrectomy extending from the level of S2 down with displacement of the rectum posteriorly, appearing similar to the prior study. Edema-type signal within the bones along the pubic symphysis is likely degenerative in etiology. The bones are otherwise within normal limits. There is a small fluid collection within the scar tissue posteriorly, perhaps slightly smaller than that seen on the prior study. Innumerable nodular masses are noted within the gluteus maximus musculature bilaterally as well as within the adjacent subcutaneous fat of the buttocks bilaterally. Additional nodular masses are situated along the posterior column of the acetabula adjacent to the obturator internus muscles, more so on the left than on the right. One of the larger masses within the left gluteus maximus muscle measures just over 6 cm in its greatest dimension on the coronal series 9, similar in size to that seen on the prior study. A second mass within the subcutaneous fat between the intergluteal cleft and the medial margin of the left gluteus maximus is approximately 2.5 x 2.3 cm, previously measuring approximately 2.0 x 1.5 x 2.3 cm. A smaller mass within the medial fibers of the right gluteus medius muscle measures approximately 1.5 x 1.0 cm, previously 1.0 x 0.8 cm.

Output: Innumerable masses within the posterior soft tissues as described above, presumably representing spread of the patient's chordoma with some lesions having increased in size compared to the prior study.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of unspecified site of left female breast [C50.912] / Low back pain [M54.5], Reason for Study: ^Reason: 71F breast cancer, new back pain in thoracic/lumbar region, CT showing paraspinal abscess History: back pain, paraspinal abscess. There are multifocal vertebral body and pedicular lesions (T1, T2, T3, T4, T7, T8, T9, T10, and T11) as well as spinous process lesions (T3, T4, T7 and T8) with evidence of enhancement indicating metastatic lesions. Especially T3 vertebral body shows about 20% of compression fracture without evidence of retropulsion.There are paravertebral soft tissue thickening with enhancement especially anterior aspect of the T2 to T4 which also indicate metastatic lesions.There is normal thoracic kyphosis. The spine alignment is anatomic. The signal of the visualized cord is normal. There is no evidence of cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. There is no evidence of spinal canal stenosis.There is no evidence of neural foraminal stenosisLeft side renal cyst is seen.Bilateral pleural thickenings are seen.

Output: 1. Multifocal various sized enhancing metastatic lesions of thoracic vertebrae and paravertebral soft tissue as described above.2. About 20% of compression fracture of T3 vertebral body.3. Spinal cord signal intensity is normal. No evidence of spinal stenosis or neuroforaminal stenosis.


Instruction: Generate impression based on medical findings.

Input: History of medulloblastoma resected in 1994, with recent seizures, for which workup detected a right parietal meningioma. There is an avidly enhancing right superior parietal convexity extra-axial mass that measures up to 22 mm, which is unchanged. There is associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema. There are postoperative findings related to left suboccipital craniotomy with encephalomalacia in the left cerebellar hemisphere, but no evidence of a mass in the posterior fossa. There is diffuse dural thickening related to calcifications. There is encephalomalacia in the right lateral temporal lobe. There are scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a left transparietal ventricular catheter in unchanged position. 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. There is an enhancing mass in the right frontal scalp that measures up to 16 mm. There are bilateral posterior maxillary cystic lesions.

Output: 1. Unchanged right parietal convexity meningioma with associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema2. Postoperative findings related to left suboccipital craniotomy related to medulloblastoma resection with encephalomalacia in the left cerebellar hemisphere, but no evidence recurrent tumor in the posterior fossa. 3. Diffuse dural calcification may be a manifestation of Gorlin syndrome.4. Bilateral posterior maxillary cystic lesions may represent keratocystic odontogenic tumors, which may also be a manifestation of Gorlin syndrome. Dedicated maxillofacial imaging may provide further insights, nevertheless.5. A persistent right frontal scalp lesion may represent a basal cell nevus or carcinoma or other neoplasm.6. Scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres may represent cavernous malformations or chronic microhemorrhage related to prior radiation. 7. Unchanged appearance of the shunted ventricular system.


Instruction: Generate impression based on medical findings.

Input: Right-sided weakness. Evaluate for hemorrhagic conversion. Reidentification of patchy asymmetric hypoattenuating area along the distribution of the left MCA corresponding to abnormality seen on MRI of 12/12/2010 and CT perfusion on 12/11/2003 is compatible with stroke. Peri-ventricular and subcortical white matter hypoattenuating foci bilaterally are consistent with chronic small vessel ischemic disease appearing similar to prior exam.Prominence of extra-axial spaces and ventricular system is compatible with parenchymal volume loss. No extra-axial fluid collections, mass, or hemorrhage. Diffuse sclerosis involves the calvarium. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Left MCA infarct as previously described without evidence of hemorrhagic conversion.2. Small vessel ischemic disease and other findings appearing similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 6 years old, with seizures and developmental delay. Assess for structural abnormality. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The rostrum of the corpus callosum may be slightly blunted, but the remainder of the corpus callosum is normally formed. The region of the pituitary is within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The pattern of white matter myelination is appropriate. No evidence of any cortical dysplasia or migrational anomaly is seen.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

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


Instruction: Generate impression based on medical findings.

Input: Headache. Follow-up of pituitary mass. There is a 5 mm, relatively well-circumscribed focus of no contrast enhancement within the superior aspect of the anterior pituitary gland. It is at least partly hyperintense on T2 imaging, relative to the remainder of the gland. It has no lateral parasellar extension. The cavernous sinuses are unremarkable. Overall volume of the pituitary gland is not increased and the suprasellar cistern is preserved. The optic chiasm is unaffected. The pituitary infundibulum is midline.The remainder of the pituitary gland is notable for a 2 mm focus of no contrast enhancement situated between the posterior and anterior pituitary glands, which probably represents an incidental pars intermedia cyst.Included brain is notable for serial changes of chronic microvascular ischemia and previous infarcts. Please refer to the brain MRI report from September 16, 2015 for more details. A 2 cm left upper cervical lymph node has a preserved fatty hilum and not significant change since September 2015.

Output: 1.5 mm focus of no contrast enhancement within the anterior pituitary gland would not be compatible with the typical MR characteristics of microadenoma (which typically show mild or delayed contrast enhancement). It may represent a small cyst. There is no extrasellar extension. 2.Changes of chronic microvascular ischemia and previous infarcts in the included brain are better assessed on the brain MRI from September 16, 2015.


Instruction: Generate impression based on medical findings.

Input: Hemiplegia, unspecified affecting unspecified side [G81.90], Reason for Study: ^Reason: Evaluate for ischemia History: R hemiparesis, has history of MS Motion artifact degraded exam quality.There is no evidence of acute ischemic lesion.Susceptibility artifacts are seen along the course of left circumflex thalamic stimulator, however, otherwise there is no MR evidence suggesting acute hemorrhagic lesion.Multifocal patch high signal intensity lesions involving bilateral periventricular white matter, centrum semiovale as well as posterior fossa are compatible with demyelinating disease such as multiple sclerosis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic lesion on this scan.2. Susceptibility artifacts are seen along the course of the left thalamic stimulator, however, there is no other MR lesion suggesting acute hemorrhagic lesion on this scan.3. White matter lesions are consistent with multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: MRI brain: There is no evidence of acute infarct. No new intracranial hemorrhage or abnormal extra-axial fluid collections are identified. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear of abnormal fluid signal. The skull and extracranial soft tissues are unremarkable.MRA head: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. There is a fetal origin of the right posterior cerebral artery and a prominent left posterior communicating artery. The left vertebral artery is dominant. The distal vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: 1. No acute intracranial abnormality.2. No flow-limiting stenosis, occlusion, or aneurysm in the major cerebral arteries.


Instruction: Generate impression based on medical findings.

Input: Yearly follow for lumbar syrinx. There is absence of posterior elements in the L4-L5 spine and sacrum, consistent with spinal dysraphism. There is partial fusion of the L3 and L4 vertebrae, consistent with segmentation anomaly. There is unchanged exaggerated lordosis of the lumbar spine and kyphosis of the thoracic spine, as well as mild rotatory scoliotic deformity. There is an unchanged low lying conus medullaris that terminates at the L3 level associated with an elongated morphology of the spinal cord, which contains long-segment syringohydromyelia that measures up to 2 mm in width. There is an ectatic thecal sac in the lumbosacral region, which contains nerve roots and a portion of the conus that herniate through the dysraphism into the posterior soft tissues of the lower back consistent with myelomeningocele. There are unchanged foci of T2 hypointensity and T1 hyperintensity in the region of the conus, which may represent residual postoperative blood products. There is anterior lumbosacral lipomatosis. There is no significant spinal canal stenosis. The paraspinal soft tissues are unchanged. There is partly imaged left hip joint dislocation and effusion.

Output: 1. Unchanged appearance of the spinal dysraphism with myelomeningocele with tethered cord configuration and syringohydromyelia.2. Partly imaged left hip joint dislocation and effusion.


Instruction: Generate impression based on medical findings.

Input: Recurrent laryngeal malignancy. Status post radiation treatment and multiple laryngeal procedures at outside hospital.Additional clinical history from electronic medical records: Recurrent laryngeal cancer; status post radiotherapy in 2012. He presented in February 2016 with a right neck mass resection of which showed squamous carcinoma with extracapsular extension. This may represent metastasis/recurrence of the original laryngeal carcinoma or may represent nodal metastasis from new head and neck primary cancer. There is a tracheostomy as well as changes of previous total laryngectomy. There is a pectoralis major flap in the right side of the neck. There is nodular contrast enhancement along the superior margin of the flap extending posterior and medial to the right parotid gland into the parapharyngeal space, which is the site of the most recently resected nodal mass. However, there is no discernible mass and there was no significant FDG activity in this region on the recent PET CT scan. Additionally, the medialized retropharyngeal course of the right internal carotid artery is probably also contributing to the asymmetric contrast enhancement in the area. There is no discrete cervical lymph node enlargement. Small, left more than right level 1B lymph nodes and tiny level 1A lymph nodes are not changed from the previous CT scan and showed only mild FDG activity on the recent PET/CT scan.There is slight asymmetric right-sided mucosal thickening along the upper end of the neopharynx but no discrete mass, which correlated with FDG avidity on the recent PET. This asymmetry also extends along the right side of the base of the tongue. An eccentric atheroma, versus intramural hematoma, involves the right common carotid artery and is not significantly changed compared to the previous CT scan, resulting in moderate stenosis. The right internal jugular vein is not visualized, probably ligated.Otherwise, the thyroid and major salivary glands are unremarkable. The cervical spinal canal is developmentally narrow. There is multilevel cervical degenerative spondylosis, most pronounced at C6-C7 where disc-osteophyte complex and ligamentum flavum thickening result in mild-to-moderate spinal canal stenosis. Focal marrow abnormality subjacent to the inferior endplates of C3 and C6 most probably represent intrabody disc herniations. There is no suspicious marrow lesion. There is fatty atrophy, increased STIR signal and contrast enhancement in the right hemitongue and the right trapezius muscle. There is small volume of fluid within the posterior naso/oro/neopharynx. There is mild mucosal thickening in the paranasal sinuses. There is fluid intensity in the right mastoid air cells. The imaged intracranial structures are unremarkable.

Output: 1.Contrast-enhancement posterior and deep to the right parotid gland, at the site of the recent nodal resection, is favored to be postoperative in nature given the lack of a discrete mass as well as the lack of significant FDG activity on the recent PET. 2.Asymmetric right-sided thickening in the oropharynx/upper neopharynx without a discrete mass might be inflammatory/postoperative in nature but is better assessed clinically. 3.Otherwise, expected postoperative changes are present in the neck as described above. 4.Small level 1 lymph nodes remain unchanged. No cervical lymph node enlargement by size criteria.5.Incidental finding of right carotid artery mural hematoma relating to dissection versus asymmetric atherosclerotic plaque, resulting in more than 50% luminal narrowing but unchanged since February 2016 examination.6.Right hemitongue and trapezius muscle abnormal signal and enhancement, likely relating to denervation of 11th and 12th cranial nerves.


Instruction: Generate impression based on medical findings.

Input: Headaches and neck pain with C3-4 cervical stenosis and instability. There is a prominent posterior disc-osteophyte at C3-4 that impinges upon the spinal cord, which displays focal signal abnormality at this level. There is also severe left and moderate right neural foraminal stenosis at C3-4. There is uncovertebral joint and facet joint hypertrophy bilaterally at C4-5, which result in moderate bilateral neural foraminal and spinal canal stenosis. There is no significant degenerative spondylosis at the other cervical spine levels. The vertebral body heights and signal characteristics are preserved. There is slight retrolisthesis of C3 on C4. The cervical spine alignment is otherwise anatomic. The paraspinal soft tissues are unremarkable.

Output: 1. A prominent posterior disc-osteophyte at C3-4 impinges upon the spinal cord, which displays focal signal abnormality at this level. There is also severe left and moderate right neural foraminal stenosis at C3-4. 2. Uncovertebral joint and facet joint hypertrophy bilaterally at C4-5 result in moderate bilateral neural foraminal and spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: There is straightening of the cervical spine, otherwise alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. There is no acute fracture or pre-vertebral soft tissue swelling. Low T1 signal throughout the vertebral bodies likely reflects red marrow. Multilevel disc desiccation without significant disc space loss. No abnormal signal within the visualized cord.C2-C3: No significant disc disease. No spinal canal or neural foraminal stenosis.C3-C4: Small central protrusion with minimal effacement of the ventral thecal sac. Mild uncovertebral joint arthropathy. Mild bilateral neural foraminal narrowing. C4-C5: No significant disc disease. No spinal canal stenosis. Mild uncovertebral joint arthropathy. Mild bilateral neural foraminal narrowing.C5-C6: No significant disc disease. No spinal canal or neural foraminal stenosis. C6-C7: There is an eccentric right paracentral disc extrusion which is slightly decreased in size compared to the prior exam, with stable 8 mm of superior migration. There is effacement of the right lateral recess and flattening of the hemicord, mildly improved. Moderate right neural foraminal stenosis is unchanged. No left neural foraminal stenosis.C7-T1: No significant disc disease. No spinal canal or neural foraminal stenosis.

Output: 1.Eccentric right paracentral disc extrusion at C6-C7 is slightly decreased in size with mild improvement in effacement of the ventral thecal sac and mass effect on the cord. Resultant moderate right neural foraminal stenosis is unchanged.2.Small central protrusion at C3-C4 is stable.


Instruction: Generate impression based on medical findings.

Input: Male 22 years old Reason: s/p sacral removal History: decubitus ulcer Patient is status post surgical distal sacrum removal. A surgical drain is in place. No definite evidence of osteomyelitis, however there is continued clinical concern for osteomyelitis an MRI is recommended.

Output: Postsurgical changes of a distal sacrum removal.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt w/ LLE sciatic pain. History: see above 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. There is only a mild degree of disk desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

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


Instruction: Generate impression based on medical findings.

Input: 65 years, Male, ataxia, rule out new ischemic event.. No restricted diffusion to suggest acute ischemia. No evidence of acute intracranial hemorrhage. No intracranial mass or mass-effect. There is extensive encephalomalacia involving the right frontal lobe extending into the right anterior temporal lobe. Minimal encephalomalacia involving the left inferior frontal lobe also noted. There is mild ex vacuo dilatation of the right lateral ventricle. No hydrocephalus. Minimal foci of susceptibility compatible with chronic blood products are noted in the right frontal and anterior temporal lobes. There are foci of T2 hyperintensity with volume loss involving the globi pallidi which may be related to prior ischemic or metabolic injury. Additional scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is cystic change/volume loss involving the left lateral aspect of the cervicomedullary junction compatible with prior injury. There is also mild to moderate generalized volume loss involving the cerebral hemispheres as well as of the cerebellar vermis and hemispheres.Paranasal sinuses are grossly clear. There is minimal opacification involving the bilateral mastoid air cells. Major flow-voids are preserved. There is mild deformity involving the bilateral medial orbital walls with medial herniation of fat and slight contour deformity involving the medial recti muscles which is suspected to be related to remote trauma.

Output: 1. No evidence of acute infarct.2. Extensive encephalomalacia in the right frontotemporal lobes favored to be related to prior trauma. Additional foci of signal abnormality and volume loss are seen in the bilateral globi pallidi which may be related to prior ischemic or toxic-metabolic injury. Additional focus of volume loss is seen involving the left lateral medulla/upper cervical cord junction also likely related to remote injury.3. Mild to moderate volume loss involving the cerebellar vermis and hemispheres and to a lesser degree the bilateral cerebral hemispheres. Finding is nonspecific and may be related to antiepileptic medications and/or chronic alcohol use, for example.


Instruction: Generate impression based on medical findings.

Input: 72 year old with severe tricuspid regurgitation presenting for evaluation of right heart enlargement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 57 ml/m2 (normal range: 65+/-11), the LVEDV is 97 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 36 ml (normal range 31+/-10), the LV mass index is 20 g/m2 (normal range 67+/-11), and the LV mass is 33 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 and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). Right AtriumThe right atrium is at least moderately dilated. Aortic ValveThe aortic valve is trileaflet and 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 significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%3. There is significant tricuspid regurgitation4. The right atrium is at least moderately dilated5. Significant artifact limited study interpretation.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: Preoperative planning for brain tumor. History of a left temporal AVM treated with radiation. There is a heterogeneous left supratentorial and infratentorial lesion with associated cystic compartments, some of which contain fluid-fluid levels suggestive of hemorrhage. There is also surrounding vasogenic edema in the left cerebellar hemisphere. There is marked effacement of the fourth ventricle and dilatation of the third and fourth ventricles, which have increased in size slightly. There is also marked mass effect upon the brainstem. There is also a similar contiguous heterogeneous lesion within the left temporal and occipital lobes with surrounding vasogenic edema. There is no herniation. There are skin-based fiducial markers.

Output: Presurgical planning MRI shows a complex mass in the left cerebellar hemisphere with associated obstructive hydrocephalus and a similar complex mass in the left temporo-occipital region. These lesions may represent radiation necrosis and perhaps vascular malformations with associated hemorrhage.


Instruction: Generate impression based on medical findings.

Input: History of high-grade obstruction in the ileum status post clinical improvement. Retrocaval ureter with percutaneous nephrostomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in size and morphology without a discrete lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval improvement of right-sided hydronephrosis with a percutaneous nephrostomy catheter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The ileum is adequately distended with oral contrast. The jejunum is suboptimally distended.The small bowel fold pattern is unremarkable.The bowel is normal in caliber without wall thickening, abnormal postcontrast enhancement, or restricted diffusion.There is no surrounding inflammatory changes or fibrofatty proliferation.There is no evidence of persistent luminal narrowing or prestenotic/upstream dilatation to suggest a flow-limiting stricture.Nonspecific small mesenteric lymph nodes are present.No evidence of sinus tract or fistula formation.The colon is normal in appearance.No significant free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of significant active small or large bowel inflammation. No flow-limiting stricture. No evidence of obstruction.Interval improvement in right-sided hydronephrosis with placement of percutaneous nephrostomy.


Instruction: Generate impression based on medical findings.

Input: Right neck mass; growing for 5 months. In the right anterior neck, there is a well-circumscribed, multilobulated mass, which measures transaxially 3.4 cm x 2.8 cm while craniocaudally measures 4.1 cm. The mass is T2 hyperintense and mildly T1-hyperintense. Following contrast injection, there is laterally nodular but otherwise thin uniform rim contrast enhancement. The mass extends from just inferior to the right submandibular gland, which is mildly deformed but not invaded by the mass, reaching inferiorly to the right thyroid lobe with no clear separation between the two. The mass is located just deep to and inseparable from the right-sided strap muscles. It causes mass-effect on the adjacent trachea and larynx causing mild-to-moderate airway narrowing. The mass also posteriorly displaces the right carotid sheath contents, without vessel narrowing, as well as the anterior margin of the sternocleidomastoid muscle. There is no active inflammation in the adjacent tissues. There are multiple mildly prominent lymph nodes in both sides of the neck, including lateral retropharyngeal lymph nodes, which is a common finding in this age group. There is no mass within the major salivary glands. There is no other mass in the thyroid gland.Cervical spine and included brain are unremarkable.

Output: Cystic anterior right neck mass, closely related to the right thyroid lobe and the strap muscles with differentials including thyroglossal duct cyst and lymphatic malformation. Location is not typical for brachial cleft cyst. Intrinsic T1 hyperintensity within the cyst and mildly nodular rim of contrast enhancement may be related to prior hemorrhage or infection.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old; Reason: evaluate for sacral osteo History: sacral decubitus ulcers, infected, deep to bone BONE MARROW: Abnormal T1 and T2 prolongation involving the left ischium compatible with osteomyelitis which is slightly increased from prior. There is also cortical irregularity in the area. There is gas and fluid that extends up to the cortical surface.There is a new deep ulcer involving the right ischium with mild edematous changes in the right ischium without definite T1 changes or definite cortical erosion.SOFT TISSUES: Severe body wall anasarca. Deep ulcers adjacent to the ischium bilaterally (left larger than right). Perirectal soft tissue edema and possible ulcer.Percutaneous bladder catheter. There is severe muscle atrophy of the gluteal muscles. There is severe body wall anasarcaJOINTS: Bilateral chronic hip dysplastic changes with osteoarthritis.ADDITIONAL

Output: Findings compatible with osteomyelitis of the left ischium with marrow changes.New right deep ulcer with marrow edema of the ischium but no T1 changes overall findings are suggestive of reactive osteitis.


Instruction: Generate impression based on medical findings.

Input: 66-year-old woman with history of cirrhosis, HCC, and second lesion seen near the gallbladder fossa. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with widened fissures and nodular contour. In segment 5 of the liver (series 6, image 17) there is a 35 x 32 mm T2 hyperintense lesion with central hypointensity which demonstrates peripheral enhancement throughout all phases of contrast including retention on delayed phases. This lesion appeared similar on the previous examination and measured 33 x 28 mm.Additionally, in segment 8 (series 6, image 13) there is a 36 x 30 mm uniformly T2 hyperintense lesion which, on the prior outside study, demonstrated arterial enhancement and washout on delayed phase of imaging. On the current study, the enhancement pattern is indeterminate. This lesion measured 35 x 20 mm on the prior examination.Additionally, in segment 2 (series 6, image 8) there is a subcentimeter lesion which is hyperintense on T2 sequences but not seen on the postcontrast images or the prior, outside examination.There is no intrahepatic or extra hepatic biliary duct dilatation. The gallbladder is normal.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There are subcentimeter renal cysts, otherwise the kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 5 lesion with similar imaging appearance to the prior examination and suspicious for intrahepatic cholangiocarcinoma.2.Segment 8 lesion with indeterminate enhancement characteristics on today's examination, but findings on the prior examination suspicious for hepatocellular carcinoma.3.Segment 2 lesion which is too small to accurately characterize.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90] / Disseminated malignant neoplasm, unspecified [C80.0] / Encounter for antineoplastic chemotherapy [Z51.11] / Encounter for examination for normal comparison and control. There are multiple variable sized the abnormal enhancing nodules including left precentral sulcus suspicious posterior aspect of pars opercularis, left frontal lobe inferior frontal gyrus pars orbitalis, right mesial thalamus, right anterior aspect of superior temporal gyrus and posterior aspect of middle temporal gyrus, medial aspect of left middle cerebellar peduncle and inferior aspect of the left cerebellar hemisphere. Considering the patient clinical history, these enhancing nodules represent multiple metastatic lesions.There is also localized not clearly circumscribed area of replacement of normal fatty marrow of skull on the midline occipital bone which shows inhomogeneous enhancement. This finding could also represent focal bony metastasis. Thus, if indicated, either head CT scan with thin section around occipital bone or bone scan can be considered for further imaging evaluation if clinically indicated.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal bihemispheric, supra and infratentorial variable sized enhancing nodules as described above, compatible with multifocal intracranial metastasis.2. Possible occipital bone lesion as described above.


Instruction: Generate impression based on medical findings.

Input: 45 year old woman with non ischemic cardiomyopathy and obstructive lung disease, referred for further evaluation of possible cardiac sarcoid. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 216 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 142 ml (normal range 31+/-10). LV dysfunction is global. There is no late gadolinium enhancement or myocardial edema to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 79 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 at least mild 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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%.2. There is no late gadolinium enhancement or myocardial edema to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%.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: 75-year-old woman with history of osteoarthritis and intra-articular pain. MENISCI: The medial and lateral menisci are intact without evidence of tear.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage over the medial femoral trochlea with with an approximately 12 mm bare area, underlying reactive marrow change, and a 5 x 5 mm subchondral cyst (series 7, image 14). There is significant thinning of the articular cartilage over the medial patellar facet with underlying reactive marrow changes. Additionally, there is fissuring of the articular cartilage over the lateral patellar facet with underlying marrow change. The articular cartilage of the tibial femoral compartment is thinned without full-thickness loss.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. The popliteus muscle and tendon are intact. EXTENSOR MECHANISM: The patella and extensor mechanism are intact.ADDITIONAL

Output: 1. Articular cartilage loss predominantly over the medial patellofemoral compartment with underlying reactive marrow change and subchondral cysts.2. Findings compatible with prepatellar bursitis.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with recent code, hypotension, on pressors. Rule out stroke Exam limited by motion artifact.Again seen is a low-attenuation lesion in the left frontal deep white matter that extends to the basal ganglia. This is seen on previous studies dating back to an MRI from 2/05 and is consistent with chronic ischemic changes.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The mastoid air cells are normally pneumatized.

Output: Chronic ischemic changes unchanged. No CT finding suggesting acute ischemia. Recommend MRI exam once the patient is clinically stable to rule-out acute ischemia as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Fecal and urinary incontinence, left leg weakness; history of multiple myeloma and cerebral hemorrhage status post evacuation. Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol which is a limited study.There is normal signal intensity and caliber of cervical and thoracic cord without detectable mass effect on the cord or any significant central spinal stenosis.The alignment of vertebral column is anatomical and without evidence of fracture. There is no detectable perispinal soft tissue abnormalities.

Output: 1.Normal signal intensity and caliber of cord.2.No evidence of fracture, malalignment or spinal stenosis.


Instruction: Generate impression based on medical findings.

Input: Depth electrode for seizures. There is a left transparietal depth electrode that terminates in the left medial temporal lobe region, a left transtemporal depth electrode that also terminates in the left medial temporal lobe region, and another depth electrode that terminates in the left thalamus region. There is new diffuse T2 hyperintensity along the left hippocampal tail, adjacent to an electrode. There is also a newly apparent T2 hyperintense lesion in the splenium of the corpus callosum. The ventricles are unchanged is size.

Output: 1. Multiple left cerebral hemisphere depth electrodes in position and new edema along the left hippocampal tail, adjacent to an electrode, which may be related to seizure activity.2. Newly apparent lesion in the splenium of the corpus callosum, which may be related to seizure activity, antiepileptic medications, or viral infection, for example.


Instruction: Generate impression based on medical findings.

Input: A 24 year old female with a history of asthma and an upper respiratory tract infection on 10/2015, since then feeling shortness of breath and chest pain together with an increase in weight. A recent echocardiography showed low normal LVEF (52.7% biplane). A recent CT showed pulmonary artery size in the upper limit of normal. The patient was referred from the pulmonary hypertension clinic to rule out pulmonary vascular disease. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 141 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 77 ml (normal range 31+/-10). There is mild global hypokinesis with 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 mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 146 ml (normal range 110+/-24), the RV end systolic volume index is 42 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. ShuntNo shunt to suggest an ASD was noted on first pass contrast imaging. PFO can be missed with this technique. No ASD noted noted with cine imaging.Aortic ValveThe aortic valve is trileaflet, 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. No coarctation noted.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (24mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 45%. There is mild global hypokinesis with no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 46%. 3. No shunt was noted4. The main pulmonary artery is normal in size (24mm). 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: 36-year-old male with positive Lachman's test MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a lateral notch along the anterolateral femoral condyle with underlying articular cartilage defect measuring approximately 1 cm in AP dimension and extensive underlying edema consistent with contusion. Linear T1 hypointense signal associated with extensive edema in the posterolateral tibial condyle is consistent with fracturing and contusion, but there is no impaction. There is mild degeneration of the articular cartilage along the medial facet of the patella and posteromedial femoral condyle.LIGAMENTS: The ACL is completely torn. The PCL is intact. The medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: The patella and quadriceps tendon are intact.ADDITIONAL

Output: 1. ACL tear with associated contusions as described above.2. Chondral injury along the lateral femoral condyle. 3. Moderate joint effusion.


Instruction: Generate impression based on medical findings.

Input: 65-year-old woman with history of liver/pancreatic lesions and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Two lesions are identified in segments 5 and 6 of the liver, both of which are T2 hyperintense, more so in the center, restrict on diffusion weighted images, and enhance peripherally. The remaining liver parenchyma is normal in signal and morphology. There is no intrahepatic biliary duct dilatation.The gallbladder is normal. There is mild common bile duct prominence measuring up to 4 mm.SPLEEN: The spleen is normal.PANCREAS: There is a multilobulated lesion with increased T2 signal in the pancreatic body measuring approximately 30 x 11 mm (series 501, image 17). Additionally, there is mild prominence of the pancreatic duct measuring up to 4 mm to the level of the ampulla.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel is unremarkable. There is colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two solid hepatic lesions in segments 5 and 6 highly suspicious for malignancy, probably metastases although a primary site is not identified. Tissue diagnosis can be considered for further evaluation if clinically warranted.2.Sidebranch type IPMN of the pancreas.3.Mild prominence of the common bile duct and pancreatic duct to the level of the ampulla, likely with benign stricture.


Instruction: Generate impression based on medical findings.

Input: Ms. Rudolph is a 52 year old female with known right breast malignancy currently undergoing neoadjuvant therapy. She presents for MRI to evaluate for treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy marker clip is identified in the right superior breast, at site of biopsy-proven malignancy. However, there is no residual abnormal enhancement seen at this location. There is no abnormal enhancement seen in the remainder of the right breast or the left breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Complete imaging response of biopsy proven malignancy in the right superior breast. Clip was appropriately placed at time of diagnosis. If breast conservation therapy is desired, a single wire can be placed in the right breast for preoperative surgical guidance.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 4 year old male with status epilepticus. Rule out structural abnormalities. No restricted diffusion to indicate an infarct. No susceptibility weighted abnormalities to indicate hemorrhage. There is diffuse increased prominence of the sulci and ventricles compatible with diffuse parenchymal atrophy, most severe within the temporal lobes. No mass effect, midline shift or herniation. No edema or evidence of a focal lesion. There are no extraaxial fluid collections or subdural hematomas. Diffuse nonspecific mucosal thickening involves the maxillary, ethmoid and sphenoid sinuses. Fluid is noted in the left mastoid air cells.

Output: 1.No evidence of intracranial hemorrhage, edema, mass effect or focal lesion.2.Evidence of diffuse parenchymal atrophy, particularly severe in the temporal lobes.


Instruction: Generate impression based on medical findings.

Input: Intracerebral hemorrhage [431], Reason for Study: ^Reason: evaluate old hemorrhage v cavernoma History: susceptibility on previous MRI Redemonstration of encephalomalacia with gliotic change on the left precuneus chronic ICH. On gadolinium enhancement, there is no significant enhancement seen within or around this lesion.On gradient echo images, there are stippled susceptibility lesions within the lesion as well as surrounding low signal intensities indicating hemosiderin deposition. However, the overall MR feature of hemosiderin deposition is not usual popcorn appearance for cavernous malformation.This is unusual intra-axial hemorrhagic foci, if AVM is one of the possible diagnosis, diagnostic catheter angiogram needs to be considered. Gadolinium-enhanced MRI cannot exclude the possibility of brain AVM.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D 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. The right PCA is fetal origin. No intracranial arterial aneurysm. No intracranial arterial luminal stenosis is seen.

Output: 1. Usual evolution of left precuneus ICH with hemosiderin deposition as described above.2. No abnormal enhancement on the scan.3. No evidence of acute hemorrhagic or ischemic lesion.4. Normal brain MRA.5. Diagnostic catheter angiography need to be considered if brain AVM is a potential diagnosis.


Instruction: Generate impression based on medical findings.

Input: 2-day-old male with apnea and multiple bradycardic events. Assess for bleed. Note is made of curvilinear hyperattenuation along the right and left tentorium consistent with a small subdural hematoma layering along the tentorium. Note is made of diffuse generalized hypoattenuation affects the entire right cerebral hemisphere, which may be related to technical artifact, however, if high clinical suspicion for acute ischemia, further evaluation with MRI could be considered. There is no evidence of intracranial mass. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.

Output: 1. Trace subdural hematoma layering along the tentorium. Close interval follow up examination is recommended. 2. Diffuse generalized hypoattenuation affects the entire right cerebral hemisphere, which may be related to technical artifact, however, if high clinical suspicion for acute ischemia, further evaluation with MRI could be considered.These findings and recommendations were discussed via direct phone call with Emily Weiss at 11:00 am on 4/13/13.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in an appropriate position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is the patient's right ventriculostomy catheter with its tip in the medial right frontal horn, appearing slightly retracted and more medially when compared to the prior CT. There has been no significant change in lateral or third ventriculomegaly. A small amount of edema is again noted around the ventriculostomy catheter. As before, there are postoperative changes from previous suboccipital craniectomy and occipital craniotomy for debulking the patient's posterior fossa mass. As before, residual right-sided tumor results in associated mass effect on the upper cervical spine, medulla, pons, and midbrain with near effacement of the fourth ventricle. As before, fluid is noted within mastoid air cells.

Output: Residual right-sided tumor results in associated mass effect on the upper cervical spine, medulla, pons, and midbrain with near effacement of the fourth ventricle.


Instruction: Generate impression based on medical findings.

Input: Male 64 years old Reason: recently newly diagnosed rectal cancer staging History: rectal cancer Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Enlarged, heterogeneous prostate gland measuring up to 4.1 x 5.3 cm.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: 3, the largest of which measures 1.7 x 1.7 cm at the left aspect of the sigmorectal junction (image 570/series 1209).Lymph nodes outside the mesorectal fascia: 0BOWEL, MESENTERY: Rectal Tumor:Size: 3.3 x 3.5 x 5.9 cm (AP by transverse by craniocaudal) (image 375/series 1209, image 21/series 901)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Upper-thirdCircumference of the rectum involved: 100%Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): No abutment or invasion.MRI T-stage: T3b - Tumor invades 0.5cm to 1cm into perirectal fat or extramural.Tumor Distance to Mesorectal Fascia: 2mm (image 54/series 601).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Rectal cancer with metastatic perirectal lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Contrast promptly passed into the radioulnar joint suggest a tear of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for further information.Exposure time: 0:31 minutes

Output: Successful arthrogram of the right radiocarpal joint. Findings suggestive of a tear of the triangular fibrocartilage complex as above. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male is status post 6-foot fall from ladder with L4 compression fracture and retrolisthesis of L4 on L5 on x-ray Advanced degenerative disk disease with significant vacuum phenomenon and sclerotic changes of the adjacent endplates at L5 -- S1 level is noted. There is grade 1 anterolisthesis at this level secondary to bilateral pars defects (spondylolysis).Less than 50% compression fracture of the superior endplate of L4 and a small loose fragment anterior to the vertebral body is noted. The alignment of the spine at this level remains normal. No evidence of any fracture of the posterior elements is noted. The facets remain aligned at this level however demonstrate degenerative changes and minimal widening of the facet space which may be secondary to degenerative changes or possibly soft tissue injury secondary to patient's fall.For better evaluation of the soft tissues and MRI would be helpful. No definitive evidence of any compromise of the spinal canal at this level is detected.

Output: 1.Compression fracture of superior endplate of L4 with no malalignment.2.Grade 1 antral listhesis at L5 -- S1 secondary to bilateral spondylolysis.


Instruction: Generate impression based on medical findings.

Input: Headache and left ear tinnitus. Additional patient history includes systemic lupus erythematosus and optic neuritis. There is no evidence of intracranial hemorrhage, mass effect, or acute infarct. There are scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter and along the undersurface of the corpus callosum, which are better appreciated on prior sagittal FLAIR imaging. No new lesions within the brainstem or elsewhere in the brain. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is a right lens implant.

Output: 1.Unchanged nonspecific white matter lesions in the supratentorial brain. Differential diagnosis again includes prior inflammation, demyelination, or ischemia.2. No new brainstem lesion is identified. Please note if high-resolution imaging of the eighth cranial nerves is warranted, dedicated MRI of the internal auditory canals can be obtained.


Instruction: Generate impression based on medical findings.

Input: Right lower extremity weakness, concern for cord compression. History of type B AAA s/p TEVAR with Nitinol Graft. The exam is limited by artifacts, such that the spinal cord is not well-delineated and apparent high T2 signal in the conus medullaris may be artifactual. However, there does not appear to be extrinsic compromise of the spinal cord. The vertebral bodies are appropriate in the overall alignment and height. The known aortic dissection is partially imaged.

Output: 1. Assessment of the spinal cord is limited and therefore a subtle spinal cord infarct cannot be excluded. If clinically warranted, repeat imaging of the spinal cord including diffusion weighted sequences may be useful. Nevertheless, no extrinsic compression of the spinal cord is apparent.2. The known aortic dissection is partially imaged. 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: 63-year-old male with pain. Evaluate rotator cuff. ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus and infraspinatus tendons indicating moderate tendinosis. There is also high signal intensity within the supraspinatus tendon at its insertion on the greater tuberosity representing a concealed interstitial tear, measuring approximately 1 cm in AP dimension, which involves approximately 1/3 to 1/2 of the tendon. There is also increased signal intensity at the insertion of the infraspinatus tendon more posteriorly which may represent additional insertional tearing without evidence of retraction. There may also be mild bursal surface fraying of the supraspinatus tendon. There is mild fatty atrophy along the myotendinous junction of the infraspinatus muscle but the supraspinatus and infraspinatus otherwise are normal in appearance. The teres minor and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint with osteophyte formation and capsular hypertrophy resulting in mild impression upon the superior fibers of the supraspinatus tendon. There is a trace amount of fluid within the subacromial/subdeltoid bursa. There is minimal increased signal intensity within the bursa on fluid sensitive sequences which may reflect mild inflammation.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint with scattered foci of signal abnormality within the labrum likely representing degeneration/degenerative tearing. There is linear signal abnormality partially separating the anterior labrum from the glenoid along with slight flattening of the lateral aspect of the humeral head which raises the possibility of prior anterior dislocation. There is a small amount of fluid within the joint but no large effusion is evident.BICEPS TENDON: There is thickening and increased signal intensity within the long head of the biceps tendon at its transition from the rotator cuff interval to the intertubercular groove, indicating moderate tendinosis. The tendon of the long head of the biceps is also perched upon the superior aspect of the lesser tuberosity which may represent a pulley lesion. There is fluid within the biceps tendon sheath which may represent mild tenosynovitis. There is a subcentimeter ovoid focus of intermediate signal intensity within the biceps tendon sheath which may represent a cartilage fragment.

Output: 1. Supraspinatus and infraspinatus tendinosis with insertional (likely concealed) tearing without evidence of retraction as described above.2. Acromioclavicular and glenohumeral joint osteoarthritis.3. Moderate tendinosis and tenosynovitis of the long head of the biceps tendon and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Eethesioneuroblastoma; received 2 cycles of chemotherapy; assess for response to therapy. Face: There is a right sinonasal mass that extends from medial maxillary sinus, through the infundibulum into the middle meatus and anterior ethmoid air cells. The tumor measures up to approximately 30 mm in craniocaudal extent, 30 mm in the anteroposterior dimension, and 20 mm transversely, which is similar to the size of the tumor in August 2015. There are obstructed secretions and mucosal thickening in the right maxillary sinus, frontoethmoid, frontal sinuses. There is apparent dehiscence of the posterior wall of the right nasolacrimal duct, which appears narrowed, but no evidence of intracranial or intraorbital extension of the tumor. There appears to be a mildly asymmetrically prominent right level 2B lymph node. There is leftward nasal septal deviation. There is a subcentimeter probable nasopharyngeal retention cyst.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. A right sinonasal mass measuring up to 30 mm that involves the right maxillary, middle meatus, and ethmoid sinuses is compatible with residual esthesioneuroblastoma without evidence of intraorbital or intracranial extension. 2. A mildly asymmetrically prominent right level 2B lymph node is nonspecific.3. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Right hip pain Note that the exam is significantly limited given the presence of a total hip arthroplasty.There is no obvious underlying bony destruction. There is a large amount of soft tissue and muscle edema about the right hip reflecting recent surgical intervention. Within the posterior soft tissues of the hip is a 5.1 cm fluid collection which appears to communicate with the joint (postcontrast image 14/26 on series 8). An additional small collection is seen within the gluteal musculature (image 21/26 on series 8).

Output: Significantly limited exam secondary to metallic artifact. There is a nonspecific fluid collection within the posterior soft tissues which appears to communicate with the joint itself end is likely postoperative in nature. Additional postoperative findings described above.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o radiculopathy History: vibration sensation in buttock and legs 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.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

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


Instruction: Generate impression based on medical findings.

Input: 68 years, Male, Reason: 68M with low risk prostate cancer. Evaluate with MRI prostate History: Prostate cancer. Left base, right transitional zone PELVIS:PROSTATE:Prostate Size: 4.7 x 2.8 x 4.1 cm.Peripheral Zone: Lesion in the left base peripheral zone with low ADC/questionable low T2 signal (704/284) suspicious for prostatic adenocarcinoma. This lesion measures 0.8 x 0.6 cm (704/304). T2 hypointense irregular signal in region of right base peripheral zone without definite corresponding abnormal ADC hypointense signal, nonspecific, may reflect underlying scarring. Central Gland: Well-defined heterogeneous nodules in the central gland suggest BPH.Seminal Vesicles: No involvement.Extracapsular Extension: No extracapsular extension.BLADDER: There is a left sided ureterocele measuring 1.6 x 1.6 cm.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Lesion in the left base suspicious for prostatic adenocarcinoma.2.Left-sided ureterocele.


Instruction: Generate impression based on medical findings.

Input: Status post right CCM resection Non-infused CT of brain:Examination demonstrate a foci of increased density measuring approximately 30 x 14.6-mm in trans-axial dimensions in the right basal ganglia. There are no prior CT examination for comparison. This finding is believed to represent patient's known cavernous malformation at this site. There is evidence of surgery and with extension of surgical tract to the right lateral aspect of this lesion. Although the above finding could represent patient's known cavernoma and does not particular area appeared like acute hemorrhage possibly itself subtle associated hemorrhage cannot be ruled out. The configuration of right frontal horn is identical to prior MRI exam which demonstrated extension of tumor into the right caudate nucleus and bulge into the right frontal horn.Postoperative changes of a right anterior frontal craniotomy and resultant air within the anterior cranial fossa bilaterally and minimal epidural collection under the craniotomy flap. There is no evidence of subarachnoid hemorrhage or definitive acute parenchymal hemorrhage. Ventricular system remains within normal size and unchanged since prior exam. There is no midline shift.

Output: 1.Postoperative changes of right frontal craniotomy for partial resection of right basal ganglial cavernoma.2.High density material within the right basal ganglia as measured could represent residual cavernoma. No definite postoperative hemorrhage is detected however high density of the mass can obscure small amount of hemorrhage.3.There is no evidence of hydrocephalus or midline shift.4.Residual air and minimal epidural hemorrhage under the craniotomy flap.


Instruction: Generate impression based on medical findings.

Input: Brain MRI:Lobular abnormality is noted centered within the clivus extending into the adjacent sphenoid sinuses (right greater than left). There are also several foci of signal abnormality throughout the calvarium.There are a few scattered foci of T2 hyperintensity within the white matter without restricted diffusion or susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within left maxillary sinus. Fluid is also present within bilateral mastoid air cells.Limited cord compression spine MRI:Widespread abnormality can be found throughout the spine with vertebral body compression deformities at several levels. Multilevel stenoses are present throughout the cervical spine as well as at the T4-T6 levels secondary to a combination of degenerative changes as well as osseous expansion. There is also narrowing of the central canal from L3 through L4, also secondary to osseous expansion. There also appear to be foci of epidural extension at the T4/5 as well as L2/3 levels. There appears to be moderate central stenoses within the cervical spine, however severe at the T4-T6 levels, with more moderate stenoses involving the lumbar spine.

Output: 1.Minimal chronic small vessel ischemic disease. No acute ischemia.2.There is widespread myeloma involvement throughout the spine with vertebral body compression deformities at multiple levels throughout each segment, including possible epidural extension at the T4/5 as well as L2/3 levels.There appears to be moderate central stenoses within the cervical spine, however severe at the T4-T6 levels by definition resulting in cord compression, with more moderate stenoses involving the lumbar spine. Given the widespread skeletal pathology without comparison, it is uncertain the chronicity of the cord compression and stenoses.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with wrist pain. Evaluate wrist mass. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact within the limitations of a non arthrogram study.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact. TENDONS: There is slight palmar subluxation of the extensor carpi ulnaris which may be chronic in etiology. There is a small amount of fluid about the extensor digitorum and extensor carpi radialis tendons which may reflect a very mild tenosynovitis. There is nonspecific subcutaneous edema within the soft tissues about the posterior aspect of the wrist as seen on fluid sensitive sequences. The flexor tendons appear intact. BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: Nonspecific subcentimeter foci of heterogenous signal abnormality about the posterior aspect of the wrist as described above, which may reflect a synovitis, although this is incompletely characterized on this noncontrast examination. Further evaluation with a dedicated contrast enhanced MRI examination could be considered if further imaging is clinically warrented. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 62-year-old BRCA-positive female. Strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few enhancing foci in the lateral inferior left breast are stable. No abnormal lymph nodes are identified in either axillary region. Stable left lobe liver cysts are noted.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Vvisual field testing abnormal, please evaluate for possible pituitary tumor. Pituitary: There is a pituitary mass with suprasellar extension that measures up to 29 mm. There is associated mass effect upon the optic apparatus, cavernous sinuses, and hypothalamus. Although the tumor abuts and perhaps partially encases portions of the internal carotid arteries, the flow voids are intact. Brain: There are two adjacent enhancing extra-axial masses along the left superior frontal convexity that measure up to 9 mm in width and 14 mm in width. The larger lesion demonstrates associated hyperostosis of the calvarium. There is no significant mass effect upon the underlying brain parenchyma. There are minimal scattered foci of nonspecific cerebral white matter T2 hyperintensity. There is no evidence of acute infarct. There are mild scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is diffuse cerebral volume loss. There is no midline shift or herniation. There is a right scleral band and bilateral lens implants.

Output: 1. Pituitary macroadenoma measuring up to 29 mm with supersellar extension and mass effect upon the optic apparatus, cavernous sinuses, and hypothalamus. 2. Two adjacent meningiomas along left superior frontal convexity that measure up to 9 mm in width and 14 mm in width. 3. Diffuse cerebral volume loss.


Instruction: Generate impression based on medical findings.

Input: There is a right-sided pituitary mass which measures 16 mm transverse by 10 mm craniocaudal by 11 mm AP dimension. It enters the adjacent cavernous sinus, abutting the cavernous carotid, however without arterial encircling or narrowing. There is no significant deviation of the pituitary stalk, and the mass does not approach the optic apparatus.A small T2 hyperintense multiloculated lesion is noted within the right paramedian clivus (best seen series 901 image 12/44) with a pedunculated portion which extends into the adjacent subarachnoid space abutting the basilar artery, however without arterial deformation or displacement. There is minimal, questionable enhancement along its lateral aspect. It demonstrates a narrow zone of transition with what appears to be intact cortical borders.There are scattered foci of T2 hyperintensity in periventricular and subcortical white matter (primarily subcortical) not associated restricted diffusion, mass effect, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Right sided pituitary macroadenoma which does not approach the optic apparatus.2.Clival-based lesion with an MRI appearance most consistent with ecchordosis physaliphora. Given the lack of significant enhancement, clival chordoma is felt to be less likely.3.Chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Vestibular schwannoma 6 months surveillance. There are postoperative findings related to left retrosigmoid craniotomy. There is persistent intermediate T2 and enhancement within the left internal auditory canal, measuring up to approximately 1 cm in length. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a left maxillary sinus retention cyst.

Output: Postoperative findings related to left retrosigmoid craniotomy with persistent intermediate T2 and enhancement within the left internal auditory canal, measuring up to approximately 1 cm in length, which may represent a combination of tumor and treatment effects.


Instruction: Generate impression based on medical findings.

Input: Chronic hepatitis C. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with prominent fissure, compatible with cirrhotic morphology. Within the hepatic dome, there is a T2 hyperintense lesion measuring 1.1 x 1.0 cm lesion (series 7, image 17), with contrast enhancement but no washout on delayed imaging. An additional lesion is identified within segment 7 (series 11, image 48) measures 1.1 x 0.9cm, is isointense on T2, enhances on arterial phase, with no washout on delayed imaging, probable perfusion defect.SPLEEN: There is mild splenomegaly. Splenic varices are present.PANCREAS: There is atrophy of the pancreas with dilatation of the main pancreatic duct measuring to 1.3 cm and side branch ectasia, unchanged from prior. There are multiple cysts within the pancreatic head and body, the largest measures 2.2 x 1.6 cm (series 7, image 27), which is similar in size to prior study but increased in size since April 2015. This lesion communicates with the main pancreatic duct, probably combined-type IPMN. There is a filling defect within this lesion on T2 imaging, that minimally enhances (series 11, image 109).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a large hiatal hernia. The bowel loops are otherwise normal in appearance. There is a small volume of perihepatic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable T2 hyperintense hepatic dome lesion, without washout on delayed imaging, in a cirrhotic liver. This lesion remains suspicious for HCC. Follow-up recommended.2.Cystic lesion within the pancreas communicating with the main pancreatic duct is unchanged since recent MRI, but increased in size since April 2015, probably combined-type IPMN.3.Additional enhancing lesion within hepatic segment 7, probable perfusion defect.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with history of chronic abdominal pain, nausea, vomiting, diarrhea, weight loss. Rule out inflammatory bowel disease or other small bowel pathology. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume of stool is noted throughout the colon. Appropriate distention of the small bowel loops for this MR enterography exam. No abnormal wall thickening or abnormal wall enhancement. Normal appearance of the terminal ileum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Normal uterus. Normal appearing right ovary containing an involuting corpus luteal cyst (series 17 image 65).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid in the dependent pelvis likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence for inflammatory bowel disease or acute small bowel pathology.2.Large volume stool throughout the colon compatible with constipation, may be correlated clinically.