Instruction: Generate impression based on medical findings.

Input: 66 year old male with a history of pulmonary hypertension status-post thromboendarterectomy who is referred for cardiac MRI Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 188 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 79 ml (normal range 47+/-19), the LV mass index is 31 g/m2 (normal range 85+/-15), and the LV mass is 63 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement present to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 relaxation times range between 900-970 ms (normal limits). No evidence of myocardial iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 196 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 107 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.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 mildly dilated (35 mm). 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 (LVEF 58%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. The right ventricle is normal in size and mildly reduced systolic function (RVEF 46%).3. The main pulmonary artery is mildly dilated (35 mm). 4. The right atrium is moderately dilated. 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: Female, 23 years old, with seizures. Encephalomalacia and cystic degeneration is seen along the left parahippocampal gyrus and a portion of the inferior temporal gyrus. The amygdala and the hippocampal formation proper are relatively unaffected. The forniceal columns and mammillary bodies are of symmetric caliber bilaterally.Elsewhere brain parenchymal morphology is unremarkable. No additional focal signal abnormality, edema, or structural anomaly is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.

Output: 1.Encephalomalacia and cystic degeneration affecting the left parahippocampal gyrus and left inferior temporal gyrus are unchanged. These findings may reflect the sequelae of prior infection or inflammation.2.The remainder of the brain is unremarkable.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of pituitary adenoma. Signs and symptoms: Surveillance scan. Pre and post enhanced pituitary MRI:Examination redemonstrate residual pituitary adenoma within the left lateral aspect of the sella and with extension into the left cavernous sinus and partial encasement of the left internal carotid artery. On coronal post enhanced images the maximum craniocaudal cephalad axis of tumor measures at 23.4 mm which is nearly identical to prior exam. Expanded left cavernous sinus and tumor on the left lateral aspect of the due to measures maximum of 15.3 mm in transverse axis which is also identical to prior study. The caliber of the internal carotid artery remains within normal.There is significant rightward deviation of pituitary stalk which terminates to the right lateral aspect of expanded sella similar to prior exam. There is no detectable mass within the basal cistern. There is inferior herniation of the suprasellar visual complex inferiorly likely as a result of treatment and scarring which also remain similar to prior exam.

Output: 1.Stable size, signal intensity and extent of residual pituitary adenoma within the left lateral aspect of sella and with extensive extension into the left cavernous sinus as detailed.2.Adhesion of the pituitary stalk to the right lateral wall of expanded sella similar to prior exam.3.Inferior herniation of the suprasellar visual complex as result of treatment remain similar to prior study as well.


Instruction: Generate impression based on medical findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Midazolam and fentanyl were administered IV by the nurses during continuous hemodynamic monitoring. A localizing CT demonstrated a lesion within the left superior pubic ramus and acetabulum corresponding to the findings on the patient's recent MRI examination.A 13 gauge OnControl core biopsy needle was advanced under CT guidance into the aforementioned lesion within the left superior pubic ramus and left acetabulum. Three 13-gauge core needle biopsy specimens were obtained. Touch preparation slides were handed to cytopathology.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT-guided biopsy of a left superior pubic ramus/left acetabular lesion.


Instruction: Generate impression based on medical findings.

Input: 45 year old man with a history of sarcoid, hypertension, and alcoholism. He presents with acute decompensated heart failure and is referred to evaluate for etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 8%, the LV end diastolic volume index is 193 ml/m2 (normal range: 74+/-15), the LVEDV is 332 ml (normal range 142+/-34), the LV end systolic volume index is 177 ml/m2 (normal range 25+/-9), the LVESV is 305 ml (normal range 47+/-19), the LV mass index is 139 g/m2 (normal range 85+/-15), and the LV mass is 239 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 14%, the RV end diastolic volume index is 135 ml/m2 (normal range 82+/-16), the RVEDV is 231 ml (normal range 142+/-31), the RV end systolic volume index is 115 ml/m2 (normal range 31+/-9), and the RVESV is 198 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated..Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace pericardial effusionExtracardiac FindingsThere is a small mediastinal lymph node noted. Large right pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 8%). No evidence of underlying myocardial fibrosis, inflammation, or infiltration. This favors hypertension or alcohol as an etiology for the cardiomyopathy over sarcoidosis.2. Moderate RV dilation with severely reduced systolic function (RVEF 14%).3. Significant biatrial dilation.4. Moderate mitral regurgitation.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of prostate cancer. Evaluate for extent of disease. Biopsy 7/16/15. Gleason 3 +4 = 7.PSA history per EMR:January 2013 - 4.3 ng/ml. May 2013 - 5.0 ng/ml April 2015 - 5.9 ng/ml PELVIS:PROSTATE:Prostate Size: 4.3 x 3.7 cm.Peripheral Zone: There are bilateral multifocal ill-defined lesions demonstrating decreased T2/ADC signal abnormality suggestive of patient's known prostatic adenocarcinoma. No definite focal abnormal enhancement. Tumor volume appears larger on the left with largest focus in the left apex. There is no evidence of extracapsular invasion or extension into the seminal vesicles.Central Gland: Numerous well-defined nodular lesions without suspicious characteristics.Seminal Vesicles: No evidence of seminal vesicle invasion of known peripheral zone lesions.Extracapsular Extension: No evidence of extracapsular extension of known peripheral zone lesions.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BONES, SOFT TISSUES: No suspicious focal osseous lesions.OTHER: No significant abnormality noted.

Output: Findings compatible with known multifocal bilateral prostatic adenocarcinoma without evidence of extracapsular invasion, lymph node metastases, or suspicious bone lesions.


Instruction: Generate impression based on medical findings.

Input: There is artifact related to patient's braces involving the anterior upper neck soft tissues. Lack of contrast also limits evaluation for small lesions. There is however no large mass involving the neck soft tissues. Multiple small T2 hyperintense lesions are seen in the neck soft tissues which may represent small lymph nodes and/or small neurofibromas.CERVICAL SPINE

Output: Stigmata of neurofibromatosis type I with multiple neurofibromas involving the cervical, thoracic, and lumbar spine. No intraspinal extension to cause spinal canal stenosis is seen. No cord signal abnormality or expansion to suggest intramedullary tumor. There are multiple neurofibromas involving the paraspinous, subcutaneous, and neck soft tissues as well which are relatively small. Please see details above.


Instruction: Generate impression based on medical findings.

Input: Bell's palsy [351.0], Reason for Study: ^Reason: eval underlying structural lesions; neurosarcoidosis History: recurrent bell's palsy Bilateral facial nerves especially geniculate ganglions, tympanic segment and mastoid segment show enhancement on Gad infusion. Although the right side enhancement appears to be a bit more prominent than that of the left, the degree of enhancement should be interpreted as not significantly different.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal intra axial enhancement.There is no mass.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Bilateral enhancement of facial nerves as described above, no definitive asymmetric or focal enhancement was seen.No evidence of acute ischemic or hemorrhagic lesion on this scan.No evidence of mass.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old, with chronic low back pain and sciatica. Grade 1 anterolisthesis is seen of L3 relative to L4, L4 relative to L5, and L5 relative to S1. Vertebral body heights are preserved. Degenerative endplate edema is seen at L4-5. Otherwise, no concerning marrow replacement or marrow edema is demonstrated.The visualized distal spinal cord and conus are within normal limits. The cauda equina nerve roots are discussed below.T12-L1: Facet arthropathy. Disc bulging. Mild spinal canal stenosis. Moderate bilateral foraminal narrowing.L1-2: Facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Marked facet arthropathy with facet effusion on the right. Ligamentum flavum thickening. Disc bulging. Mild spinal canal stenosis. Moderate bilateral foraminal narrowing. L3-4: Marked facet arthropathy. Ligamentum flavum thickening. Disc bulging with vacuum phenomena and a superimposed central superiorly directed extrusion. Severe spinal canal stenosis with effacement of CSF and crowding/impingement of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Marked facet arthropathy with bilateral effusions. Ligamentum flavum thickening. Disc bulging. Moderate spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Marked facet arthropathy. Disc bulging and annular fissuring. Moderate spinal canal stenosis. Mild bilateral foraminal narrowing. Multiple bilateral renal cystic lesions are seen including a large cystic lesion in the right upper pole.

Output: Significant disc and posterior element degeneration is seen, particularly affecting L3-4 and L4-5 where there is significant spinal canal stenosis. Scattered mild-to-moderate foraminal narrowing is also demonstrated.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with DLBCL of the primary bone site (left hip). Restaging examination. Please reassess for response in the primary site BONE MARROW: Note is made of increased signal abnormality within the left acetabulum extending inferiorly along the left inferior ramus, consistent with the patient's history of primary lymphoma of bone. There is associated enhancement on postcontrast sequences. There is cortical destruction with a small amount of soft tissue extension involving the obturator internus muscle on the left. When compared to prior imaging from 8/24/2015, these findings appear decreased in size and extent. There is also nonspecific increased signal abnormality on fluid sensitive sequences within the superolateral left femoral head/neck which does not definitively enhance, but also appears decreased in size when compared to the prior study. Attention to this finding on follow-up examination is recommended.SOFT TISSUES: Again seen is enhancing soft tissue extension involving the left obturator internus muscle which appears decreased in size when compared to the prior examination.JOINTS: The femoroacetabular joint alignment is anatomic.ADDITIONAL

Output: Enhancing lesion within the left acetabulum extending to the inferior pubic ramus with soft tissue extension as described above, consistent with the patient's known history of primary lymphoma of bone. These findings appear decreased in size and extent when compared to the prior examination from 8/24/2015. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: History of Chiari malformation, thoracic syrinx, and tethered cord. Follow-up exam. Again seen are postoperative changes in the lumbar spine with discontinuous fatty filum compatible with prior fatty filar transection and tethered cord release. There is no new cord signal abnormality or syrinx in the visualized lower thoracic cord. The lumbar spine is in normal alignment with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris terminates at the lower L1 level. There is 1 to 2 mm of ventral motion of the conus on prone images although this is not well evaluated due to motion.At L3-4 there is mild disc bulge and minimal right greater than left neural foraminal stenosis. At L4-5 there is mild disc bulge with mild bilateral neural foraminal stenosis. There is no significant spinal canal or foraminal narrowing at any other level within the lumbar spine.

Output: 1.Postsurgical findings from tethered cord release and fatty filum/lipoma are unchanged. No new cord signal abnormality or syrinx in the visualized lower thoracic cord. There appears to be 1-2 mm ventral motion of the conus on the prone images. 2.Minimal spondylosis at L3-4 and L4-5 with mild neural foraminal stenosis at these levels.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for cerebellar brain metastases, concern for CNS progression of disease. Signs and symptoms: Vertigo. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a thick irregular rim enhancing mass in the left cerebellum measuring approximately a 29 x 20.5-mm and consistent with patient's previously known metastatic lesion.This lesion demonstrated no significant enhancement on prior study. On nonenhanced exam there is no significant change in the size of this lesion. There is slight interval decreased surrounding vasogenic edema. The fourth ventricle remains reading normal and in midline similar to prior study. There is no detectable additional foci of enhancement in the posterior fossa.Images through supratentorial space remains negative for parenchymal or leptomeningeal metastases.Ventricle are patent the lesser degree subcortical foci of there and T2 hyperintensity is less conspicuous on current exam compared to prior which may be due to technique difference of 3T scan on prior exam and 1.5 on current. Examination also mildly degraded due to motion artifact on flair sequence. Focus of encephalomalacia in the left occipital lobe without abnormal enhancement remains similar to prior exam. Prominence of cortical sulci similar to prior study. Stable normal size of ventricular system and without deviation of midline.

Output: 1.No significant change in the size of a previously known metastatic lesion in the left cerebellum. In comparison to prior exam however this lesion demonstrate intense irregular rim enhancement which was not present on prior study and could be as result of change in treatment regimen/medication. Subtle regional mass effect of this lesion remains identical to prior study.2.No detectable additional metastatic lesions.3.Stable focus of encephalomalacia without enhancement in the left occipital lobe since prior study.


Instruction: Generate impression based on medical findings.

Input: Chiari malformation and surgery, headaches, neck pain, numbness, and tingling both hands and arms: 3 month follow up. Brain: There are stable postoperative findings related to Chiari decompression and fourth ventricular stenting. The cerebellum displays an unchanged morphology and signal characteristics. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.Spine: There is a posterior disc-osteophyte complex that indents the spinal cord and results in mild bilateral neural foramen stenosis. Otherwise, there is no evidence of spinal cord signal abnormality or syrinx. There is no significant neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unchanged.

Output: 1. Stable postoperative findings related to Chiari decompression and fourth ventricular stenting without evidence of syringohydromyelia or ventriculomegaly.2. A posterior disc-osteophyte complex at C6-7 indents the spinal cord and results in mild bilateral neural foramen stenosis.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with history of cervical/uterine neoplasm who presents for evaluation. PELVIS:UTERUS, ADNEXA: There is a T1/T2 heterogeneous mass within the cervix and the uterus with extension into the upper vagina. When compared to the 2/26/2016 MRI examination, there has been interval increase in the heterogeneity of the mass, likely related to radiation treatment. As compared on the sagittal images, there has been interval decrease in the tumor bulk which measures 2.1 x 3.6 (series 401, image 45) on the current examination and previously measuring 8.3 x 3.4 cm. The bulk of the tumor is hypoenhancing making it difficult to demarcate to the uterine portion of the tumor.In the region of the right ovary, there are T1 hyperintense, T2 low to intermediate signal, nonenhancing foci with the largest measuring 3.0 x 3.5 cm (series 801, image 29), previously measuring 3.3 x 3.2 cm (series 9, image 38). The signal characteristics of these 2 foci are not significantly changed compared to the previous examination. BLADDER: No significant abnormality noted.LYMPH NODES: No definite lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval treatment/radiation make difficult to demarcate the cervical/uterine tumor. However, as compared on the sagittal images, there has been significant reduction in the tumor bulk as detailed above.2.In the region of the right adnexa, T1 hyperintense, nonenhancing foci are identified as detailed above. Differential considerations include hemorrhagic cyst versus endometriomas.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old, with history of right tonsil/glossotonsillar sulcus squamous cell carcinoma, T1 N1, p16+, status post resection with lymph node dissection. Postoperative changes are seen compatible with resection of the right palatine tonsil. No evidence of recurrent mucosal tumor is seen. Findings are also demonstrated compatible with right neck dissection. The previous pathologic level II node on the right has been excised. No additional pathologic adenopathy is detected by size criteria. The salivary glands are within normal limits. The thyroid is not well visualized due to artifactual signal loss. Bone marrow signal characteristics are unremarkable.

Output: Postoperative findings are demonstrated with no evidence of recurrent tumor or pathologic adenopathy.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with a history of hypertension and episodes of dizziness. There is no evidence of acute intracranial hemorrhage, extra-axial fluid collection, mass or edema. 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. Incidental note is made of a dysmorphic pituitary fossa without evidence of focal mass lesion in the expected region of the pituitary gland. If the patient has symptoms consistent with a pituitary abnormality further evaluation with a dedicated MRI examination could be considered for further characterization. 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 clear.

Output: 1. Dysmorphic pituitary fossa without evidence of focal mass lesion. If the patient has symptoms suggestive of pituitary pathology, further evaluation with a dedicated MRI examination could be considered for further characterization. 2. No acute intracranial abnormality. No evidence of acute intracranial hemorrhage or mass.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Malignant neoplasm of bronchus and lung, unspecified site Other malignant neoplasm without specification of siteClinical question: looking for brain mets given metastatic lung cancer, possible candidate for WBRTSigns and Symptoms: metastatic lung cancer There are punctate foci of diffusion weighted imaging signal hyperintensity present one in the subcortical white matter of the right precentral gyrus another one in the right centrum semiovale and another one in the subcortical white matter of the right inferior parietal lobule another is present in the left frontal lobe subcortical white matter and middle frontal gyrus and another one is present in the left posterior temporal lobe subcortical white matter in the couple more are present in the cerebellar hemispheres. Some of these are associated with some subtle perceptible diffusion restriction by ADC map but this is not evident on all of the lesions. These lesions can also be identified on FLAIR and T2 MRI and are not associated with any susceptibility effect. There is no associated contrast enhancement appreciated with these lesions.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.Incidental note is made of partial empty sella

Output: There are multiple lesions scattered in the subcortical and periventricular white matter as well as the cerebellar hemispheres numbering approximately 15. These are nonspecific and of unclear etiology. It's possible that these represent vascular events in the late subacute stage. Given the patient's history of the lung cancer a follow-up exam would help exclude the possibility is these are related to metastatic disease. Another possibility is that these are related to septic emboli.


Instruction: Generate impression based on medical findings.

Input: Reason: Abnormal LFTs History: Nausea; Constipation; Fatigue. History of breast cancer ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensity in the right hepatic lobe, likely a cyst. Mild intrahepatic biliary ductal dilatation with pneumobilia, similar to the prior CT. Prominent common bile duct measuring 7 mm, within normal limits for age. Status post cholecystectomy. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense lesions, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion, unchanged.

Output: 1.No suspicious hepatic lesion or other acute abnormalities.2.Small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Lateral knee pain MENISCI: There is abnormal signal and morphology of the posterior horn of the medial meniscus at and near its root indicating complex tearing and fragmentation. As a result, there is mild medial extrusion of the body of the meniscus into the medial gutter. These changes are superimposed upon additional increased signal within the meniscus representing intrasubstance degeneration. Furthermore, there is vertically oriented abnormal signal at the junction of the body and posterior horn of the meniscus which extends to the tibial articular surface, representing an additional small tear.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate degenerative articular cartilage loss with areas of full-thickness loss along both the medial and lateral patellar facets. There is associated underlying subchondral cystic change. Focal degeneration of the articular cartilage of the medial facet of the femoral trochlea is also noted inferiorly.There is partial thickness articular cartilage loss of the medial femoral condyle anterior to the posterior horn of the medial meniscus. There is focal full-thickness degeneration of the weightbearing portions of the medial tibial plateau with associated underlying degenerative marrow signal.There is thinning of the articular cartilage of the lateral femoral condyle at the level of the anterior horn of the meniscus. Otherwise the cartilage of the lateral compartment is preserved.LIGAMENTS: There is slightly increased signal of the ACL representing mucoid degeneration with extension of this abnormal signal to the ACL insertion on the tibial plateau. The ACL and remaining ligamentous structures are intact. EXTENSOR MECHANISM: There are enthesopathic changes of the quadriceps tendon upon the superior aspect of the patella. The extensor mechanism is otherwise intact.ADDITIONAL

Output: 1. Intact lateral meniscus.2. Medial meniscal tears as described above.3. Articular cartilage loss and degeneration of the medial and patellofemoral compartments further detailed above.4. Small joint effusion and Baker's cyst. 5. Mucoid degeneration of the ACL with other findings described above.


Instruction: Generate impression based on medical findings.

Input: Aphasia, right sided weakness. MRI: There is encephalomalacia and susceptibility effect in the inferior left parietal lobe. There is also gyriform susceptibility effect and punctate subcortical susceptibility effect in the left occipital lobe. There is a background of diffuse cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute infarct. There is diffuse mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions in the major head and neck arteries. There is a three vessel aortic arch. The bilateral vertebral arteries are tortuous and the left vertebral artery is diminutive diffusely. There is no evidence of cerebral aneurysms. There is a fetal left posterior cerebral artery, which represents an anatomic variant.

Output: 1. No evidence of acute acute infarct. Encephalomalacia and susceptibility effect in the inferior left parietal lobe, as gyriform susceptibility effect and punctate subcortical susceptibility effect in the left occipital lobe may represent prior hemorrhages, perhaps related to amyloid angiopathy.2. No evidence of significant steno-occlusive lesions in the major head and neck arteries.


Instruction: Generate impression based on medical findings.

Input: The lacrimal glands are slightly prominent but symmetric and without focal lesions. The optic nerves are symmetric and normal in size and signal intensity. There is no suspicious intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable. There are scattered patchy foci of T2 hyperintensity within the supratentorial white matter. Mild prominence of the bilateral parotid glands also seen. Small left intraparotid lymph node. No suspicious salivary gland lesions are seen. No significant cervical lymphadenopathy.

Output: 1.Mild symmetric enlargement of the bilateral lacrimal glands and slight prominence of the bilateral parotid glands compatible with known Sjogren's. No priors are available for comparison; however, no aggressive features are seen to suggest lymphoma. 2.Scattered patchy foci of T2 hyperintensity within the supratentorial white matter are nonspecific but compatible with mild chronic small vessel ischemic changes. 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: a 53 years old female with history of coronary artery disease with a CABG in 2006 (LIMA to CX, RIMA to LAD) and 2008 (SVG to DG, RI and OM1) + PCI to LAD prox+mid and LM into CX. Now presenting with increasing angina, referred to cardiac MR for evaluation of ischemia. MEDICATIONS: Aspirin, Clopidogrel, Atorvastatin, Metoprolol, Amlodipine, Nitroglicerin First Pass PerfusionDuring hyperemia, there is a severe and extensive perfusion defect which involves the entire ventricle except the basal infero-septum and apical lateral wall. Viability/ Myocardial ScarThere was a small amount of non-transmural late gadolinium enhancement noted in the basal inferolateral segment suggesting that there is prior myocardial infarction. This segment has an intermediate probability of viabiltiy. The remainder of the myocardium is free of myocardial infarction and is viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. There is akinesis of the inferolateral wall. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 82 ml (normal range 31+/-10), the LV mass index is 49 g/m2, and the LV mass is 101 g. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. Axillary lymphadenopathy is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Extensive myocardial ischemia as described above.2. A small, non-transmural myocardial infarction is noted in the basal inferolateral wall. This segment has an intermediate probabilty of viability. The remainder of the myocardium is free of myocardial infarction and is highly likely to be viable.3. Normal LV size and systolic function (LVEF 50%) with akinesis of most of the inferolateral wall.4. Normal RV size and systolic function (RVEF 57%).5. Mild biatrial dilation.6. Mild mitral and tricuspid regurgitation.7. Extra-cardiac findings as above. Findings conveyed to Dr. Nathan.


Instruction: Generate impression based on medical findings.

Input: Evaluate for obstructive mass. Patient found to have duodenal obstruction at D2/D3 on upper GI study 1/21/2016. Metastatic urothelial bladder cancer with retroperitoneal lymph nodes. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar subcentimeter T2 hyperintense lesion, too small to characterize, similar to prior.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral percutaneous nephroureterostomy stents are in place, terminating in the urinary bladder, unchanged from prior. No hydronephrosis. Left lower pole simple cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Paraduodenal lymph node measures 1.0 x 0.8 cm (Series 1104, image 80). Additional small retroperitoneal lymph nodes are present.BOWEL, MESENTERY: Enteric tube terminates within the stomach. There is severe narrowing/obstruction of the second/third portion of the duodenum (series 4, image 31), compatible with prior site of obstruction on upper GI series January 21, 2016, and probably progressed from prior CT January 20, 2016. These findings may represent a high-grade stricture, anterior paraduodenal hernia or less likely mass. Status post left lower quadrant colostomy. There is unchanged colonic wall and perirectal thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Severe narrowing/obstruction of the second/third portion of the duodenum, may represent a high-grade stricture, paraduodenal hernia or less likely mass. Upper endoscopy is recommended. 2.Unchanged colonic and bladder wall thickening.Findings were discussed by Dr. Stephen Thomas with the surgical team January 25, 2016.


Instruction: Generate impression based on medical findings.

Input: 18-year-old woman with history of obesity and left lower extremity numbness. Five lumbar type vertebral bodies are presumed to be present. There is a small Schmorl's node at the anterior superior endplate of T12. Vertebral body heights are within normal limits. Alignment is within normal limits. There is apparent mild, diffuse T1 hypointensity of the bone marrow which may be artifactual. No discrete suspicious osseous lesions are evident. The conus medullaris is normal in position. There is no abnormal enhancement on postcontrast images.There is no significant disc disease, spinal canal, or neural foraminal stenosis. The paraspinous soft tissues are within normal limits.

Output: 1. No significant disc disease, spinal canal, or neural foraminal stenosis in the lumbar spine.2. Examination is mildly technically degraded due to patient's body habitus.


Instruction: Generate impression based on medical findings.

Input: Assess for lumbar stenosis. Known cervical stenosis. Right leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen including mild generalized facet arthropathy. Individual levels as below:L1-L2: Minimal disc desiccation and bulge. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Minimal degenerative changes in the lumbar spine. No spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Male, 11 years old. History of stage 4 neuroblastoma s/p chemo, radiation, transplant. Intermittent stabbing pains in bilateral legs. Intermittent abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy. No focal lesion in the surgical bed.KIDNEYS, URETERS: Surgical changes adjacent to the left kidney. Focal atrophy of the left lower pole with small cystic areas without local abnormal enhancement or solid nodular component, likely postprocedural in etiology. No focal lesion or hydronephrosis on the right. No obstructing urinary stone.RETROPERITONEUM, LYMPH NODES: Scattered signal voids in the retroperitoneum and left upper abdomen, corresponding with surgical clips.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction. No free intra-abdominal air or abnormal free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of local tumor recurrence, metastatic disease, or other acute abnormality.2.Focal atrophy of the left lower renal pole and findings of scarring and cyst formation, may be postsurgical in etiology.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain, fistulizing ileocolonic Crohn's disease 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: Wall thickening and enhancement involving approximately 20 cm of the distal ileum with focal areas of stricturing compatible with acute inflammatory bowel disease. There are chronic changes involving a long segment of the ileum with straightening of the mesenteric border and fibrofatty proliferation. The distal ileum abuts a segment of markedly angulated sigmoid colon in the right lower quadrant without discrete evidence of fistula. Status post ileocecectomy.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine contraceptive device.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening and enhancement of the rectosigmoid.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Acute on chronic inflammatory bowel disease involving the distal ileum with focal areas of stricturing as described above.2.Wall thickening and enhancement the rectosigmoid compatible with acute inflammatory bowel disease.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: evaluate for osteomyelitis History: wound x 3 weeks with increased drainage, increased pain. hx lymphedema. There is skin thickening and reticulation of the subcutaneous fat consistent with stated history of lymphedema. There is replacement of the subcutaneous fat along the posterolateral aspect of the calcaneus with abnormal signal intensity and enhancement, presumably representing inflammation related to the overlying wound. Focal signal abnormality within the underlying calcaneus, specifically within the inferolateral aspect of the posterior tuberosity, that demonstrates slightly decreased signal on T1-weighted images and slightly increased signal on T2 weighted images as well as contrast enhancement and is suspicious for osteomyelitis. We see no additional foci of osteomyelitis.TENDONS: The visualized tendons are intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Mild degenerative arthritic changes affect the ankle, hindfoot, and midfoot. Additionally, please refer to 'findings' above.ADDITIONAL

Output: Signal abnormality within the inferolateral aspect of the posterior tuberosity of the calcaneus suspicious for osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female history of pancreatic mass, evaluate for interval change or other abnormalities ABDOMEN:LIVER, BILIARY TRACT: Mild intra- and extrahepatic biliary ductal dilation. The common bile duct measures up to 11 mm in diameter possibly secondary to a distal stenosis. No evidence of choledocholithiasis. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesions in the pancreatic head and tail, which communicate with the main pancreatic duct and measure up to 13 mm in the tail, unchanged.Pancreatic duct measures 3mm in diameter.ADRENAL GLANDS: Bilateral adrenal nodularity.KIDNEYS, URETERS: Stable renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesions in the pancreatic head and tail communicate with the main pancreatic duct most consistent with IPMNs measuring up to 13 mm in the tail.2.Stable intra-and extrahepatic biliary ductal dilation possibly related to a distal CBD stenosis. No evidence of choledocholithiasis.


Instruction: Generate impression based on medical findings.

Input: Recurrent patellar dislocation MENISCI: There is a lobulated collection of fluid signal intensity which appears to arise from the peripheral fibers of the posterior horn of the medial meniscus and extends along the posterior margin of the MCL. Based on the proximity to the posterior horn, this could represent parameniscal cyst although we see no fluid-filled tear extending to either articular surface. Alternatively, it may represent a ganglion.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. The femoral trochlea appears shallow suggesting dysplasia. There is no abnormal marrow signal.LIGAMENTS: The cruciate and collateral ligaments are intact. Portions of the MPFL are not well visualized which may reflect chronic tearing. There is nonspecific edema within the soft tissues surrounding the medial retinaculum.EXTENSOR MECHANISM: No significant abnormality noted. There is no patella alta and the TT to TG distance is 9 mm, which is within normal limits.ADDITIONAL

Output: 1. Imaging findings of femoral trochlea dysplasia with poor definition of portions of the MPFL consistent with known history of recurrent patellar dislocation. The TT to TG distance is normal.2. Lobulated cystic structure along the distal femur and medial meniscus which could represent a parameniscal cyst although no discrete meniscal tear is identified. Alternatively, this may represent a ganglion.


Instruction: Generate impression based on medical findings.

Input: 18 year old female with history of Ewing sarcoma now with metastases. Status post craniotomy for tumor resection. Patient has small postoperative subdural collection The patient is status post left frontal craniotomy appeared and there is an extra-axial hemorrhagic fluid collection of present underneath the craniotomy flap with a fluid fluid level associated some air bubbles. It is adjacent to the high convexities and measures approximately 9 mm in thickness . AP hypodense subdural component extends more posteriorly measuring approximately 5 mm in thickness and is also unchanged. There is mild midline shift the shift of the Falx cerebri up to approximately 6 mm to the right of the midlineA 0.7 cm hyperdense focus is present adjacent to the right chest appear frontal gyrus which has an extra-axial location. It was present on the MRI of 11/17/09.There is vasogenic edema present where the patient's known mass was paired this is edema pattern is stable since 11/19/09 MRI. There is some mass effect associated.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post left frontal craniotomy for tumor surgery with the some findings which can be accounted for on the basis of a immediate postoperative effects such as a lobe of intracranial air and subgaleal soft tissue swelling.2.There is a left-sided subdural hemorrhagic fluid collection present with some mild mass effect and midline shift. This has not changed since the prior exam.3.A 7mm extra-axial hyperdense focus is present adjacent to the right superior frontal gyrus. This could represent a small meningioma.


Instruction: Generate impression based on medical findings.

Input: Lower back pain, left hip pain, rule-out new myeloma this lesion Five lumbar type vertebral bodies are presumed to be present. Multiple compression fractures are seen including T12, L3, L4, and L5, worst at T12 where there is approximately 50% loss of height. These are new since 4/29/2013 but do not demonstrate significant marrow edema to suggest recent loss of height. There is mild anterolisthesis of L4 and L5 and minimal retrolisthesis of L5 on S1. Alignment of the lumbar spine is otherwise maintained. Bone marrow signal is heterogeneous compatible with history of multiple myeloma. There is enhancing lesion involving primarily the posterior elements of the T12 vertebra which is significantly decreased in size from 4/29/2013. Numerous additional smaller enhancing lesions have also regressed compared to 4/29/2013. No new lesion is definitively appreciated. No evidence of epidural tumor.Multilevel degenerative changes are seen, as described below:T12-L1: T12 compression fracture with up to approximately 50% loss of height as mentioned above. No significant disk disease. There is mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L1-L2: No significant spinal canal or neural foraminal stenosis.L2-L3: No significant spinal canal or neural foraminal stenosis.L3-L4: There is mild bilateral neural foramina narrowing, relatively worse on the right related to mild disk bulge and facet arthropathy. No significant spinal canal stenosis.L4-L5: There is mild spinal canal stenosis related to mild anterolisthesis, small disk bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening. There is moderate right neural foramina stenosis and mild left neural foramina stenosis.L5-S1: There is mild to moderate right and moderate left neural foramina stenosis related to diffuse disk bulge and advanced facet arthropathy. No significant spinal canal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. No recent MRI is available for comparison. Compared to 4/29/2013, there is been regression of numerous enhancing lesions with residual enhancing lesion involving the posterior elements of T12 again identified.2. Multiple compression fractures involving the T12, L3, L4, and L5 vertebral bodies, worst at T12 where there is up to 50% loss of height. These appear to be chronic but are new since 2013. 3. Multilevel degenerative changes including mild spinal canal stenosis at L4-5 and variable neural foraminal narrowing as detailed above.4. Multilevel facet arthropathy, worst at L4-L5 and L5-S1, which may be contributing to low back pain. There is mild L4-L5 anterolisthesis.


Instruction: Generate impression based on medical findings.

Input: 20 year-old male. Evaluate for lateral meniscal tear. MENISCI: The medial and lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is unremarkable. The articular cartilage is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: Normal MRI of the knee with no evidence of lateral meniscal tear or other findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: 17-year-old female with history of scoliosis, tethered cord with voiding dysfunction. Evaluate for hydronephrosis. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 9.0 cm Left: 9.5 cm   Mean for age: 10.3 cm  Range for age: 9 - 11.5 cmADDITIONAL OBSERVATIONS: There is a bulge in the left renal midpole cortex which is similar in appearance to the MRI lumbar spine examination.

Output: Normal examination.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on medical findings.

Input: Evaluate liver mass identified on CT and biliary ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour and normal in morphology. There is mild common bile duct dilatation with smooth tapering. No obstructing lesion is identified. Within segment 7, there is a T2 hypointense lesion measuring 2.3 x 1.3 cm (series 13, image 215) with peripheral nodular enhancement, probable hemangioma. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is normal in caliber. No focal lesion is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Resolution of previously identified right lower lobe pneumonia.

Output: Segment 7 T2 hypointense lesion with peripheral nodular enhancement, represents a probable hemangioma.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for stenosis. Signs and symptoms: Low back pain and lumbar radiculopathy. Nonenhanced lumbar MRI:There is unremarkable signal intensity and normal anatomical alignment of the vertebral column.There is a slight generalized narrower than expected caliber of the lumbar spinal canal at L3 and L4 levels which is believed to represent a congenital anatomical variation.There is no appreciable degenerative disk disease and no evidence of disk protrusion/extrusion. Examination however demonstrate mild hypertrophic changes of the ligamentum flavum in a symmetrical fashion in the mid to lower lumber spine. Very mild facet degenerative changes and including minimal facet effusion is also suspected.There is no evidence of spinal stenosis or definitive neural foraminal compromise at any level.Partially visualized SI joints demonstrate no abnormality.The paraspinal musculature remains normal in signal intensity and morphology.

Output: 1.No evidence of spinal stenosis or definitive neural foraminal compromise.2.Mild hypertrophic changes of the ligamentum flavum and mild facet disease in the lower lumber spine is present3.Mild decreased caliber of the spinal canal at L3 and L4 levels likely representing a congenital anatomical variation.


Instruction: Generate impression based on medical findings.

Input: 21-year-old man with history of mixed germ cell tumor of the testis, evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder appears normal and there is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable small inguinal lymph nodes.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old, with history of non-small cell lung cancer with brain metastases status post whole brain radiotherapy, now with vocal cord paralysis and dysphagia. Left piriform sinus mass status post ENT scope and biopsy. Multiple enhancing lesions are redemonstrated scattered through the cerebral hemispheres and cerebellum. These include punctate foci of solid enhancement measuring 2 to 3 mm in size located at the gray-white junction, as well as somewhat larger solidly enhancing nodules in the bilateral cerebellum, and ring-enhancing lesions measuring between 1 and 2 cm including one in the right superior frontal gyrus and several in the inferior left cerebellum. Some of these lesions demonstrate associated susceptibility effect. However, none produce any significant edema in the surrounding parenchyma.No evidence of generalized mass effect is seen. Additional scattered small foci of T2 hyperintensity are noted without correlating pathologic enhancement. No findings are seen to suggest acute intracranial hemorrhage. Ventricular size and morphology are within normal limits. No abnormal extra-axial collections are detected.

Output: Multiple enhancing lesions are redemonstrated scattered through the cerebral hemispheres and the cerebellum. These range from punctate solidly enhancing foci to somewhat larger rim-enhancing, hemosiderin stained lesions. Given the patient's history, it is possible that several of the above-mentioned lesions represent prior treated metastases, though it seems likely that some of the lesions probably reflect active metastatic deposits. Comparison with prior examinations may be helpful if these can be made available.


Instruction: Generate impression based on medical findings.

Input: Suboccipital craniotomy changes are again seen. The previously demonstrated solid and cystic extra-axial mass measuring approximately 3.7 x 2.3 cm in greatest axial dimensions (series 7, image 25) is not significantly changed compared to prior examination. The mass encases the vertebral basilar arteries as well as extends into the Meckel's cave and right internal auditory canal. In addition, the tumor extends caudally along the dorsolateral aspect of the upper cervical spinal cord. The caudal spinal extent of the lesion is difficult to delineate. On postcontrast images, the tumor does not demonstrate significant enhancement, similar to prior examination. There is persistent significant mass effect upon the caudal brainstem and upper cord.There is a right posterior parietal approach ventriculostomy catheter stable position, with the tip of the catheter near the right foramen of Monro. The lateral and third ventricles are stable and decompressed. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. Mucosal thickening of the sphenoid sinus has resolved.

Output: Stable appearance of predominantly extra-axial right posterior fossa mass with persistent mass effect on the caudal brainstem and upper cervical spinal cord.


Instruction: Generate impression based on medical findings.

Input: 41 year old male with history of repaired Tetralogy of Fallot who presents for cardiac MRI to evaluate for pulmonary regurgitation severity and right heart dysfunction. 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 76 ml/m2 (normal range: 74+/-15), the LVEDV is 134 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 51 ml (normal range 47+/-19), the LV mass index is 50 g/m2 (normal range 85+/-15), and the LV mass is 87 g (normal range 164+/-36). Abnormal septal motion consistent with prior sternotomy is noted. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process of the LV myocardium.There is no evidence of interventricular (or interatrial) shunt by first pass perfusion.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated in size and moderately reduced in systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 155 ml/m2 (normal range 82+/-16), the RVEDV is 273 ml (normal range 142+/-31), the RV end systolic volume index is 97 ml/m2 (normal range 31+/-9), and the RVESV is 171 ml (normal range 54+/-17). The RVOT is aneurysmal with evidence of late gadolinium enhancement, most likely representing a patch-repair.Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere is severe pulmonic regurgitation (regurgitant volume is 65ml, regurgitant fraction is 48%)Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is an over-riding aorta. There is a right sided aortic arch with mirror imaging brachiocephalic branching pattern. The proximal portion of the left subclavian artery is not seen but the remainder of the vessel fills via collaterals, suggesting that the patient may have had a Blaylock-Taussig shunt. The aortic root is mildly dilated (sinus of Valsalva 41mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. There is mild narrowing of the proximal left (15x17mm) and right (13x17) pulmonary artery; however, there is no evidence of flow acceleration suggesting that the narrowing is not hemodynamically significant.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 (LVEF 62%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is severely dilated in size and moderately reduced in systolic function (RVEF 37%). The RVOT is aneurysmal with evidence of late gadolinium enhancement, consistent with a patch repair. 3. There is severe pulmonic valve regurgitation.4. There is no evidence of residual ventricular septal defect. 5. There is mild stenosis of the right and left branch pulmonary arteries.6. The aortic root is mildly dilated. 7. There is an over-riding right sided aortic arch with mirror imaging. The proximal left subclavian artery is not seen and the vessel fills via collaterals. This suggests the patient may have had a BT shunt at one point.


Instruction: Generate impression based on medical findings.

Input: Reason: progressive vision loss for the past few years History: progressive vision loss for the past few years MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Similar punctate lesions are present in the ponsNo abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Some of the images are degraded by patient motion

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions are present in the pons which are most likely vascular related at this age.3.No abnormal lesions are appreciated within the orbits.4.Some of the images are degraded by patient motion which could obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: 46 years, Female, Reason: History of small bowel, colonic, and perianal fistulizing Crohn's disease. Needs assessment of disease activity and rectovaginal fistula. History: abdominal pain, diarrhea, rectovaginal fistula drainage. Please include cuts of the the perineum.. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney is atrophic with severe hydronephrosis, likely chronic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:There is an area of narrowing with bowel wall thickening, diffusion restriction and hyperenhancement in the distal ileum, proximal to the terminal ileum, which extends 5 to 10 cm in length and causes proximal small bowel obstruction with loops dilated to 3.9 cm. This segment remains narrowed on multiple sequences, likely representing stricture. There are two fistulous tracts which extend from this strictured segment to the adjacent sigmoid colon (6/16 and 6/21). The sigmoid appears narrow on T2 weighted images but expands on subsequent imaging sequences.No evidence of abscess. No evidence of perirectal fistulas. No evidence of rectovaginal fistula as clinically questioned.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Inflammatory changes in the distal ileum with stricturing and two ileosigmoid fistulas.2.Small bowel obstruction proximal to the narrowed ileal segment.3.No evidence of rectovaginal fistula on MRI. If there is strong clinical concern, a barium fluoroscopic study may be considered4.Atrophic left kidney with severe hydronephrosis, likely chronic.


Instruction: Generate impression based on medical findings.

Input: Brain: There are several enhancing lesions in the skull. For example, the largest in the right frontal calvarium measures up to approximately 20 mm. There are associated defects in the cortex, but no mass effect upon the underlying brain. There is no evidence of intraparenchymal mass lesions. However, there is diffuse cerebral white matter T2 hyperintensity and a chronic lacunar infarct in the right pons. There is no evidence of intracranial hemorrhage or acute cerebral infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.Cervical spine: There are multiple enhancing lesions in the cervical spine and upper thoracic spine. In particular, there is epidural extension of tumor involving the C3 and C4 vertebrae with negligible spinal canal stenosis, but substantial encroachment upon the neural foramina at those levels. There is no evidence of spinal cord compression or signal abnormality. There is mild endplate deformity of several cervical vertebral bodies, which may represent pathologic fractures. There is underlying multilevel degenerative spondylosis, which is most pronounced at C5-6, with mild spinal canal stenosis.

Output: Multiple metastases involving the imaged axial skeleton without evidence of metastatic lesions in the brain parenchyma or spinal cord compression.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: 71-year-old male with history of thoracic soft tissue mass. Additional clinical history of prior radiology requisitions indicates myeloma and prostate cancer.IMAGE ACQUISITIONS: CT of the thoracic and lumbar spine was performed without the administration of IV contrast. On this nonenhanced CT examination, there is no gross soft tissue abnormality to suggest a mass. The paraspinal soft tissues appear normal. However, this type of examination is not optimal for detection of soft tissue masses, and if there is continued clinical concern, MRI is recommended for a better evaluation of the soft tissues.Within the thoracic spine, there are diffuse bone changes of myeloma. There is kyphosis at the level of the severe compression fracture of the T5 vertebral body. Severe compression deformity of the T12 vertebral body is also present. T11 is status post vertebroplasty. More mild compression deformities are seen at the T7, T8 and T 11 levels.Within the lung bases, there is patchy opacity with air bronchograms which could be infectious in etiology.LUMBAR SPINE

Output: 1. No definite soft tissue mass. If there is continued concern for soft tissue mass, MRI is recommended for a more sensitive evaluation.2. Extensive changes within the bony spine consistent with the history of myeloma. Numerous compression fractures throughout the thoracolumbar spine.3. Opacity within the lungs which could represent pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p tumor resection History: s/p tumor resection Prelim pathology suggestive of metastatic carcinoma. There has been interval left temporal parietal craniotomy for resection of previously seen underlying mass. Prominent susceptibility along the anterior aspect of the frontal lobes with mild mass effect as well as a few scattered foci near the convexity likely relate to pneumocephalus. There is now prominent susceptibility underlying the craniotomy flap in the surgical bed likely representing postoperative blood products as well as air. There is no significant diffusion abnormality in the area of the resection. Two punctate foci of apparent hyperintensity are seen along the cerebellar vermis (302/104) on diffusion-weighted images only, hand without correlative FLAIR abnormality or susceptibility. These may be artifactual.A tiny vessel medial to the posterior medial margin of the mass has seen on preoperative exam remains delineated. Apparent enhancement along the upper margin of the resection cavity is likely artifactual when evaluating precontrast imaging.Extent of surrounding abnormal T2/FLAIR hyperintensity extending into the adjacent left parietal lobe appears overall similar, with continued mild localized mass effect on the adjacent left ventricular atrium. There is a stable small oval area of T2/FLAIR hyperintensity in the left frontal subcortical white matter, which remains nonspecific.

Output: Interval expected postoperative changes following gross total resection of previously seen left posterior parietal/superior temporal region mass, with residual vasogenic edema and mild localized mass effect upon the left lateral ventricle. No definite residual enhancement to suggest residual tumor, although continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: History of cervical mass. PELVIS:UTERUS, ADNEXA: Anteflexed anteverted uterus without evidence of a congenital mullerian duct abnormality. The uterus measures approximately 8.0 x 3.4 cm in the sagittal plane.The endometrium/endometrial cavity is normal in thickness measuring 1 to 2 mm.The inner myometrium/junctional zone is normal in thickness and there are no additional specific findings of adenomyosis.Along the posterior lower uterine/cervical segment there is an exophytic/subserosal well-defined T1 and T2 weighted hypointense round mass measuring 4.2 x 3.3 cm in the sagittal plane most compatible with a large fibroid which was present on a 2002 MR in which it measured approximately 5.2 x 4.2 cm in axial plane. The fibroid demonstrates isointense enhancement to the remainder of the myometrium. There are additional small intramural probable fibroids.The right and left adnexa are unremarkable with subcentimeter hyperintense foci in the left ovary, within physiologic limits.The cervical stroma is unremarkable. The parametrial soft tissues are unremarkable.The vaginal canal and perineum is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: Small subcentimeter right pelvic wall lymph nodes are also unchanged dating back to 2002.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 4.2 cm posterior lower uterine/cervical segment probable fibroid is unchanged in appearance dating back to 2002 and may correspond to the palpable mass on examination


Instruction: Generate impression based on medical findings.

Input: Female, 14 years old, with autoimmune disease with new brain lesions, preoperative planning exam for brain biopsy. Multiple patchy ill-defined areas of parenchymal and brain surface enhancement are again seen involving the bilateral cerebral hemispheres and the cerebellum. These appear similar to the prior examination accounting for differences in technique. Several of the enhancing lesions, and particularly the dominant enhancing lesion in the right cerebellum, are associated with surrounding T2 hyperintensity. Also noted is an area of subcortical T2 hyperintensity and mild gyral volume loss without enhancement involving the left parietal lobe, again similar to prior.

Output: Redemonstration of multiple cerebral and cerebellar lesions, most of which enhance, which appear similar to the immediate prior examination.


Instruction: Generate impression based on medical findings.

Input: DLBCL recurrent in CSF. Now receiving IT rituximab. Brain: There is increased patchy T2 hyperintensity and enhancement in the medial right basal ganglia region. There is increase in size of a lesion in the right basal ganglia region with enhancement along the margin of the right frontal horn. There also appears to be new T2 hyperintensity along the bilateral cerebellar tonsils. There is persistent infiltrative abnormal enhancement involving the optic apparatus. There are unchanged nonspecific foci of T2 hyperintensity without corresponding enhancement in the cerebral white matter. There is no evidence of acute infarction or intracranial hemorrhage. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is no significant interval change in the size of the ventricular system. There is no midline shift or herniation. There is moderate right maxillary sinus mucosal thickening and an apparent fluid level in the left maxillary sinus. There is mild fluid signal within the mastoid air cells.Spine: There is no evidence of mass lesions or abnormal leptomeningeal enhancement in the spine. There is loss of the usual cervical and lumbar lordosis, but the thoracic vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is degenerative spondylosis at multilevel levels of the cervical spine with mild spinal canal stenosis. The vertebral bone marrow signal is unremarkable, aside from degenerative endplate signal alterations. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Persistent infiltrative abnormal enhancement involving the optic apparatus likely related to involvement by lymphoma. 2. Increase in size of a lesion in the right basal ganglia region with enhancement along the margin of the right frontal horn and involving the cerebellar tonsils also likely represent involvement by lymphoma. 3. No evidence of leptomeningeal disease in the spine.4. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: Patient with 3 episodes of TIA/stroke like symptoms. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple scattered foci of T2 hyperintensity in the cerebral white matter. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is hyperostosis frontalis and scattered prominent dural ossification.

Output: No evidence of acute infarct. Rather, multiple scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Left arm pain. History of lymphoma (humerus). There is slight disorganization of the trabecular pattern of the mid humeral diaphysis that corresponds to the lesion seen on an MRI examination from 2015. The degree of lucency within the mid humeral diaphysis has perhaps decreased slightly when compared with the prior study, and I see no findings to suggest disease progression or fracture. Minimal osteoarthritis affects the glenohumeral and acromioclavicular joints. A tiny density in the soft tissues adjacent to the posterolateral aspect of the humeral head may represent calcific tendinosis of the rotator cuff, but is of uncertain current clinical significance.

Output: Poorly defined lucency within the mid humeral diaphysis likely corresponds to the presumably treated lymphomatous lesion seen on prior MRI, but I see no fracture or evidence of disease progression. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: assess sinuses, aspergillus: sinusitis. There are postoperative findings related to prior sinonasal debridement. However, there is diffuse pansinus mucosal enhancement and debris that displays low T2 and intermediate T1 signal. The enhancement along the walls of the sphenoid sinuses extend to the planum sphenoidale and anterior sella, where there are corresponding bony dehiscences that are more clearly depicted on CT. There are also dehiscences in the bilateral lamina papyracea and nasolacrimal ducts, with persistent enlargement of the left lacrimal sac, but no gross intraorbital extension, although the images are not optimized for the evaluation of the orbits. However, the left optic nerve canal is narrowed secondary to reactive thickening of the adjacent bone, which is also more clearly depicted on the prior CT. There is no evidence of intracranial abscess. There is no midline shift or herniation.

Output: 1. Postoperative findings related to prior sinonasal debridement with persistent extensive diffuse pansinus fungal disease.2. Inflammation along the walls of the sphenoid sinuses extend through bony dehiscences at the planum sphenoidale and anterior sella, which are more clearly depicted on CT. 3. Dehiscences in the bilateral lamina papyracea and nasolacrimal ducts, with persistent enlargement of the left lacrimal sac, but no gross intraorbital extension, although the images are not optimized for the evaluation of the orbits.4. The left optic nerve canal is significantly narrowed due to what appears to be reactive thickening of the adjacent bone. This is also more clearly depicted on the prior CT.


Instruction: Generate impression based on medical findings.

Input: No known prostate cancer. Negative biopsy in 2008. PELVIS:PROSTATE:Prostate Size: 5.3 x 6.4 x 7.3 cmPeripheral Zone: The peripheral zone demonstrates homogeneously T2 weighted hyperintensity. Central Gland: In the right apex there is a well-defined 1.2 x 0.9 cm nodule predominantly in the transition zone demonstrating T2 weighted hypointensity (series 401/73) with associated decreased ADC signal most likely a benign nodule. Several additional similar nodules are noted in the transition zone. It has similar enhancement characteristics to other regions in the transition zone.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular tumor extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific pelvic lymph nodes are not pathologically enlarged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant BPH without a discrete suspicious lesion.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with tenderness, fever. Evaluate for epidural abscess. Alignment and bone density are within normal limits. Vertebral body heights and disk spaces are maintained. Hypertrophy of the facet joints at L3-4, L4-5, and L5-S1. The dorsal epidural fat pads are intact. There is no definite dural thickening along the ventral aspect of the spinal canal. No evidence of effacement on the thecal sac to suggest an epidural process. The paraspinous muscles are normal. No evidence of central spinal stenosis or neuroforaminal compromise at any level.

Output: Limited study in evaluating for an epidural abscess. However, within the limitations, there are no findings to suggest an epidural process. No other specific findings on this study to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Left ankle swelling and pain. Evaluate for fracture, stress fracture, or achilles tendonitis. TENDONS: No significant abnormality noted. The tendons are intact and normal in appearance.LIGAMENTS: No significant abnormality noted. The ligaments are intact and normal in appearance.ARTICULAR SURFACES AND BONE: No significant abnormality noted. No fracture or osteochondral defect is seen ADDITIONAL

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


Instruction: Generate impression based on medical findings.

Input: Reason: 57 y.o. with autoimmune enterocolitis on cyclosporine, with persistently elevated bilirubin. h/o gallstones. Please eval for obstruction/choleystatis. History: persistently trending up bilirubin, jaundice. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Low insertion of the cystic duct is noted. There is no intra or extrahepatic biliary ductal dilatation. The common duct is well seen to the level of ampulla. No evidence of choledocholithiasis.There is biliary sludge within the gallbladder with layering stones.SPLEEN: No significant abnormality noted.PANCREAS: Age-related pancreatic atrophy. Pancreatic duct is normal in caliber.ADRENAL GLANDS: Right adrenal gland nodule measures 1.7 cm. It loses signal on out of phase imaging and is compatible with an adenoma.KIDNEYS, URETERS: Kidneys are mildly atrophic bilaterally. No suspicious focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of choledocholithiasis. There is layering biliary sludge and stones within the gallbladder. No intra or extrahepatic ductal dilatation.1.7 cm right adrenal adenomaI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Rule out rotator cuff tear. Pain ROTATOR CUFF: Marked abnormality involving the supraspinatus representing a suspected full-thickness tear near the attachment with mild possible retraction of a proximally 1 cm, no clear fibers are observed through to the insertion. The remainder of the rotator cuff including the infraspinatus and subscapularis are otherwise intact and only demonstrate minimal tendinopathy. Minimal subdeltoid fluid.SUPRASPINATUS OUTLET: Mild narrowing with associated degenerative changes. See detail belowGLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritic changes are observed, with extensive progression of degenerative changes since prior study. Multiple subchondral cysts complicate the appearance of the humeral head with particular new abnormality involving the tuberosity. A small nondisplaced fracture fragment cannot entirely be excluded. Please correlate with physical exam and possibility of a subacute injury.Marked degenerative changes of the AC joint with underlying inflammation and small cysts or erosions.BICEPS TENDON: Tendon is grossly intact, no significant abnormality noted. ADDITIONAL

Output: Marked interval changes most pronounced involving the greater tuberosity of the humoral head and AC joint. Given the past reported history of a fall and injury, a small subacute fracture cannot be excluded but the changes and distribution (although odd given the short period of time) additionally raise concern for an inflammatory process superimposed upon the rotator cuff abnormality involving the supraspinatus insertion.Dr. Purakel assisted in this discussion and EPIC history.


Instruction: Generate impression based on medical findings.

Input: There is a heterogeneously enhancing mass in the pituitary gland with infiltration into the clivus and extension into the right cavernous sinus, where there appears to be partial encasement of the internal carotid artery. The mass also extends into the sphenoid sinuses where there has interval decrease in size of an intrinsically high T1 and both high and low T2 hyperintense component with the sphenoid sinus, now measuring up to 18 mm in anteroposterior dimension, previously 24 mm. The infundibulum is slightly displaced to the left. There is no mass effect upon the optic apparatus.

Output: Invasive pituitary macroadenoma with unchanged right cavernous sinus extension, but decrease in size and evolution of the signal characteristics in the sphenoid sinus component that likely contains subacute hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Evaluate for aneurysm, angio architecture. Left occipital cavernoma/venous anomaly. Aneurysm, attention communicating arteries. Headaches/possible seizure.TECHNICAL:Enhanced CTA of intracranial vasculature is performed.Utilizing an independent workstation reformatted images were acquired and utilized in interpretation of the exam.65 cc of Omnipaque 350 was administered for this study.A nonenhanced head CT was also performed. CTA of intracranial circulation:Patent and unremarkable bilateral intracranial vertebral arteries (dominant left vertebral) is noted. Bilateral pica branches are visualized and unremarkable. Basilar artery and all of its branches are within normal limits. Right vertebral artery is patent and within normal limits across the skull base and in its supraclinoid portion. Right ophthalmic artery is visualized and unremarkable. There is absence of posterior communicating artery on this side (anatomical variation). There is also anatomical variation off hypoplastic right A1. Right middle cerebral artery and its branches are unremarkable and without evidence of an aneurysm.Left internal carotid artery is larger than right and likely secondary to hypoplastic right A1.The left internal carotid artery is patent across the skull base and in its supraclinoid portion. The left ophthalmic artery is visualized and unremarkable.There is a prominent left posterior communicating artery however without evidence of an aneurysm as clinically is questioned. A dominant left A1 is present with filling of bilateral anterior cerebral arteries.There is a vascular fenestration of the distal portion of the left A1. The anterior communicating artery is unremarkable. The bilateral anterior cerebral arteries beyond the anterior communicating artery are unremarkable. The previously noted left occipital lobe cavernoma is not identified on this study. A developmental venous anomaly in the left occipital lobe over his present. This multi-branch developmental venous anomaly appears to traverse the left occipital lobe and in the vein terminating into the left perimesencephalic vein. On the outside MRI examination the left occipital developmental venous anomaly extends into the occipital horn of left lateral ventricle.Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact.Visualized paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable. A

Output: 1.Negative CTA of intracranial circulation for aneurysm. There are normal anatomical variations of hypoplastic right A1, absence of right posterior communicating artery and a prominent left posterior communicating artery, a small vascular fenestration of distal dominant left A1, developmental venous anomaly of left occipital lobe which appears to communicate with left perimesencephalic vein.2.Negative nonfused head CT.


Instruction: Generate impression based on medical findings.

Input: Male 56 years old Reason: cancer surveillance - rectal carcinoma. s/p transanal endoscopic microsurgical History: rectal carcinoma Overall image quality: Good, but patient refused intravenous contrast, which limits evaluation.PELVIS:PROSTATE/SEMINAL VESICLES: Diffuse low T2 signal in the peripheral zone of the prostate is nonspecific, please correlate with PSA levels.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: NoneLymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor: There is asymmetric thickening of rectosigmoid colon, this may be in part due to residual fecal material or underdistention, but given the lack of contrast cannot be characterized further. There is no abnormal diffusion signal at this region or mesorectal lymph node.Size: 2.7 x 1.8 x 3.5 cm (image 601/series 38)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Rectosigmoid region(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 4 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 9 cmCircumference of the rectum involved: 50%Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Not invaded.MRI T-stage: T2 - Tumor invades submucosal and/or tumor invades muscularis propriaNo extension outside the serosa and no encroachment on the mesorectal fascia.BONES/SOFT TISSUES: No significant abnormality noted.OTHER: Focal fat herniation through the right levator muscle.

Output: This is a limited study due to lack of IV contrast as patient refused further imaging.1.Asymmetric thickening of the rectosigmoid colon could represent neoplasm as characterized above, but given lack of contrast please correlate with direct visualization.2.Nonspecific diffuse T2 hypointensity in the peripheral zone of the prostate, please correlate with PSA levels.


Instruction: Generate impression based on medical findings.

Input: Follow up of a pituitary lesion. There is a mildly hypoenhancing lesion in the left pituitary gland that measures up to 10 mm. There is no mass effect upon the optic apparatus or cavernous sinus. There is slight deviation of the pituitary infundibulum to the right. The cavernous carotid artery flow voids are intact.

Output: An unchanged lesion in the left pituitary gland that measures up to 10 mm likely represents an adenoma.


Instruction: Generate impression based on medical findings.

Input: Large sacral decubitus ulcer, evaluate for osteomyelitis. There is motion degradation on multiple sequences limiting the study. Five lumbar type vertebral bodies are presumed to be present. Compared to 10/29/2011, there is been development of a compression fracture involving the L3 vertebral body with moderate loss of height with minimal retropulsion. There is edema involving the L3 vertebral body extending into the inferior L2 and upper L4 vertebral bodies as well as the intervening disc spaces. There is focus of linear signal void involving the L3 vertebral body which is suspected to represent a vacuum cleft. There is also a mild compression deformity involving the L5 vertebral body with resolution of edema seen on prior MRI. Alignment is within normal limits. The conus medullaris is normal in position. Mild multilevel degenerative changes are seen including mild disc bulges at the L2-L3, L4-L5, and L5-S1 levels without significant spinal canal or neural foraminal stenosis at any level.There is soft tissue thickening and enhancement involving the partially imaged subcutaneous soft tissues in the left upper gluteal region. There is adjacent T1 hypointensity involving the posterior aspect of the left iliac bone with enhancement. This abnormality is seen on the most inferior slices, series 10 axial images 55 and 56.There is mild deformity involving the sacrum at the S2 level which remains unchanged and may be related to remote trauma.Multiple renal cysts again seen.

Output: 1. Compared to CT dated 10/2/2015, there has been interval development of a compression fracture involving the L3 vertebral body with linear signal void suggestive of vacuum cleft, which can be seen with avascular necrosis or osteoporotic compression fracture. Signal void can also be seen with cement from vertebroplasty if there is such history, but this seems less likely. There is significant associated edema and enhancement which extends from L2 to L4 which is favored to be reactive to the recent compression fracture. No surrounding paraspinous or epidural fluid collections to suggest infection. If there remains high suspicion for discitis-osteomyelitis at this level, would suggest follow-up imaging.2. Chronic mild compression fracture involving the L5 vertebral body with resolution of edema seen on remote MRI study from 10/29/2011. Chronic fracture/ deformity of the sacrum also again seen.3. Soft tissue thickening and enhancement involving the subcutaneous soft tissues in the left upper gluteal region presumably corresponding to the known decubitus ulcer. There is subtle focus of signal abnormality involving the immediately adjacent left iliac bone which may represent osteomyelitis (axial T1 series 10 image 56). This abnormality is partially imaged with motion degraded sequences and would suggest dedicated MRI pelvis study to more completely image this region for osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: 56 years Female (DOB:1/29/1960)Reason: 56F with AIDS and cryptococcal meningitis, p/w lethargy, found to have lab e/o adrenal insufficiency and metabolic acidosis, ?pituitary pathology History: 56F with AIDS and cryptococcal meningitis, p/w lethargy, found to have lab e/o adrenal insufficiency and metabolic acidosis, ?pituitary pathologyPROVIDER/ATTENDING NAME: SCOTT V STERN SCOTT V STERN MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.There is T1 and T2 signal hyperintensity centered in the right basal ganglia.

Output: 1.There is no pituitary mass or other abnormality that is appreciated.2.A lesion is present in the right basal ganglia. It is not clearly defined on this exam. Given the suspicion for cryptococcal meningitis, this may be related to cryptococcal meningitis. An MRI of the brain with gadolinium may help confirm define this better if clinically indicated.