Instruction: Generate impression based on medical findings.

Input: 76-year-old man with left-sided weakness and probable meningioma. Brain: Multiple sequences are degraded by motion artifact. There are multiple foci of restricted diffusion and high T2 signal in the right putamen, caudate, periventricular white matter of frontal lobe, right cerebellar hemisphere, and right middle cerebellar peduncle. There is no gross evidence of intracranial hemorrhage, although dedicated susceptibility weighted imaging was not performed. There is a dural based mass just to the left of midline and superficial to the left paracentral lobule that measures up to approximately 30 mm. There is also a left cerebellopontine angle tumor that measures up to 15 mm in diameter with mass effect upon the left brainstem and cerebellar hemisphere. The ventricles and basal cisterns are normal in size and configuration for the patient's age. There is no midline shift or herniation. The skull, and scalp soft tissues are grossly unremarkable. There is a T1 hyperintense subcentimeter left maxillary sinus retention cyst. There is right posterior globe intermediate T1 hemorrhage.Cervical Spine: There is reversal of the normal cervical lordosis and mild anterolisthesis of T2 on T3. There is anterior fusion of C3 and C4 and C5, C6 and C7 vertebral bodies as well as anterior and posterior fusion of the T1 and T2 vertebral bodies. There is multilevel degenerative spondylosis with mild spinal canal stenosis and up to severe neural foraminal stenosis from C3 to T1. There is a T1 and T2 hypointense lesion in the T2 vertebral body. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1.Multiple small recent infarcts involving the right putamen, caudate, and periventricular white matter, as well as the right cerebellar hemisphere and right middle cerebellar peduncle.2.A left paramidline mass likely represents a meningioma.3.A left cerebellopontine angle mass likely represents a vestibular schwannoma, but is incompletely characterized.4.Multilevel degenerative changes in the cervical spine without spinal cord compression.5.Nonspecific sclerotic lesion in the T2 vertebral body, which is better depicted on the prior CT.6. Right retinal hemorrhage.Findings discussed by phone with Dr Aliesje Sorgeloos at 2:24 pm on 10/8/2015.


Instruction: Generate impression based on medical findings.

Input: Congenital lymphangioma status post sclerotherapy. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable.Face: There is a large multicystic trans-spatial right face mass with a hemorrhage level in a right parapharyngeal cystic compartment that measures up to 17 mm, increase in size of a dominant right oral cavity cystic component that measures up to 35 mm, but decrease in size of the nasopharyngeal cystic components, measuring up to 25 mm. The submental region cystic component are similar in size and there is an unchanged heterogeneously fatty component in the left nasal and oral cavity that measures up to approximately 25 mm. There is associated deformity of the mandible and a cleft palate. There is persistent effacement of the upper pharyngeal airway, which is otherwise intubated.Neck: There is no significant cervical lymphadenopathy. The salivary glands are unchanged. The thyroid gland is unremarkable. The cervical spine appears to be intact.

Output: 1. Multicystic trans-spatial right face mass with recent hemorrhage in a right parapharyngeal cystic compartment, increase in size of a dominant right oral cavity cystic component, but decrease in size of the nasopharyngeal cystic components. The lack of vascular elements on the prior biopsy and the presence of a fatty component associated with the mass raises the possibility of a teratoma, perhaps in conjunction with a lymphatic malformation.2. Cleft palate, which is better depicted on the prior CT.3. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Previous history of focal seizure activity left frontal, behavior challenges. There is a linear area of high T2 signal in the white matter of the anterior left superior frontal gyrus. There is no evidence of intracranial hemorrhage, mass, or encephalomalacia. The hippocampi are unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: Nonspecific linear T2 hyperintensity in the white matter of the anterior left superior frontal gyrus may potentially be related to cortical malformation.


Instruction: Generate impression based on medical findings.

Input: There is a wedge-like area of volume loss affecting the lateral aspect of the left cerebellar hemisphere. There is poorly defined mild T2 hyperintense signal in the left superior frontal lobe extending from the roof of the frontal horn of the left lateral ventricle into the subcortical white matter of the superior and middle frontal gyri, without associated mass effect or volume loss. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.No acute abnormality is identified.2.A small defect or area of volume loss is seen in the left cerebellar hemisphere which may be congenital or related to a previous insult, possibly ischemic.3.Vague left frontal lobe white matter signal abnormality is seen as described above of uncertain significance. The differential would include sequela of prior insult, an area of relatively delayed myelination, or less likely, a subtle cortical dysplasia.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old, history of smouldering multiple myeloma, now with new lesions seen on skeletal survey. Assess for additional bony disease. Cervical:No areas of concerning marrow signal replacement, edema or enhancement are seen. Vertebral body morphology is normal. Spinal alignment is anatomic. Spinal cord signal intensity and morphology are within normal limits.Mild facet hypertrophy is seen within the cervical region, most severely affecting C7-T1 on the right. Small central disk osteophyte complexes are also present at C3-4 and C4-5. No high-grade spinal canal or neuroforaminal stenosis is suspected.Thoracic:No areas of concerning marrow signal replacement, edema or enhancement are seen. Vertebral body morphology is normal. Spinal alignment is anatomic. Spinal cord signal intensity and morphology are within normal limits.Scattered facet hypertrophy is seen through the thoracic spine. No significant degenerative disk disease, spinal canal or neuroforaminal stenosis is suspected.Lumbar:No areas of concerning marrow signal replacement, edema or enhancement are seen. Vertebral body morphology is normal allowing for small Schmorl's nodes the superior endplates of L2 and L3. Spinal alignment is anatomic. The visualized conus and cauda equina demonstrate normal signal intensity and morphology.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with a small superimposed central protrusion. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy. Mild bulging disk with small central annular fissure. No significant spinal canal or neuroforaminal stenosis.

Output: No evidence to suggest myelomatous disease in the spine.


Instruction: Generate impression based on medical findings.

Input: 69 years Male (DOB:7/7/1946)Reason: grade II astrocytoma on TMZ. History: grade 2 astrocytoma.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is a mass involving right basal ganglia, thalamus, insular cortex and adjacent right frontal lobe which extends to involve gray and white matter of the insular cortex and right orbital gyrus and right inferior frontal gyrus as well as the anterior aspect of the right temporal lobe. It does not display any contrast enhancement. On the current exam there is new T2 signal hyperintensity which extends further superiorly into the right frontal lobe white matter. This is a new T2 signal hyperintensity is higher signal than the rest of the lesion. There is an associated cystic component measuring 12 x 17 mm in size within this tumor which on the March exam measured 8 x 6 mm axial dimensions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and mucosal thickening elsewhere in the paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a mass involving right frontal lobe, anterior temporal lobe, insular cortex, right thalamus and basal ganglia. Since the prior exam a new area of T2 signal hyperintensity has developed in the right frontal lobe subcortical white matter adjacent and superior to the previously seen lesion. It is possible this represents vasogenic edema with or without tumor infiltration. There is also a new cystic component within the tumor which has enlarged compared to the previous exam.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt w/ mesothelioma s/p multiple debulkings, HIPEC x2, last in September 2015 now w/ chronic SBO - please eval for transition point and eval for recurrent disease History: chronic SBO ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Prominent common bile duct measuring 1.1 cm without an obstructing lesion evident. Mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is mild edema and diffusion restriction involving the pancreatic tail and head which may reflect a mild pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is dilatation of small bowel to 3.8 cm with collapsed terminal ileum and a transition point in the lower pelvis (19/17), likely representing a partial small bowel obstruction. Stool within the colon has slightly increased since the prior exam. There is a rim of low T2 signal surrounding multiple bowel loops in the pelvis, likely reflecting thickening and fibrosis of the peritoneal reflections. No cystic lesions are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dilated small bowel loops with collapsed terminal ileum likely represents a partial small bowel obstruction; air seen distally in colon.2.There is thickening and likely fibrosis of the peritoneal reflections in the pelvis which is suggestive of sclerosing encapsulated peritonitis, may in combination be contributing to aforementioned partial SBO.3.Bowel thickening involving the rectosigmoid suggests a mild nonspecific proctitis.4.No cystic lesions identified to suggest multicystic peritoneal mesothelioma.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer status post prostatectomy. PELVIS:PROSTATE: Status post prostatectomy. No evidence of tumor recurrence at the cystourethral anastomosis. No evidence of residual or recurrent disease in the prostatectomy bed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of tumor recurrence in the prostatectomy bed or pelvis.


Instruction: Generate impression based on medical findings.

Input: There is redemonstration of a saccular aneurysm arising from the basilar tip measuring approximately 4 x 5 mm, not significantly changed.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis. No additional aneurysms are identified.

Output: Aneurysm arising from the junction of the basilar tip measuring approximately 4 x 5 mm, not significantly changed when allowing for differences in technique.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Syringomyelia and syringobulbiaClinical question: hx of lumbar syringomyelia, assess for any changesSigns and Symptoms: lower back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The distal spinal cord demonstrates a syrinx at the T11 and T12 vertebral levels measuring approximately 3 x 1.5 mm axial dimensions on the current exam and the same on the 10/16/2015 exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: The patient has a known small syrinx measuring approximately 3 mm x 1.5 mm axial dimensions in the distal spinal cord is stable compared to the 10/16/2015 exam.


Instruction: Generate impression based on medical findings.

Input: Low back pain, evaluate for infection at the operative site Compared to 8/21/2015, previously seen epidural hematoma extending from L4-L5 to L5-S1 level has been evacuated. Current study demonstrates a fluid collection dorsal to the thecal sac at the L4-L5 level extending to the L5-S1 level with moderate to severe degree of mass effect on the thecal sac right greater than left. This collection measures approximately 2.7 x 2.7 x 2.3 cm in the AP, transverse, and craniocaudal dimensions.There is peripheral enhancement associated with this collection, with susceptibility artifact slightly limiting evaluation. Also noted is enhancement involving the epidural space along the right lateral aspect of the spinal canal in the epidural space along the right L5 to S1 levels. This enhancement is increased since prior postoperative study from 8/21/2015 and may represent granulation tissue.Small more superficial fluid collection is also seen in the midline posteriorly along the surgical tract. Enhancement of the paraspinous soft tissues is also increased since prior which may reflect postsurgical change.Again seen are earlier postsurgical changes of L4-L5 bilateral laminectomy with placement of bone graft material and an interspinous clamp. There is minimal anterolisthesis at L4-L5, otherwise alignment is anatomic. Vertebral body heights are intact. Multilevel disc desiccation with degenerative disc disease, most severe at L4-L5. Endplate degenerative changes at L4-L5. Normal signal within the distal cord and conus which ends at L1-L2. Again seen is mild clumping of the cauda equina below L2-L3 which likely reflects arachnoiditis.Degenerative changes including mild bilateral neural foraminal stenosis at L3-L4 as well as moderate to severe right and mild to moderate left L4-L5 neural foraminal stenosis are again seen related to disc bulge and facet arthropathy.Numerous bilateral renal cysts.

Output: Again seen are prior postsurgical changes of L4-L5 laminectomy and interspinous fusion with interval evacuation of epidural hematoma since MRI from 8/21/2015. Current study demonstrates a fluid collection dorsal to the thecal sac extending from L4-L5 to L5-S1 at the level of the laminectomy/facetectomies with mass effect on the thecal sac resulting in moderate to severe spinal canal stenosis, right worse than left. There is mild peripheral enhancement associated with this collection as well as enhancement involving the epidural space particularly on the right L5 to S1 levels. This enhancement is nonspecific and may reflect granulation tissue, with infection not excluded. The fluid collection may represent a pseudomeningocele, with superimposed infection again not excluded.Moderate to severe right L4-L5 neural foraminal stenosis which may be impinging on the L4 nerve root again seen and similar to prior.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old, history of Crohn's disease, history of breast cancer in 2005, now with recurrence in the axillary nodes, a right upper lung nodule positive on PET, and increased signal in the pituitary. Assess for pituitary adenoma versus metastasis. Along the right aspect of the sella, and involving the right cavernous sinus, there is an ill-defined region of soft tissue thickening which is asymmetric relative to the left sella and cavernous sinus (see key images). This tissue correlates with the region of hypermetabolic activity seen on prior PET scan.The visualized pituitary gland is within which can be normal for age. No additional pituitary sellar or suprasellar lesions are seen.

Output: A region of soft tissue thickening is evident involving the right aspect of the sella and the right cavernous sinus. This does correlate with an area of hypermetabolic activity seen on prior PET scan. Without the benefit of IV contrast, no further characterization can be made. The differential diagnosis therefore remains broad and would include metastatic disease, a primary pituitary neoplasm, an incidental cavernous sinus meningioma, as well as an inflammatory/granulomatous process.


Instruction: Generate impression based on medical findings.

Input: BRAIN: Motion artifact slightly limits the study. A curvilinear area of enhancement in the anterior right cingulate gyrus is likely represents a developmental venous anomaly. The susceptibility weighted images are degraded due to motion artifact, however there is no definite evidence of mixed vascular malformation. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There is no additional abnormal enhancement within the brain. There is mild diffuse mucosal thickening of the bilateral maxillary sinuses and ethmoid air cells. LUMBAR SPINE: Vertebral body and intervertebral disc heights are preserved. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is normal. The conus is normal in signal and morphology and terminates at an appropriate level. There is no evidence of neural foraminal stenosis. There are no areas of abnormal enhancement. The visualized intra-abdominal and paraspinal contents are unremarkable.

Output: 1.No finding to explain the patient's symptoms in the brain or lumbar spine. 2.Diffuse mucosal inflammation of the paranasal sinuses.


Instruction: Generate impression based on medical findings.

Input: Complex febrile convulsions [R56.01], Reason for Study: ^Reason: rule out brain structural abnormality History: seizure There are a couple of small (less than 2mm) T2 high and T1 low signal intensity lesions on the right hippocampal head which follow the signal intensity of CSF. There is no MR evidence of focal parenchymal signal abnormality of the hippocampus nor evidence of volume loss. Constellation of above findings suggest possible hippocampal sulcus cysts. The left side hippocampus appears to be normal.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Hippocampal sulcus cysts on the right hippocampal head, otherwise no remarkable finding.


Instruction: Generate impression based on medical findings.

Input: 74 year-old woman with fall. There is no evidence of intracranial hemorrhage, mass or edema. There are atherosclerotic changes of the internal carotid and vertebral arteries. There are moderate, periventricular regions of hypoattenuation consistent with age-indeterminate, small vessel ischemic disease. If stroke remains a clinical concern, recommend MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is mucosal thickening in the visualized portion of the maxillary sinuses bilaterally. The mastoid air cells are normally pneumatized.

Output: No CT findings of acute intracranial process. If stroke remains a clinical concern, recommend MRI.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female for evaluation of meniscal tear MENISCI: There is a large complete radial tear through the posterior horn and body of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is degeneration of the articular cartilage of the medial femoral condyle above the torn meniscus. There is mild edema within the medial tibial plateau below the torn meniscus. There is near-full-thickness to full-thickness degeneration of the articular cartilage of the undersurface of the patella along the median eminence and along the medial facet resulting in the defect that is just over 1 cm. There is underlying degenerative signal abnormality within the subchondral bone. Focal degeneration of the articular cartilage of the inferior aspect of the medial facet of the femoral trochlea with underlying subchondral cyst formation. The lateral tibiofemoral compartment is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complete radial tear of the medial meniscus as described above.2.Cartilage degeneration and joint effusion.


Instruction: Generate impression based on medical findings.

Input: Known left breast malignancy present for I-Spy research MRI. Two areas positive for malignancy in the breast, and additional malignant axillary biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Bilateral retropectoral silicone implants are present.In the left inner breast, the index enhancing mass near 8:00 measures 2.0 x 2.7 x 2.8 cm (LM x CC x AP). Adjacent to this mass are small foci/areas of non-mass enhancement measuring up to 7 mm and extend up to 1.4 cm from the mass. This index mass extends posteriorly close to the thin pectoralis muscle overlying the implant. But there is no definite abnormal pectoralis enhancement. Additionally, there is abnormal non-mass enhancement surrounding a cyst in the lower outer left breast which measures 2.7 x 3.2 x 5.7 cm. These areas together measure 5.2 x 6.5 cm in the axial plane.No abnormal enhancement is seen in the right breast. There are at least 4 enlarged left axillary lymph nodes, including a subpectoral node. A representative node adjacent to the pectoralis minor measures 1.1 x 1.1 cm in the axial plane. A focus of low T1 signal in one of these nodes suggests biopsy clip artifact. No abnormal axillary lymph nodes are identified in the right axillary region.A port-a-cath is present in the right upper chest wall. A high T2 signal hepatic lesion is likely a benign cyst.

Output: Know left breast cancer with left axillary metastasis with pre-treatment measurements as above. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: 47-year-old woman with history of Crohn's disease and liver lesions on MR from 2010. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 bright, lobular lesions with discontinuous and gradual peripheral enhancement on perfusion sequences have increased in size compared to the prior examination. The previously seen indeterminate lesion in the right hepatic lobe is not reliably seen on today's examination. There are no new suspicious focal hepatic lesions.Gallbladder is normal and there is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. The pancreatic parenchyma appears normal.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: Left breast cyst noted.OTHER: No significant abnormality noted.

Output: 1.Multiple benign hemangiomas, increased in size from the prior exam.2.Previously indeterminate lesion seen in the right hepatic lobe not reliably seen on today's exam.


Instruction: Generate impression based on medical findings.

Input: 11-year-old male with mosaic neurofibromatosis and bilateral optic nerve gliomas s/p chemotherapy experiencing visual loss, right eye, unchanged from prior Redemonstrated is an oval T2/FLAIR hyperintense lesion along the right optic tract, extending inferiorly into the mesial right temporal lobe, unchanged in appearance on noncontrast techniques. There has been interval resolution of previously demonstrated enhancement.As before, there is a nonenhancing T2/FLAIR hyperintense and T1 hypointense lesion in the left optic chiasm/hypothalamus which has not significantly changed since prior exam.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of new pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Smaller foci of T2/FLAIR hyperintensity along the more posterior portions of the bilateral optic tracts are again noted, unchanged in appearance.Redemonstrated is an oval mildly peripherally enhancing right orbital segment optic nerve lesion with central cystic appearance, unchanged in appearance. Orbital structures are otherwise unremarkable. As before, there is mild scattered mucosal thickening within the paranasal sinuses without air-fluid level. Mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: 1.Redemonstrated is an oval T2/FLAIR hyperintense lesion along the right optic tract, extending inferiorly into the mesial right temporal lobe, unchanged in appearance on noncontrast techniques, although there has been interval resolution of previously demonstrated enhancement.2.Other presumed bilateral optic pathway gliomas are stable.


Instruction: Generate impression based on medical findings.

Input: Aphasia and left-sided weakness. Stenosis potentially requiring intervention. Brain MRI: Many of the sequences are degraded by patient motion. There are small areas of restricted diffusion and high T2 signal in the right superior and middle frontal gyri. There is underlying encephalomalacia in the right basal ganglia, middle frontal gyrus, and right corona radiata. There is also diffuse patchy cerebral white matter T2 hyperintensity without corresponding restricted diffusion. There is no evidence of intracranial hemorrhage or mass. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: The images are largely degraded by patient motion. There is paucity of flow-related enhancement in the right internal carotid vein. There is tenuous reconstitution of flow-related enhancement in the right middle cerebral artery at the circle of Willis, with a relative paucity of flow-related enhancement in the distal middle cerebral artery branches. There also appears to be asymmetrically less flow-related enhancement in the right anterior cerebral artery. There also appears to be irregular narrowing of the bilateral posterior cerebral arteries. The intradural vertebral arteries and Neck MRA: There is no discernible enhancement of the entire right internal carotid artery. The right common carotid and external carotid arteries appear to be patent. The left internal carotid, common carotid, and external carotid arteries also appear to be patent. However, there appears to be stenosis of the bilateral vertebral artery origins.

Output: 1. Acute right middle cerebral artery territory infarct superimposed upon chronic small vessel ischemic disease and chronic infarcts, without gross hemorrhagic transformation.2. Critical steno-occlusive disease at the origin of the right internal carotid artery. Further evaluation via Doppler ultrasound may be useful.3. Apparent stenosis of the bilateral vertebral artery origins. Discussed with Physician: AGNIESZKA A ARDELT at 2:40 PM on 10/28/15.


Instruction: Generate impression based on medical findings.

Input: 49-year-old history of CHF 3 presenting with headache and dizziness x 2 days. Increased right-sided weakness and paresthesia. There is no evidence of intracranial hemorrhage, mass or edema. No definite acute cortical stroke is seen however MRI is recommended if concern for ischemia is present. Focal hypoattenuation in the left centrum semiovale consistent with old subcortical infarct. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No evidence of acute cortical stroke. Old left subcortical stroke.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old, with dizziness. Assess for metastases. History of breast cancer. Extensive thick, and in some areas nodular, leptomeningeal enhancement is evident throughout the cerebellar fissures with modest associated parenchymal edema. Leptomeningeal enhancement also coats the tectum.Supratentorially, scattered sulcal enhancement is seen, most notably along the medial and anterior right temporal lobe, and along the anterior left temporal lobe where the enhancement is more nodular and in contact with the overlying dura. Mild leptomeningeal enhancement is seen along the proximal sylvian fissures, within the interpeduncular cistern, along the fifth cranial nerves and seventh/eighth cranial nerves bilaterally, and questionably along the optic apparatus and sella.Parenchymal edema is most evident within the posterior fossa and in the left anterior temporal lobe. There is likely some effacement of the fourth ventricle, but elsewhere no significant mass effect is detected. The supratentorial ventricular system remains within normal limits for size.No evidence of significant intracranial hemorrhage is seen. No abnormal fluid collections are detected.

Output: Extensive leptomeningeal enhancement is seen, most severely affecting the posterior fossa but with scattered areas supratentorially with involvement of several cranial nerves.Given the history of breast cancer, leptomeningeal carcinomatosis is felt to be the most likely underlying etiology.


Instruction: Generate impression based on medical findings.

Input: Neck pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C5 on C6 and mild straightening of the cervical spinal curvature. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge associated with the mild retrolisthesis with small annular fissure. There is also minimal ligamentum flavum thickening at this level. There is no significant spinal canal or neural foraminal stenosis. C6-7: Minimal disc bulge and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Minimal degenerative changes in the cervical spine as described above without significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: 67-year-old woman with history of PSC status post partial hepatectomy. High-grade dysplasia of the left intrahepatic and extrahepatic bile ducts on surgical pathology, margins clear. ABDOMEN:LIVER, BILIARY TRACT: Patient is status post left hepatectomy with hepaticojejunostomy. No focal hepatic lesions are identified.Multifocal mild intra and extra hepatic biliary strictures (11/57 and 58) are identified. Additionally, a stricture within the central right posterior bile duct (11/52) appears slightly worsened from the prior exam and there is new pre-stenotic ductal dilatation.SPLEEN: Spleen appears normal.PANCREAS: The pancreatic duct appears normal. The pancreas is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Intra and extrahepatic biliary strictures with newly worsening stricture and prestenotic dilatation of a right posterior bile duct.2.No evidence of malignancy.


Instruction: Generate impression based on medical findings.

Input: 74 year old woman with history of HTN, COPD and multiple myeloma, with SCT, referred for evaluation of possible cardiac amyloid. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 125 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 47 ml (normal range 31+/-10). There is severe LVH. There are no regional wall motion abnormalities present. . There is patchy late gadolinium enhancement in multiple segments of the myocardium, consistent with infiltrative diseases such as cardiac amyloid.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 mildly dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%2. There is patchy late gadolinium enhancement in multiple segments of the myocardium, consistent with infiltrative diseases such as cardiac amyloid.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with left index finger ulcer. Radiograph shows index finger ulceration without osteolysis. Ring finger ulceration as provided by clinical service. Examination is degraded due to motion. Please not that the distal index finger is not included within the field-of-view on all sequences. Mild high T2 signal and enhancement at the distal aspect of the index finger only on seen on axial sequences, incompletely evaluated. No loculated fluid collection. The tendons demonstrate grossly normal signal provided the above-mentioned limitation.Mild to moderate degenerative disease affects the carpometacarpal and intercarpal joints.

Output: Please note that the distal index finger is not included in the field-of-view on all sequences and thus incompletely evaluated. Mild high T2 signal and enhancement at the distal aspect of the index finger only seen on axial sequences. Close follow-up is recommended.Findings discussed with Dr. Kyle Borque at 1130 on 11/22/15.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with question of left shoulder nerve entrapment. ROTATOR CUFF: The rotator cuff appears intact without significant tearing or tendinopathy. The bellies of the visualized musculature appears intact without significant fatty atrophy. The subscapular notch and spinoglenoid notch appear without significant abnormality.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. No significant tearing of the glenohumeral joint and glenoid labrum is seen.BICEPS TENDON: The biceps tendon appears well seated without significant abnormality. ADDITIONAL

Output: No findings to suggest nerve entrapment as clinically queried.


Instruction: Generate impression based on medical findings.

Input: Reason: history brain mets s/p SRS to pituitary met please compare History: none Dedicated pituitary sequences were not again acquired on this exam. Images are somewhat limited by patient motion as well. Available imaging demonstrates there has been further slight interval decrease in the size of the previously seen slightly irregular mildly enhancing sellar/suprasellar mass. The lesion demonstrates diffuse T2 hypointensity which may relate to hemosiderin staining and/or mineralization. Postoperative changes from previous transphenoidal sellar surgery are again noted. The pituitary infundibulum and optic chiasm are better visualized than on previous exam, with relative hypoenhancement suggested to the left of midline along the upper margin of the pituitary gland.The ventricles and sulci are within normal limits for age. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The remainder of the midline structures and craniocervical junction are within normal limits. The patient's known left masseter mass visualized on coronal T1 postcontrast images, measuring 1.1 cm transverse by 1.5 similar CC. It is overall T1 hypointense with mild patchy enhancement as well as a more prominent halo of ill-defined enhancement surrounding it. Is not entirely included within the previous field-of-view on dedicated MR brain exams.

Output: Exam limited due to lack of dedicated pituitary imaging as well as motion artifact. Further interval decrease in size of the sellar/suprasellar mass, with improved visualization of the suprasellar cistern, pituitary infundibulum, and optic chiasm.


Instruction: Generate impression based on medical findings.

Input: 33-year-old male with nocturnal diarrhea. Evaluate for small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: There are multiple liver lesions that are T1 hypointense (axial series 14 images 18, 19, 30, 31, 38, 45), T2 hyperintense, and demonstrate restricted diffusion, located relatively peripherally. A thin rim of enhancement with central hypoechoic enhancement are noted on the early/arterial phase imaging on the dynamic series (coronal series 19 images 300, 307, 312). These findings are concerning for multifocal hepatic abscess formation.SPLEEN: Mild splenomegaly measuring 14 cm in craniocaudal length. The timing of the IV contrast injection for the enterography exam poorly evaluated the splenic vein and main portal vein.PANCREAS: In the expected region of the pancreatic neck/proximal body, there is a 5.1 x 3.2 cm centrally T1 hypointense masslesion suggested with suspected peripheral enhancement expanding the lesser sac and causing mass effect on the distal gastric body and antrum (axial series 20 image 51). Normal contours of the pancreas are not clearly seen. This raises the question for a pancreatic phlegmon. There is poor visualization of the distal pancreatic body and tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal wall thickening or significant contrast enhancement. Trace free fluid in the dependent pelvis. Mild apparent thickening of the terminal ileum (coronal series 11 image 25) is likely related to underdistention, as appearance resolves on later imaging sequences. There is no significant upstream dilatation and no abnormal wall enhancement at this level. The stomach is distended with oral contrast, and there is suboptimal distention of the small bowel loops (especially proximally), and a partial gastric outlet obstruction cannot be excluded.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unremarkable appearance of small and large bowel, please refer to details above.2.Multiple peripherally based rounded hepatic lesions with imaging findings suspicious for multifocal hepatic abscess formation. Correlation with patient's clinical history and laboratory values recommended.3.Findings concerning for necrotizing pancreatitis, centered at level of pancreatic neck/proximal body, with superimposed infection and phlegmon. This finding causes mass effect on the stomach with upstream gastric dilatation noted, appearance concerning for underlying partial gastric outlet obstruction. Correlation with symptomatology and laboratory data is needed. A CT abdomen with pancreas protocol may provide a more detailed assessment, with CT being less prone to image degradation secondary to artifacts including motion artifact.Findings were discussed with Dr. Leslie Yang of gastroenterology on 9/7/2016 at 17:14.


Instruction: Generate impression based on medical findings.

Input: 67-year-old woman with history of pelvic mass. PELVIS:UTERUS, ADNEXA: In the cul-de-sac posterior to the uterus, there is a 117 x 99 x 94 mm multilobulated, irregularly-shaped mass. This mass is predominantly T2 hypointense, however contains reticular T2 hyperintensity. There is no definite cystic change within this mass. Only a small portion of this mass enhances (10011/273). This lesion is distinct from the uterus and the rectum.A second lesion with similar appearance is seen along the superior right aspect measuring 26 x 19 mm (4/32).Within the left uterine fundus (3/48) there is a 9 mm T2 hypointense intramural lesion, likely a fibroid. The ovaries are not identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Hemangioma in the L5 vertebral body.OTHER: No significant abnormality noted.

Output: Large, irregular shaped pelvic mass in the cul-de-sac and smaller, satellite mass with similar imaging characteristics. Imaging and enhancement characteristics are nonspecific but differential considerations include fibrous tumor of the adnexa (such as an ovarian fibrothecoma) or pedunculated, torsed fibroid.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Other injury of unspecified body region Accidental discharge from unspecified firearms or gun, initial encounter Unspecified open wound of unspecified part of head, initial encounter Accidental discharge from unspecified firearms or gun, initial encounterClinical question: Evaluate for interval changeSigns and Symptoms: GSW to head The patient is status post recent suboccipital craniotomy.There is heterogeneous diffusion restriction throughout the cerebellum, brainstem globus pallidus on a and portions of the thalami associated with blood products within the cerebellar hemispheres and swelling of the cerebellar hemispheres. Some blood products also present in the brainstem and medial thalami. The brainstem is flattened against the clivus and stretched superiorly.. There is a superior transtentorial herniation of posterior fossa contents above the tentorial notch. The third ventricle, thalami and basal ganglia are displaced superiorly. The brainstem is flattened against the clivus and there is near obliteration of the fourth ventricle. The inferior aspect of the right cerebellar hemisphere appears less affected. The rest of the cerebellum has abnormal signal throughout. The brainstem has abnormal signal on the left side more than the right. There is some herniation of intracranial contents into the craniotomy defect. There are subdural hematomas present adjacent to the occipital lobes bilaterally. The one on the left is larger than the one in the right. One of the left measures 6 mm in thickness whereas the one on the right measures approximately 4 mm in thickness.The flow voids of the basilar artery and vertebral arteries are small. The internal cerebral veins are displaced superiorly. The flow void of the vena Galen appears compressed. The straight sinus flow void is identified and also appears somewhat compressed. The flow-void of the right and left sigmoid sinus are both identified.There is leptomeningeal enhancement present in the posterior fossa.A ventriculostomy tube courses to the right frontal lobe into the right lateral ventricle with tip in the region of foramen of Monro.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are opacified. The visualized portions of the orbits are intact.

Output: 1.Marked cerebellar swelling associated with infarctions and hemorrhage and superior transtentorial herniation. Additional infarcts are present in the medial thalami and globus pallidi. There is associated compression of the brainstem and near obliteration of the fourth ventricle. The inferior aspect of the right cerebellar hemisphere appears less affected.2.There are subdural hematomas adjacent to the occipital lobes bilaterally.3.The patient is status post suboccipital craniotomy. There is some herniation of intracranial contents into the craniotomy defect4.A leptomeningeal pattern of enhancement could be inflammatory in nature or it could also be reaction to subarachnoid blood products. The possibility of meningitis cannot be excluded on the basis of this exam.5.A ventriculostomy tube is in place. The ventricles are not particularly dilated.


Instruction: Generate impression based on medical findings.

Input: 57 year old man with history of ESRD, NASH cirrhosis, CVA and CAD s/p CABG presenting with chest pain Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 71%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 207 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 61 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 134 g (normal range 164+/-36). There are no regional wall motion abnormalities present. No evidence of intracardiac iron (T2 *decay time 39 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 93 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsIron present in liver. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal biventricular function2. No evidence of cardiac iron overload.


Instruction: Generate impression based on medical findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: hx brain lesion. preop planning for craniotomy History: none- preop Multiple fiducial markers attached to the scalp.There is 33.5mm (RL) x 35.7mm (AP) x 40mm (CC) sized irregular margined peripheral enhancing intra axial mass with surrounding edema at the right precuneus. The right lateral ventricle occipital horn is slightly effaced due to mass effects.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Right precuneus intra axial mass as described above. Differential diagnosis include malignant lesion such as malignant glioma or metastatic lesion.


Instruction: Generate impression based on medical findings.

Input: Back pain. There is congenital fusion of the C2 and C3 and C6 and C7 vertebrae associated with straightening of the cervical spine alignment in the sagittal plane, but no spondylolisthesis. The thoracic and lumbar spine alignments are normal. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is a short segment of relatively high T1 signal in the posterior sacral canal that measures less than 2 mm in thickness. The conus medullaris is located at the level of L1-2. The paravertebral soft tissues are unremarkable. There is horseshoe kidney.

Output: 1. Congenital fusion of the C2 and C3 and C6 and C7 vertebrae with straightening of the cervical spine alignment in the sagittal plane.2. The conus medullaris is located at the level of L1-2. 3. A short segment of relatively high T1 signal in the posterior sacral canal may represent a fibrofatty filum terminale.4. Horseshoe kidney.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with SLE, HTN, CAD with episodes of hallucination with facial weakness and limited upgaze. A moderate or vasculitis or vascular pathology. CT of brain without infusion.No evidence of hemorrhage, cortical stroke, mass effect, edema or midline shift is detected. Previously reported small muscle disease on MRI examination is not visible on this study.The bony density of calvarium, pneumatization of paranasal sinuses and mastoid air cells are also unremarkable.CTA of intracranial circulation.CTA of the carotid system demonstrates patent bilateral intracranial portions of the carotid arteries with no abnormality in particular no evidence of vasculitis. There is also good visualization of bilateral anterior and middle cerebral arteries and all of their branches. Within the limitation of CTA no evidence of vasculitis of the left middle or anterior cerebral arteries or their branches is detected.CTA of vertebral basilar system demonstrates patent bilateral intracranial components of the vertebral arteries with no pathology. There is good visualization of bilateral PICAs. The basilar artery is also well visualized and demonstrates no pathology. There is normal visualization of bilateral posterior cerebral arteries and superior cerebellar arteries with no evidence of pathology in particular no evidence of vasculitis.Within the limitation of CTA no evidence of vasculitis of the branches of the posterior cerebral arteries or superior cerebellar arteries is detected.

Output: Unremarkable CTA of intracranial circulation.Within the limitation of CTA for detection of small vessel vasculitis this is study is unremarkable.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Memory loss with vascular risk factors. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted images.Examination demonstrate periventricular and subcortical foci of FLAIR hyperintensity in bilateral cerebral hemispheres. Minimal similar signal changes are also present in bilateral basal ganglia and pons. Although nonspecific considering patient's stated age of 79 this appearance is often result of microvascular ischemic changes. The findings are not associated with any hemorrhagic changes.There is generalized prominence of cortical sulci for patient of stated age of 79. The ventricular system are mildly prominent however likely within normal for stated age.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are normal.Unremarkable images through the orbits, calvarium, soft tissues of the scalp and paranasal sinuses.

Output: 1.No diffusion-weighted abnormalities.2.Changes suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.3.Generalized prominence of cerebral cortical sulci for patient's stated age as detailed.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male. Evaluate subcentimeter hypodensity seen on CT scan in patient with history of pancreatic cancer, status post resection in 2015. Concern for metastasis. ABDOMEN:LIVER, BILIARY TRACT: Loss of signal intensity on the out of phase imaging compatible with diffuse hepatic steatosis.At the hepatic dome, there are two faintly T2 hyperintense lesions demonstrating restricted diffusion (axial series 9 images 112, 116) and peripheral enhancement consistent with metastases (axial series 13 images 340, 346). These lesions were noted on the 9/23/2016 CT exam, and the sizes have slightly increased in the interval with reference measurements listed below.There are punctate arterially enhancing foci in the inferior peripheral right hepatic lobe that are only seen on the arterial phase and are most compatible with perfusional variants.SPLEEN: No significant abnormality noted.PANCREAS: Stable surgical changes status post Whipple. There is mild dilatation of the pancreatic duct measuring 5 mm in diameter. A 1.1 x 0.8 cm pancreatic tail cyst is unchanged (axial series 600 image 21).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. In the right lower renal pole, there is a 2 x 2 centimeters simple cyst. Other subcentimeter T2 hyperintense foci of the right renal parenchyma are too small to fully characterize.RETROPERITONEUM, LYMPH NODES: Similar mildly prominent periportal lymph nodes.BOWEL, MESENTERY: Surgical changes from Whipple procedure. No acute abnormality.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 10/6/2016 08:59:21)RIGHT HEPATIC LESION 1 - POSTERIOR: 0.9 x 1.0 cm (Image 116, Series 9); (Image 346, Series 13); 0.8 x 0.8 cm on prior (9/23/2016) (Image 66, Series 9).RIGHT HEPATIC LESION 2 - LATERAL: 0.5 x 0.7 cm (Image 112, Series 9); (Image 340, Series 13); 0.4 x 0.4 cm on prior (9/23/2016) (Image 63, Series 9).

Output: Slight interval enlargement of known two hepatic dome lesions, which demonstrate peripheral enhancement consistent with metastases. Reference measurements listed above.


Instruction: Generate impression based on medical findings.

Input: 62 year old male with elevated PSA. Evaluate for prostate carcinoma. PELVIS:PROSTATE:Prostate Size: 4.8 x 2.5 x 3.6 cm (TR x AP x CC)Peripheral Zone: There is extensive decreased T2 signal abnormality with associated restricted diffusion and enhancement in the left posterior base of the peripheral zone of the prostate gland which is suspicious for prostate carcinoma. This extends into the left base and mid body anteriorly as well. There is an additional focus of enhancing signal abnormality in the left posterior apex of the peripheral zone of the prostate gland which is also suspicious for prostate carcinoma.Note is made of multiple foci of signal abnormality with restricted diffusion and enhancement in the right mid body and base of the peripheral zone of the prostate which are also suspicious for prostate carcinoma. Seminal Vesicles: There appears to be extension of signal abnormality in the left posterior base to the level of the left seminal vesicle which raises the question of seminal vesicle involvement by tumor. Extracapsular Extension: There is a capsular bulge along the aforementioned areas of signal abnormality which is suspicious for extensive extracapsular extension with involvement of the left seminal vesicle and probable extension to involve the neurovascular bundle. BLADDER: There is concentric thickening of the bladder suggestive of chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple foci of signal abnormality in the left base, body, and apex of the peripheral zone of the prostate gland, suspicious for prostate carcinoma. There is apparent extracapsular extension and probable involvement of the left seminal vesicle. No evidence of lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Female; 55 years old. Reason: further characterization of heptic biliary duct dilatation seen in CT scan. Etiology of obstruction? History: 55yo F with OLT in 2011 c/b biliary stricture who presents with hepatic abscess s/p IR drain 4/30 and noted chronic biliary dilation on prior CT scans; question of cause of this dilation. MRCP images are limited due to body wall anasarca and ascites. ABDOMEN:LUNG BASES: Small right pleural effusion and moderate right lower lobe nonspecific atelectasis/consolidation similar to prior CT. Cardiomegaly.LIVER, BILIARY TRACT: Mild right and moderate left intrahepatic biliary ductal dilation, presumably due to stricturing near Klatskin's point as the confluence of the main right and left hepatic ducts is not well seen, all similar to prior MRI on 8/6/13. Small filling defects within dilated left intrahepatic biliary ducts noted, likely due to stones and/or debris.Findings suspicious for multiple left hepatic microabscesses with confluent abscess in the posterior left hepatic lobe status post placement of percutaneous drain, not significantly changed since prior CT on 4/30/15.SPLEEN: Splenomegaly with left upper abdominal varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged cardiophrenic, porta hepatis, and gastrohepatic lymph nodes, likely reactive in the setting of infection.BOWEL, MESENTERY: Mild abdominal ascites.BONES, SOFT TISSUES: Body wall anasarca.OTHER: No significant abnormality noted.

Output: 1. Mild right and moderate left intrahepatic biliary ductal dilation presumably due to stricturing just proximal to the anastamotic site with the small bowel.2. No significant interval change in findings suspicious for multiple left hepatic lobe abscesses since prior CT on 4/30/15.


Instruction: Generate impression based on medical findings.

Input: Unspecified disturbances of skin sensation [R20.9], Reason for Study: ^Reason: cervical myelopathy History: R sided numbness There is broad based disc extrusion at the level of C56 which compressed thecal sac and severely narrows the right side lateral recess.There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: there disc-ligament complex abutting thecal sac which results mild spinal canal stenosis.C4-C5: there is central to slightly right disc protrusion which indents and abuts thecal sac results mild spinal canal stenosis. C5-C6: there is extrusion of disc toward right side neuroforamen results moderate spinal stenosis and significant right lateral recess stenosis. C6-C7: there is broad based disc protrusion central to left laterally which indents thecal sac. C7-T1: no neuroforaminal narrowing or spinal stenosis. T12-L1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Disc herniations at the level of C45, C56 and C67 as described above. Among them, the C56 disc demonstrates disc extrusion which results severe narrowing of the right lateral recess.2. Normal spinal cord signal intensity.


Instruction: Generate impression based on medical findings.

Input: Right hip pain, evaluate for labral pathology. ACETABULAR LABRUM: There is a superior labral tear best seen on the radial images, (series 1101 image 6), which appears similar to the prior study. In addition, there are new articular cartilage defects adjacent to the labrum which are new on this study when compared to prior (series 1101 image 4).ARTICULAR CARTILAGE AND BONE: No significant abnormality of the bone noted. Articular cartilage defects adjacent to the labrum as described above.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Superior labral tear with new adjacent articular cartilage defects.


Instruction: Generate impression based on medical findings.

Input: T10 vertebral body lesion. Possible metastatic disease. Head and neck cancer. 49-year-old male. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: T10 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on medical findings.

Input: Female 54 years old Reason: vaginal cuff tenderness and drainage after TLH @ north shore History: vaginal drainage and vaginal cuff tenderness, exposed suture PELVIS:UTERUS, ADNEXA: Status post hysterectomy.There are postsurgical changes along the superior aspect of the vagina with some delayed enhancement of the vaginal cuff possibly due to granulation tissue. The superior aspect of the vagina area abuts the small bowel however, no discrete fistulous connection.BLADDER: Urinary bladder is unremarkable.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the lower abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes with granulation tissue along superior aspect of the vagina but no discrete fistulous connection or fluid collections.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old, with history of breast cancer and metastases to the brain with left meningeal carcinomatosis, assess for spinal disease. Fine, diffuse leptomeningeal enhancement is seen along the entire spinal cord, the conus and the nerve roots of the cauda equina. Spinal cord morphology is otherwise unremarkable. There is no evidence of significant cord edema. Thick leptomeningeal enhancement is partially visualized along the cerebellum. The CSF along the inferior aspect of the cerebellum may be loculated.No definite evidence of any osseous metastases is seen. T1/T2 hyperintense signal within the T6 vertebral body likely represents a benign hemangioma. Spinal alignment is anatomic and the vertebral body morphology is within normal limits.No significant disc degeneration is seen in the cervical or thoracic spine. In the lumbar spine there is mild disc bulging at L4-5 without significant spinal canal or foraminal stenosis. At L5-S1, facet arthropathy is seen, right side more than left. In addition, there is a bulging disc which results in mild effacement of the ventral thecal sac, moderate left and mild right foraminal narrowing.

Output: 1.Findings compatible with diffuse leptomeningeal carcinomatosis along the spinal cord and conus.2.No definite osseous metastatic lesions are seen.3.Disc degeneration and facet arthropathy at L5-S1.


Instruction: Generate impression based on medical findings.

Input: 36 years Male (DOB:12/3/1979)Reason: preoperative planning for OR 2/14 History: preoperative planning for OR 2/14PROVIDER/ATTENDING NAME: IRA J BLUMEN ISSAM A AWAD There is redemonstration of a hemorrhagic focus centered in the right optic tract and adjacent basal ganglia involving the right optic tract, right side of the optic chiasm and posterior most aspect of the right optic nerve. The component that extended into the right optic tract and optic nerve has an exophytic appearance and extends into the suprasellar cistern. The optic nerve component is adjacent to the right A1 segment. There are fluid-fluid levels present within 2 components of this cavernous malformation. One fluid fluid level which is located at the optic tract measures approximately 7 mm diameter the other one is located in the right basal ganglia and measures 5 mm.There is redemonstration of a developmental venous anomaly in the left frontal lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Right optic tract and basal ganglia cerebral cavernous malformation.


Instruction: Generate impression based on medical findings.

Input: Female 16 years old Reason: right knee pain now with swelling and pain. Mild effusion. Pain with full extension MENISCI: Medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: T2 hyperintense bone contusion in the inferior aspect of the patella, with focal thinning of the patellar articular cartilage.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Parameniscal cysts anterior to the lateral meniscus. Even though no discrete tear is evident, meniscal tear is the most likely etiology of parameniscal cyst.2.Patellar contusion suggesting transient dislocation of the patella.


Instruction: Generate impression based on medical findings.

Input: 69 years Female (DOB:7/17/1947)Reason: stroke rule out History: stroke rule out with new onset AMSPROVIDER/ATTENDING NAME: KOUROSH D REZANIA KOUROSH D REZANIA MRI of the brainNo diffusion weighted abnormalities are appreciated.This a focus of encephalomalacia present in the right middle frontal gyrus associated with some gyral signal loss and susceptibility imaging. A similar focus is present in the left middle frontal gyrus.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR signal hyperintensities are present in the brainstem.No abnormal mass lesions are appreciated intracranially. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Patient motion degrades some of the pulse sequence acquisitions.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The right vertebral artery appears to be hypoplastic.

Output: 1.No evidence for cerebrovascular occlusive disease. 2.No evidence for intracranial aneurysm..3.Findings suggest a small foci of encephalomalacia in the right and left middle frontal gyri. Most likely these are related to ischemic events.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. Additional patchy lesions in the brainstem are also likely vascular related5.The exam is degraded due to patient motion which could excrete obscure some subtle abnormalities.6.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: Male; 68 years old. Reason: Assess extent of prostate cancer History: prostate cancer on active surveillance PELVIS:PROSTATE:Prostate Size: 5.2 x 5.7 x 6.3 cm.Peripheral Zone: 3 x 3 mm focus of low T2 signal with restricted diffusion in the left mid gland, suspicious for prostate cancer (series 704/204). This focus is slightly more prominent when compared to prior study.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small focus in the left mid gland suspicious for prostate cancer. No evidence of extracapsular extension.


Instruction: Generate impression based on medical findings.

Input: MRI CARDIAC W/FLOW QUANT WWO, 9/14/2016 11:21 AM Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%. The LVEDV is 160 ml (normal range 109+/-23), LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), LVESV is 69 ml (normal range 31+/-10), and LV end systolic volume index is 41 ml/m2 (normal range 18+/-5). The LV mass is 76 g (normal range 114+/-24) and the LV mass index is 45 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 143 ml/m2 (normal range 69+/-14), the RVEDV is 85 ml (normal range 110+/-24), the RV end systolic volume index is 63 ml/m2 (normal range 22+/-8), and the RVESV is 37 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Normal left ventricular size and systolic function.2.Normal right ventricular size and systolic function.3.There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.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: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: Evaluate for cause of AMS with recent OHT History: Evaluate for cause of AMS with recent OHT No evidence of acute ischemic or hemorrhagic lesion on the scan.Several scattered susceptibility lesions on bilateral hemisphere white matter indicating chronic hemorrhagic foci or calcification, no change since prior scan.On FLAIR imaging, several scattered high signal intensity lesions on subcortical white matter indicating nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of several punctate chronic hemorrhagic foci and non specific small vessel disease since prior scan.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male. Man with NF1 who has a deep muscular neurofibroma on the right upper abdomen. Please define intramuscular neurofibroma in the upper lateral abdomen. 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: Small and mildly enlarged retroperitoneal lymph nodes, nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Three subcentimeter round STIR hyperintense foci in the right erector spinae muscle, likely intramuscular neurofibromas. The largest measures 0.8 x 0.7 cm (series 11, image 21).OTHER: Numerous cutaneous nodules consistent with neurofibromas, the largest is approximately 1.3 x 0.6 cm in the central abdomen.

Output: 1.3 subcentimeter STIR hyperintense foci in the right erector spinae muscle, likely small intramuscular neurofibromas.2.Numerous cutaneous neurofibromas consistent with known NF1.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with strong family history of breast cancer. Family history of breast cancer in her mother 4 times. Personal history of benign biopsy of a left breast mass two o'clock (fibroadenoma). Patient has also undergone two benign stereotactic biopsies in the left breast at an outside institution There is heterogeneous amount of fibroglandular tissue in both breasts.There is a cyst in the right breast.Mild parenchymal enhancement is noted bilaterally.Again seen is the patient's previously biopsied left breast fibroadenoma at the 3 o'clock position of the left breast with faint enhancement.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Female 59 years old Reason: eval biliary system, assess hepatic vessel patency History: s/p OLT, elevated AP ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged and demonstrates signal drop out on in phase images consistent with iron deposition. Postoperative changes compatible with orthotopic liver transplant. No focal liver lesion within the limitations of this noncontrast study. No biliary dilatation. Expected vessel flow voids in the main portal vein.SPLEEN: Mild splenomegaly at 13.6 cm. Splenic varices noted, increased compared to prior study.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes with blooming artifact in the anterior abdominal wall.

Output: 1.Status post orthotopic liver transplant. Hepatomegaly with iron infiltration throughout the liver. 2.Within the limitations of this noncontrast study the main portal vein is patent.


Instruction: Generate impression based on medical findings.

Input: MRI BRAIN:T2/flair signal abnormalities in the right posterior parietal and right cerebellar hemisphere. The cerebral and cerebellar hemispheres and the brain stem are normal morphologically. No restricted diffusion is seen to suggest acute infarction.Intracranial vascular flow voids are normal caliber.The ventricles are normal volume and the midline is maintained. No abnormal extra axial fluid collections, mass, acute infarction or intracranial hemorrhage.MRA Head and Neck : Right dominant vertebral artery, a normal variant. The vertebral, left and right carotid basilar, ACA, MCA, PCA, posterior and anterior communicating arteries demonstrate no evidence of stenosis, obstruction or dissection. Head CT: Encephalomalacia in the right posterior parietal and right cerebellar hemisphere likely corresponds to regions of prior stroke. The cerebral and cerebellar hemispheres and the brain stem are normal morphologically.The ventricles are normal volume.No abnormal extra axial fluid collections, mass, acute infarction or intracranial hemorrhage.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CTA: Right dominant vertebral artery, a normal variant. The vertebral, left and right carotid basilar, ACA, MCA, PCA, posterior and anterior communicating arteries demonstrate no evidence of stenosis, obstruction or dissection.

Output: Old strokes in the right posterior parietal and right cerebellar hemisphere.No acute intracranial pathology.Unremarkable CTA and MRA of the head and neck.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old, history of right parietal grade 3 oligodendroglioma status post resection, radiation and chemotherapy. Again seen are postsurgical changes of right parietal craniotomy for tumor resection. The resection cavity involving the inferior parietal lobule. There is surrounding T2/FLAIR hyperintensity, which remains unchanged, including signal abnormality extending into the posterior temporal lobe. No new T2/FLAIR hyperintensity, mass effect, or suspicious enhancement is appreciated. Intrinsic T1 hyperintensity and susceptibility effect are again seen and compatible with blood products and/or mineralization.There is a small developmental venous anomaly within the right thalamus. Mild ex vacuo dilatation of the right lateral ventricle is again seen. There is subcentimeter focus of susceptibility within the right paramedian midbrain which is more prominent than prior studies from 9/4/2015 and 3/9/2015. Remainder of the brain parenchyma is unremarkable without evidence of new infarct, hemorrhage, mass, or mass effect. No hydrocephalus. Aside from postsurgical changes, calvarium and extracranial soft tissues are unremarkable.

Output: 1. Posttreatment changes in the right temporoparietal lobes remain unchanged. No evidence of tumor progression.2. Gradual increasing size of focus of susceptibility/microhemorrhage within the right paramedian midbrain which may represent a small cavernous malformation, possibly related to prior radiation treatment although unclear if this area was within the radiation field. No surrounding edema.


Instruction: Generate impression based on medical findings.

Input: 69 years, Male, mesothelioma, now with hypoglossal nerve route. Evaluate for tumor involvement. There is an enhancing mass involving the left occipital bone including the left occipital condyle, inferior aspect of the clivus, and the left hypoglossal canal. There is a small soft tissue component. Mass measures approximately 2.4 x 5.5 cm in the axial plane, series 2801 image 49, and approximately 3 cm in the craniocaudal dimension, coronal STIR series 1901 image 27. No abnormal enhancement or masses within the brain parenchyma are appreciated. No evidence of acute ischemia or hemorrhage. There is a focus of susceptibility in the right occipital lobe consistent with chronic microhemorrhage. No extra-axial collections. No hydrocephalus. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. There is opacification of the left mastoid air cells. Minimal mucosal thickening is seen involving the paranasal sinuses. No additional lesions within the calvarium within the limits of MRI are appreciated. There is a 15 mm x 4 mm raised skin lesion involving the left frontotemporal scalp.There is mild ptotic appearance of the left posterior tongue. Images of the neck are mildly motion degraded but demonstrate left supraclavicular lymphadenopathy, measuring up to 16 mm in the short axis. Diffuse nodular pleural thickening involving the left hemithorax related to known mesothelioma as well as mediastinal extension of tumor is again seen and better assessed on recent chest CT from 11/12/2015.There is an enhancing lesion measuring 11 x 9 mm involving the left upper sternocleidomastoid muscle, axial post gadolinium series 2301 image 29.There is edema involving the C3 and C4 vertebral bodies along the endplates favored to be degenerative in etiology. Diffuse low T1 marrow signal is seen in the cervical spine, which is nonspecific with no large destructive lesions within the cervical spine are appreciated within the limitations of motion degradation.

Output: 1. Osseous metastasis involving the left posterior skull base measuring approximately 2.4 x 5.5 x 3.0 cm with involvement of the left hypoglossal canal.2. There is posterior drooping of the left tongue base compatible with cranial nerve palsy.3. 11 x 9 mm enhancing lesion involving the left upper sternocleidomastoid muscle suspicious for metastasis.4. Metastatic left supraclavicular lymphadenopathy.5. Extensive nodular pleural thickening involving the left hemothorax extending into the mediastinum consistent with known mesothelioma and better assessed on recent chest CT from 11/12/2015.6. No abnormal enhancement or masses within the brain parenchyma.7. 15 x 4 mm raised skin lesion along the left frontotemporal scalp which is nonspecific and can be correlated with direct visualization.


Instruction: Generate impression based on medical findings.

Input: Unspecified papilledema [H47.10], Reason for Study: ^Reason: disc swelling History: photosensitivity Brain MRIOn axial scan, bilateral orbital globe show subtle flattening of posterior globe, subtle buckling (tortuosity) of optic nerves (left more prominent than right) and slightly prominent CSF spaces of distal optic nerve sheath. The pituitary gland shows slightly flattened superior aspect of the gland considering the patient's age but there is no evidence of empty sellar. Constellations of these findings indicate possible diagnosis of intracranial hypertension. There is a well circumscribed extra axial lesion at the midline hypothalamus, tuber cinereum area. The lesion is measured about 4.2mm (RL) x 5.6mm (AP) x 2.9mm (CC). The lesion shows high signal intensity on T1, low signal intensity on T2, low signal intensity on Fat saturation T1 and without evidence of enhancement, thus indicating fat containing lesion. On gradient echo images, there are subtle signal loss especially on peripheral and anterior aspect of the lesion indicating possible mineralization. To confirm, head CT with thin section around the hypothalamus can be considered if clinically indicated. Differential diagnosis include hypothalamic lipoma/ osteolipoma or Rathke's clef cyst. Possibility of dermoid or epidermoid cannot be completely excluded but slim. Scattered FALIR/T2 high signal intensity lesions at bilateral frontal lobes and right insular cortex are seen which are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no 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.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Subtle flattening of posterior globe, slightly prominent CSF spaces around distal optic nerve sheath and subtle buckling of optic nerves especially left side indicate possible intracranial hypertension. 2. Hypothalamic fat containing lesion. Differential diagnosis include lipoma/osteolipoma and Rathke's cleft cyst.3. No evidence of acute ischemic or hemorrhagic lesion.4. Normal brain MRV.


Instruction: Generate impression based on medical findings.

Input: Pituitary adenoma: paresthesias and headaches. There is a cystic focus in the right pituitary gland that measures up to 6 mm. There pituitary gland is otherwise not particularly enlarged. The optic apparatus and cavernous sinuses are intact. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged mild punctate foci of high T2 signal in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A subcentimeter cystic lesion in the right pituitary gland may represent a cystic microadenoma.


Instruction: Generate impression based on medical findings.

Input: T4aN2b BOT SCC, p16+ on OPTIMA IC with carbo/Abraxane. There has been marked interval decrease in size of a right tongue base tumor, without measurable residual tumor. There is no evidence of residual significant lymphadenopathy in the neck. For example, a necrotic right level 2B lymph node measures 6 mm in short axis and an ill-defined right level 2A lymph node measures 5 mm in short axis. The thyroid salivary glands are unremarkable. The larynx appears to be intact. There is multilevel degenerative cervical spondylosis with mild spinal canal narrowing at C3-4 and C4-5. The orbits and imaged intracranial structures are unremarkable.

Output: No evidence of residual measurable tumor in the right tongue base and no evidence of residual significant lymphadenopathy in the neck.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with right frontal sinusitis. Complains of right pressure in forehead x 8 months. Patient has history of glioma right orbit/temporal. Extensive opacification of right frontal sinus is noted. Priors MRI examination of the brain from 4 -- 11 -- 07 as well as 9 -- 26 -- 06 were also reviewed which also demonstrated presence of inflammatory sinus disease in the right chamber of frontal sinus. Findings are believed to represent chronic sinusitis.The right chamber of the frontal sinus has a multi-loculated appearance due to septation. The rest of the paranasal sinuses demonstrates only minimal ethmoid sinus disease bilaterally. Maxillary sinuses remain unremarkable an osteomeatal units of the maxillary sinuses are patent.

Output: 1.Extensive chronic sinusitis of right chamber of frontal sinus as detailed.2.Minimal bilateral ethmoid sinus disease.3.Unremarkable paranasal sinuses otherwise.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with right shoulder pain. ROTATOR CUFF: There is mild heterogeneity of the supraspinatus suggesting mild tendinosis, but we see no fluid-filled tear. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is no evidence of joint effusion. There is intermediate signal intensity within the superior labrum suggesting degenerative tearing. The anterior superior labrum is attenuated which may represent additional degenerative tearing. The inferior labrum appears intact. BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which is of questionable significance.

Output: 1. Mild tendinosis of the supraspinatus tendon without evidence of a rotator cuff tear.2. Mild osteoarthritis of the acromioclavicular joint.3. Degenerative tearing of the glenoid labrum.


Instruction: Generate impression based on medical findings.

Input: History of left lumpectomy in 2011 for breast carcinoma. Patient received radiation therapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post-surgical changes including scarring seen as low T2 signal are again noted in the left outer breast. Other low T2 signal areas in each breast are also stable and without suspicious enhancement. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Metastatic papular thyroid cancer with single met to L3 vertebral body. Status post RT. Please assess for progression of disease. Unenhanced CT of thoracic spine:Axial immediate CT images of the entire thoracic spine were obtained. Sagittal and coronal 2-D reformatted images were acquired as well.The bony density in the alignment of the vertebral column is within normal limits. There is no evidence of a sclerotic or lytic changes of vertebral column. No minimal degenerative changes of the thoracic spine are noted. There is no evidence of any perispinal soft tissue abnormality. This examination remains stable since prior study.Unenhanced CT of the lumbar spine:Examination again demonstrates a stable findings of the L3 vertebrae. Subtle sclerotic changes of the L3 vertebrae are similar to prior exam. The exact etiology of this finding is not clear. Possibility of a hemangioma or a metastatic disease should be considered. CT exam is not the appropriate test for definitive diagnosis of metastatic bony lesions. MRI examination is recommended. There is however as mentioned above no change in the size, distribution and pattern of this not a specific L3 vertebrae. This lesion however can be further evaluated with biopsy if patient is unable to obtain an MRI examination.

Output: 1.Unremarkable CT of breath.2.Stable nonspecific sclerotic changes of L3 vertebrae since prior exam.


Instruction: Generate impression based on medical findings.

Input: 67 years Female (DOB:8/15/1948)Reason: Primary CNS lymphoma status post treatment. History: Primary CNS lymphoma status post treatment.; please compare with previous MRI done here and the outside MRI images.PROVIDER/ATTENDING NAME: CHADI NABHAN CHADI NABHAN There is some exact effect on the frontal horn of the left lateral ventricle. There is a T2 and FLAIR signal hyperintense focus present adjacent to the frontal horn of the left cerebellar ventricle measuring 13 x 32 mm in axial dimensions which is unchanged compared to prior exam. There is no associated contrast enhancement. Signal hyperintensity along the left corticospinal tract and atrophy of the left cerebral peduncle suggest Wallerian degeneration. There is a burr hole present along the left frontal calvarium.There is a T2 and FLAIR hyperintense focus present in the left parietal bone which was also present on the prior exam and has not changedNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no interval change. There is no evidence for recurrence of the patient's known lymphoma. The appearance of the bed of the lesion in the left frontal periventricular white matter is stable. There are findings which are compatible with a wallerian degeneration.


Instruction: Generate impression based on medical findings.

Input: Reason: Include ankle and mid foot. Assess lateral posterior superior calcaneal cyst. Ganglion vs reactive bursitis History: pain and swelling and increasing in size There is an ovoid mass within the soft tissues lateral to the Achilles tendon at its insertion on the calcaneus, corresponding to soft tissue opacity seen on prior radiographs. It measures approximately 13 x 8 mm in transverse dimension and approximately 15 mm in craniocaudal dimension. It is of similar signal intensity to muscle on non-fat-suppressed T1-weighted images, and is slightly hyperintense to skeletal muscle on fat-suppressed T1-weighted images. It is hyperintense on the fat-suppressed proton density weighted sequence, but is isointense to skeletal muscle on the STIR sequence. The mass enhances homogeneously following contrast administration. The mass abuts the lateral margin of the distal Achilles tendon and posterior calcaneus, but does not deform or invade either of these structures. The mass lies posterior to the sural nerve and lesser saphenous vein. We see no additional soft tissue masses. Bone marrow signal intensity is normal. We see no tenosynovitis or other significant tendon abnormalities.

Output: Enhancing soft tissue mass along the lateral margin of the Achilles at its insertion on the calcaneus. This does not have the typical appearance of a cyst, ganglion or bursa, and its uniform enhancement suggests a solid tumor. Although the signal intensity of the mass is relatively low on the STIR sequence, overall the characteristics of this lesion are nonspecific, and tissue sampling is recommended.