Instruction: Generate impression based on medical findings.

Input: 65-year-old male patient with history of HCC status post Intra-Op RFA. Assess for liver lesions. Please note that this is a technically limited exam secondary to multiple technologist-related errors including partially unplugged coil leading to extensive signal loss (most pronounced anteriorly and affecting left liver lobe) and failure to acquire appropriate arterial or portal venous and delayed postcontrast imaging sequences. Patient to be contacted for reimaging and acquisition of additional sequences. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Findings concerning for new and enlarging hepatic lesions with corresponding restricted diffusion. Again visualized postablation cavities hepatic segment 7/6 on image 110 series 1401 and in segment 5 on image 92 series 1401. Unable to assess for arterially enhancing lesion along the caudal/medial aspect of the hepatic segment 7/6 ablation cavity as a reliable postcontrast arterial sequence was not acquired by the technologist. But the corresponding site of signal abnormality appears increased in size and shows restricted diffusion, lesion measures approximately 2.6 x 2.5 cm on image 101 series 1401 and on image 464 series 1308, previously measured 1.5 x 1.4 cm. Previously visualized focal arterial enhancement along anterior/lateral aspect of segment 5 cavity also unable to be evaluated for reasons above and again site of signal abnormality shows increased size now measuring approximately 2.5 x 1.5 cm on image 43 2 series 1/3/2008, previously measured 1.8 x 1.1 cm. There are additional more pronounced than on earlier exam focal ill-defined sites of apparent restricted diffusion, for example, in inferior pole of liver on image 288 series 1/3/2008, new sites of disease cannot be excluded.Postablation cavity in hepatic segment 2/3 stable to mildly increased in size.Subcentimeter previously seen hepatic segment 8 of arterially enhancing lesion not reliably seen.On submitted imaging sequence labelled arterial phase there are multiple peripherally based enhancing foci seen that are favored to be perfusional in etiology.Accounting for differences in technique stable to mildly increased in size subcentimeter simple appearing T2 hyperintense focus at level of dome on image 34 series 901, may reflect a cyst. Small perihepatic fluid.SPLEEN: Splenomegaly measuring 19.1 cm in longitudinal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Splenorenal shunting present.RETROPERITONEUM, LYMPH NODES: Small porta hepatis and cardiophrenic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously alluded to punctate vertebral body enhancing focus not visualized, again likely technical.OTHER: No significant abnormality noted.

Output: Very limited exam due to technical errors made, see above. Patient to return and be re-imaged, please await report or addendum for that exam.Within limitations of study findings concerning for new and enlarging hepatic lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female, with a history of right lumpectomy for DCIS in 2002. Patient received radiation and tamoxifen. Known BRCA two mutation carrier. Family history breast carcinoma in her mother, maternal first cousin, and paternal aunt. Family history of ovarian carcinoma in her maternal aunt at age 35. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Postsurgical changes are present within the right retroareolar region, unchanged from prior examinations. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 58 year old man with history of HTN, AF, referred for cardiac MRI prior to planned AF ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVEDV is 142 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 103 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrial volume is 190.7ml. The left atrial volume index is 82.5ml/m2, which is severely increased. There is artifact on the dedicated 3-dimensional delayed viability sequences. No reliable evidence of left atrial enhancement.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 75 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. The mitral valve leaflets appear thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid arteries (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Individual dimensions are:RUPV:16x17mm. There is either early branching or common origin of right middle lobe branches.RLPV: 21X26mm. There is early branching.LUPV: 14x16mmLLPV: 16x8mmPulmonary 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 pericardial effusion effusion.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 51%. There is no late gadolinium enhancement in the left ventricle to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.3. The left atrial volume index is 82.5ml/m2, which is severely increased. 4. Early branching of the right superior and inferior pulmonary veins. Two left pulmonary veins drain normally into the left atrium, dimensions as above. 5. Severe bi-atrial enlargement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: History of IVC sarcoma status post resection 10/8/2014 ABDOMEN:LIVER, BILIARY TRACT: The previously described nonspecific focus in segment 8 now demonstrates a peripheral rim of enhancement and measures approximately 1.0 cm with associated restricted diffusion, highly suspicious for metastatic disease. Additionally there is a new punctate enhancing focus in the more peripheral aspect of segment 8. There are several additional punctate foci of restricted diffusion with associated T2-weighted mild hyperintensity and abnormal postcontrast enhancement (series 4 image 75, 77, and 80) in segment 4A and 7. Stable left hepatic lobe subcentimeter hemangioma. SPLEEN: The spleen is normal in size and morphology without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The punctate focus of restricted diffusion along the anterior aspect of the crus of the right hemidiaphragm is unchanged. The mildly enhancing soft tissue surrounding this focus is difficult to accurately measure and is not significantly changed (series 9, image 152).The low-density focus along the right posterolateral margin of the IVC is nonenhancing and likely represents postsurgical fluid, unchanged.No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Abdominal wall postsurgical changes.OTHER: No significant abnormality noted.

Output: Increasing size of previously noted liver lesion and several new punctate liver lesions as described are suspicious for metastatic disease. Stable postsurgical changes of the resection bed.


Instruction: Generate impression based on medical findings.

Input: Reason: Breast CA, new lesion right side of T12 suspicious for a metastasis. Please obtain core biopsies to document tumor. History: Pain at site of left rib fractures. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. No hematoma formation identified on post procedural images

Output: T12 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis.


Instruction: Generate impression based on medical findings.

Input: NMO, nearly blind: worse vision and pressure behind eyes. Thoracic pain. Orbits: There is diffuse atrophy and high T2 signal involving the right optic nerve. There is also atrophy of the left optic nerve, but to a lesser degree. The globes, extraocular muscles, lacrimal glands, and orbital fat are unremarkable bilaterally. There is scattered paranasal sinus mucosal thickening.Cervical Spine: There is loss of the usual cervical lordosis and multilevel degenerative cervical spondylosis with spinal canal narrowing at C3-4 to C6-7, without spinal cord compression. The spinal cord displays normal signal and morphology. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.Thoracic Spine: The thoracic vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Right greater than left optic nerve atrophy.2. No evidence of spinal cord lesions.3. Multilevel degenerative cervical spondylosis.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of cervical or axillary mass or lymphadenopathy. There is no abnormal signal or enhancement involving the right brachial plexus. The visualized cervical spine is unremarkable.

Output: No evidence for right brachial plexus abnormality.


Instruction: Generate impression based on medical findings.

Input: 4-year-old male with history of pilocytic astrocytoma status post laser ablation, surveillance imaging. Redemonstrated are postoperative findings related to laser ablation with no interval change in size of a tectal plate mass, as measured with T2 technique, measuring approximately 16 x 20 mm in the same location utilized previously. However, previously demonstrated more diffuse enhancement centrally within the mass has decreased. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a right transfrontal ventricular catheter that terminates adjacent to the right caudate nucleus, unchanged in position. Also redemonstrated are postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle, unchanged in appearance. Nevertheless, the third and lateral ventricles remain enlarged, unchanged in extent. There is no midline shift or herniation. There is a left cerebellar hemisphere developmental venous anomaly. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: 1.Redemonstrated are postoperative findings related to laser ablation with no interval change in size of a tectal plate mass, as measured with T2 technique, measuring approximately 16 x 20 mm in the same location utilized previously. However, previously demonstrated more diffuse enhancement centrally within the mass has decreased.2.Stable findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. 3.Stable third and lateral ventricular enlargement.


Instruction: Generate impression based on medical findings.

Input: 74 year-old man with history of CVA two years ago with right-sided weakness. Now alert and oriented x 0 with increased right-sided weakness. There are multiple areas of periventricular, subcortical, and cortical hypodensity. The most prominent is a region of cortical hypodensity with encephalomalacia in the left occipital lobe. This was present on the prior study dated 5/8/2006. There is a smaller left parietal hypodensity which was also present on the prior study. The subcortical hypodensities in the left parietal region appear more pronounced on the current study. MRI could better determine whether or not this represents an acute event. There are no CT findings of intracranial hemorrhage.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: 1. Increased prominence of left parietal subcortical hypodensities. MRI is recommended to evaluate for acute stroke.2. Stable findings of periventricular, subcortical, and cortical hypodensities consistent with prior stroke and small vessel ischemic disease.2. No CT evidence of intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Reason: osteomyelitis at based of proximal phalanx based on XR, evaluate for additional source of infection (abscess, additional foci of osteomyelitis) History: as above Note is made of soft tissue irregularity along the plantar aspect of the fifth MTP joint consistent with patient's known history of ulceration. There is increased subcutaneous and soft tissue signal abnormality/inflammatory change in the surrounding area which extends to the level of the base of the proximal phalanx of the fifth toe and also extends posteriorly to the level of the fifth MTP joint. There is increased signal abnormality within the base of the proximal phalanx on fluid sensitive sequences with corresponding decreased signal abnormality on T1-weighted images indicating osteomyelitis. There is increased signal abnormality within the head of the fifth metatarsal on fluid sensitive sequences without corresponding decreased T1 signal abnormality likely reflecting reactive osteitis. There is fluid within the fifth MTP joint which may represent a very mild synovitis. No encapsulated fluid collection is identified to suggest abscess formation. There is increased signal abnormality within the base of the fourth metatarsal which likely represents degenerative change and subchondral cyst formation. There is increased signal abnormality within the distal phalanx of the great toe without corresponding decreased T1 signal abnormality, likely representing reactive osteitis or degenerative change. There is nonspecific subcutaneous edema about the imaged portions of the midfoot/forefoot most pronounced along the dorsal aspect of the tarsals and metatarsals. There is fluid within the first MTP joint which may represent a mild synovitis.

Output: Findings indicating osteomyelitis of the proximal phalanx of the fifth toe of the left foot and other findings as described above. No drainable abscess is identified.


Instruction: Generate impression based on medical findings.

Input: Male, 5 years old. Perianal abscess, possible fistula. Drainage, pain. There is a 1.1 x 0.9 x 1.0 cm enhancing collection along the right perianal skin/subcutaneous tissue, compatible with a given history of abscess. A T2 hyperintense and enhancing tract extends to this collection from the anus, compatible with a fistula. Mild surrounding subcutaneous edema. No other fluid collections or fistulae are identified. The imaged intrapelvic contents and osseous structures are grossly unremarkable.

Output: A 1 cm right perianal abscess with associated fistula to the anus.


Instruction: Generate impression based on medical findings.

Input: The thin bilateral convexity subdural hygromas that were noted on the previous outside MRI study are resolved. There is no abnormal signal or enhancement. No evidence of bleed, mass effect, or edema. There is mild prominence of the ventricles and sulci with mild global volume loss, more than the expected for age. No midline shift. There is normal gray-white matter differentiation. The basal cisterns are patent. Normal flow voids of the vessels.

Output: Mild global volume loss greater than expected for the patient's age. Otherwise, the study is unremarkable. The subdural hygromas that were noted in the previous outside MRI study are resolved.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male patient post TACE/RFA. Evaluate for new or recurrent HCC. Reevaluate faint enhancement noted adjacent to segment 7/8 cavity on prior MRI. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is a segment 5 lesion cavity measuring approximately 3.9 x 3.2 cm (image 52, series 11). There is no evidence of marginal recurrent or residual disease.The 7/8 ablation cavity measures approximately 3.1 x 2.2 cm (image 71, series 11). Again seen is faint nodular enhancement along the anterior superior aspect of the ablation cavity, appearing similar to the 5/26/2016 study and similar in location to a lesion on a pretreatment scan. There is an additional faint focus of enhancement more posteriorly. Neither of these foci show washout on more delayed imaging. No new suspicious arterial enhancing lesion is identified. Mild diffuse interstitial T2 signal abnormality may reflect mild hepatic fibrosis. The patient is status post cholecystectomy. No intrahepatic biliary ductal dilatation.SPLEEN: The spleen measures 14 cm in length without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postablation changes of segment 5 without specific evidence of marginal recurrent or residual disease.2.Redemonstration of faint nodular enhancement (more anteriorly located focus in particular is at site of preexisting neoplastic lesion when compared to pretreatment imaging) along the segment 7/8 ablation cavity, no washout seen on more delayed imaging. Continued follow up is recommended.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with gallbladder lesion invading into the liver. History of hepatitis C. ABDOMEN:LUNG BASES: Small hiatal hernia.LIVER, BILIARY TRACT: Mild gallbladder wall thickening and enhancement with nodular appearance at the fundus (e.g. series 102/56), decreased when compared to prior CT. Few small gallstones. No biliary ductal dilation. No focal hepatic lesions. SPLEEN: Previously seen hypoattenuating lesion in the spleen demonstrates dark T2 signal with delayed enhancement, most suggestive of sclerosing angiomatoid nodular transformation (SANT) lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Previously seen nonspecific prominent portacaval lymph node has decreased in size and appears within normal limits.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild gallbladder wall thickening with nodular appearance at the fundus has decreased when compared to prior CT with no focal liver lesions seen on the current MRI. Overall, the findings favor chronic cholecystitis with reactive changes in the adjacent liver on prior CT. Follow-up imaging with ultrasound can be obtained as clinically indicated to ensure resolution.


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain ROTATOR CUFF: There is extensive cyst formation adjacent to and within the supraspinatus muscle with extension of these cysts into the suprascapular notch. The fibers of the supraspinatus tendon can be traced to its insertion upon the greater tuberosity although there is diffuse thickening of the tendon likely representing chronic attritional tearing. A more focal full-thickness defect of the supraspinatus tendon is noted at the apex of the humeral head. There is moderate to severe fatty atrophy of the remaining supraspinatus muscle.There is moderate to severe fatty atrophy of the infraspinatus muscle although the tendon itself can be traced to its insertion on the greater tuberosity. The atrophy of the muscle may be secondary to compression of the nerve within the suprascapular notch. The teres minor tendon and muscle are intact. There is mild tendinosis and minimal fatty atrophy of the subscapularis tendon and muscle respectively.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. The humeral head is high riding and there is a small amount of fluid/inflammation within the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe osteoarthritis of the glenohumeral joint with bone-on-bone apposition and extensive subchondral cystic changes. There is diffuse degenerative tearing of the labrum. There is a small joint effusion present, possibly with a component of mild synovitis, and multiple loose bodies are noted within the axillary and subscapular recesses.BICEPS TENDON: The biceps tendon appears slightly attenuated but is otherwise intact.

Output: 1. Severe osteoarthritis of the glenohumeral joint with multiple loose bodies.2. Cystic replacement of the supraspinatus muscle with extension of these cysts into the suprascapular notch. This likely results in impingement upon the nerves supplying the infraspinatus and supraspinatus muscles leading to fatty atrophy. There is also thinning of the supraspinatus tendon likely reflecting chronic attritional tearing with what appears to be a more focal full-thickness defect at the apex of the humeral head.3. Additional findings further detailed above.


Instruction: Generate impression based on medical findings.

Input: Meningioma, 6 month follow up for changes. There is an extra-axial enhancing left lateral skull base mass centered along the left petrous apex with extension into the cavernous sinus left prepontine cistern and along the left tentorial leaflet. There is associated hyperostosis and permeation of tumor into the underlying bone. The mass also protrudes in the sella, traverses the left lateral wall of the sphenoid sinuses, and extends into the left optic canal. Overall, the mass measures up to approximately 7 cm. Although the mass has not significantly changed since 2014, it appears to have increased slightly in size since 2013. There is mass effect and a patchy area of high T2 signal in the inferior left temporal lobe, which is compatible with vasogenic edema. There is encasement of the left cavernous carotid artery with diffuse narrowing of the flow void. The ventricles are normal in size and configuration. There is no significant midline shift. There is staphylomatous deformity of the bilateral globes. There is mild high T2 signal within the left mastoid air cells suggestive of fluid or mucosal thickening. There appears to be filler material within the bilateral nasolabial folds.

Output: An extra-axial enhancing left lateral skull base mass centered along the left petrous apex with extension into the cavernous sinus left prepontine cistern and along the left tentorial leaflet with associated hyperostosis and permeation of tumor into the underlying skull, as well as encasement of the left cavernous carotid artery, and vasogenic edema in the left temporal lobe is compatible with a meningioma. Although the mass has not significantly changed since 2014, it appears to have increased slightly in size since 2013.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with metastatic small cell lung carcinoma status post radiation therapy. Neck mass. Headache. There is a 1.7 x 1.5 cm ring enhancing mass within the right high parietal convexity, with surrounding hypodensity consistent with a metastatic lesion with surrounding vasogenic edema. There are also questionable punctate enhancing lesions within the left frontal lobe and the left high parietal convexity. Brain MRI with contrast is recommended for more sensitive evaluation of these lesions. No midline shift or intra-cranial hemorrhage is seen. 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.The neck demonstrates a 2.8 x 2.7 x 3.1 cm enhancing mass within the right neck, with mass effect and compression of the right internal jugular vein. This likely represents a deep cervical nodal metastasis. In addition, there are multiple sclerotic lesions within the C3, T1, T3, T5, and T6 vertebral bodies, as well as the right posterior elements of C5. Within the visualized lung, there is bilateral pleural thickening and left-sided fibrosis and focal calcification. Please refer to dedicated chest CT for further discussion.

Output: Multiple intracranial, osseous, and deep cervical metastatic lesions as described above. Brain MRI with contrast is recommended for more sensitive characterization of intracranial lesions.


Instruction: Generate impression based on medical findings.

Input: Left-sided paresthesias, word finding difficulties, concern for MS, previous MRI due to left-sided paresthesia for weeks with T2 FLAIR hyperintensities. No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. Scattered T2/FLAIR hyperintense foci are seen in the periventricular and subcortical white matter, unchanged from the prior study. No enhancement is seen associated with these lesions. No lesions are seen within the posterior fossa. No new lesions are identified. No abnormal areas of enhancement are seen. The CSF spaces are appropriate for the patient's stated age with no midline shift. Prominent perivascular spaces are seen in the right inferior basal ganglia. Normal vascular flow voids are present in the major intracranial vasculature.The imaged portions of the paranasal sinuses are clear. The imaged portions of the mastoid air cells are clear. The imaged portions of the orbits are intact.

Output: Nonspecific T2/FLAIR hyperintense foci are unchanged. Differential diagnosis most likely includes demyelinating disease, migraine sequela, diffuse axonal injury, and small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 16-year-old male with history of shoulder dislocation, evaluate for labral tear ROTATOR CUFF: Mild increased signal at the distal supraspinatus tendon consistent with tendinosis with more pronounced changes in the subscapularis with intact fibers extending throughout to the attachment. No evidence of discrete tear with retraction. Muscles appear normal without atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Large labral tear inferiorly with associated mild detachment along the inferior margin and associated large cartilage defect measuring greater than 1 cm in the longer dimension extending towards the anterior labrum. The defect extends approximately from a 3 o'clock position to beyond 6 o'clock. The largest fragment is not entirely free and dependant, suggesting that the fragment remains partially attached along the inferior aspect (image 16 series 5). BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild distal supraspinatus tendinosis. No discrete labral tear.


Instruction: Generate impression based on medical findings.

Input: Anaplastic oligodendroglioma, WHO grade III, status post treatment. There are postoperative findings related to left craniotomy with a resection cavity in the left frontal and temporal lobes and a persistent overlying extra-axial fluid collection. There is intrinsic T1 hyperintensity and susceptibility effect along the posterior margins of the surgical cavity, without definite nodular enhancement. There is unchanged confluent T2 hyperintensity in the surrounding brain parenchyma. There is no evidence of acute infarct. The ventricular system appears unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Post-treatment findings in the left the left frontal and temporal lobes without evidence interval tumor progression.


Instruction: Generate impression based on medical findings.

Input: Patient with right knee pain, evaluate osteochondrosis dissecans lesion. Per chart review, Patient had a repair in 2010 and had a recent injury. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: Again seen is a large osteochondral defect in the posterior aspect of the medial femoral condyle. The previously seen fragment within this defect has dislodged and now lies along the posterior rim of the medial tibial plateau. The fragment is just under 2 cm in its greatest dimension. There is cyst formation and edema within the marrow deep to the medial femoral condyle defect, which appears similar to that seen on the prior study. There is new edema within the marrow of the posterior aspect of the medial tibial condyle subjacent to the displaced osteochondral fragment.Also again seen is cyst formation within the anterior aspect of the medial femoral condyle with heterogeneity of the overlying cartilage that appears similar to that seen on the prior study, likely representing an additional osteochondral defect that we suspect is stable. There is also focal degeneration of the anterior aspect of the lateral femoral condyle with small cysts in the underlying marrow, unchanged from the prior study. Small tricompartmental osteophytes are noted.LIGAMENTS: Anterior cruciate ligament appears intact. The posterior cruciate ligament appears intact. The medial collateral ligament appears intact. The lateral collateral ligament appears intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Large osteochondral defect along the posterior aspect of the medial femoral condyle with displacement of the osteochondral fragment posterior to the medial tibial plateau and edema in the underlying posterior tibia. Additional loose bodies are noted both anteriorly and posteriorly within the joint.2.Osteochondral lesion along the anterior aspect of the distal femur appears similar as that seen on the prior study.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with metastatic colon CA with lesion in T11. Urinary incontinence, RLE pain/weakness. Please evaluate for cord compression. Limited imaging of the cervical, thoracic, and lumbar spine shows preserved vertebral body heights, alignment, and disc spaces. There is no evidence of severe central canal stenosis or spinal cord signal abnormality. Schmorl's node deformity is seen at the inferior endplate of T11. The T11 vertebral body marrow is otherwise unremarkable. Fatty changes along the superior endplate of T12 are additionally noted.

Output: Limited imaging of the cervical, thoracic, and lumbar spine shows no evidence of acute spinal cord compression.


Instruction: Generate impression based on medical findings.

Input: Examination is limited by lack of intravenous contrast. Redemonstrated is diffuse destruction and replacement of the L1-2 disc space with T2 hyperintense signal with destruction of the adjacent endplates and significant collapse of the L1 greater than L2 vertebral body. There is no significant change in residual abnormal T2/STIR hyperintensity involving the bone marrow and intervertebral disc. The degree of moderate retropulsion appears similar at the L1 level with unchanged moderate spinal canal stenosis and bilateral L1-L2 foraminal stenosis. No other worrisome marrow signal is appreciated. There is persistent but decrease in diffuse edema, with poor definition of the bilateral psoas muscles, the right greater than left iliacus muscles, as well as the paravertebral muscles, which may represent a component of atrophy/degeneration superimposed upon edema. There are areas of T1 and T2 hypointensity involving the right greater than left psoas musculature which are again seen and not significantly changed compared to 4/1/2015; these correspond to sites of previously seen abscesses and may represent areas of cavitation/necrosis or possibly minimal residual fluid collections with low T2 signal. The lumbar spine is otherwise in stable alignment. The vertebral body and disc heights are otherwise unchanged. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The previously described degenerative changes appear similar. Again noted is prominence of the epidural fat including focal epidural fat along the right lateral aspect of the thecal sac at the L3-4 level. Partially imaged are bilateral renal atrophy with innumerable microcysts. There is clumped appearance of the cauda equina nerve roots suggestive of arachnoiditis and more prominent than prior.

Output: 1. Lack of contrast again limits evaluation. Compared to 5/6/2015, there is no significant change in residual signal abnormalities related to L1-L2 discitis-osteomyelitis and associated compression fractures of the L1 greater than L2 vertebral bodies. No significant change in osseous retropulsion at L1 with associated moderate spinal canal stenosis as well as moderate to severe bilateral L1-L2 neural foraminal stenosis. 2. Mild interval decrease in edema involving the bilateral psoas musculature. Otherwise signal abnormality involving the iliopsoas and paraspinous musculature is not significantly changed and compatible with edema and possible superimposed atrophy/degeneration. Focal areas of low T1 and T2 signal involving the bilateral psoas musculature corresponding to sites of previously seen abscesses may represent areas of cavitation/necrosis or possibly minimal residual fluid collections with low T2 signal. No new or enlarging fluid collections or worsening marrow or disc signal abnormalities to suggest progression of infection. 3. Clumping of the cauda equina nerve roots, which appears more prominent than prior, and consistent with arachnoiditis.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: 56 yo F hx of cystic pancreatic lesion s/p distal pancreatectomy in 8/2013,EUS 5/2015 showed residual pancreas with chronic pancreatitis changes and a cystic lesion in uncinate process. 1 year f/u MRI to assess for growth, also eval for chronic pancreatic History: cystic lesion of pancreas, chronic pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.Status post cholecystectomy. Intrahepatic bile ducts and common bile duct are normal in caliber.SPLEEN: Status post colectomy. Probable residual splenic tissue adjacent to the left kidneyPANCREAS: Status post resection of the pancreatic tail. There is a subcentimeter cystic focus in the head of the pancreas measuring 9 mm that appears to communicate with the pancreatic duct and represents a small branch type IPMN.There is mild fatty atrophy of the pancreas.There is mild ductal irregularity of the pancreatic duct in the head of the pancreas in the region of calcifications previously noted.Upon administration of secretin, response is mildly blunted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: In the left kidney, there is a 9 mm partially exophytic lesion as seen on image 25/series 7. The lesion has questionable subtle enhancement. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post pancreatic tail resection and splenectomy. Small cystic lesion (9mm) in the pancreatic head with imaging features suggestive of a IPMN. Allowing for differences in modality the lesion is not significantly changed.2.Slightly blunted response to secretin in the setting of mild pancreatic atrophy.3.Cystic lesion in the left kidney has slightly suspicious features. The lesion is too small to fully characterize and a follow-up imaging study in 12 months can be performed.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with biopsy-proven right breast cancer, suspected second lesion on MRI and right breast non-mass enhancement. Second look ultrasound for further evaluation. Targeted ultrasound of the left lower inner breast demonstrates two adjacent hypoechoic masses with microcalcifications. These masses are 1 cm apart. The more lateral and inferior of these masses (right breast 4:00 7 cm from the nipple) measures 1.0 x 0.8 x 1.2 cm and contains a biopsy clip and is consistent with the biopsy-proven malignancy. The more superior and medial of these masses (right breast 4:00 position 6 cm from the nipple) measures 1.1 x 0.8 x 1.0 cm and correlates with the additional lesion seen on MRI. Multiple cysts are present in the right inferior breast as well, but there is no definite pathologic sonographic correlate for the non-mass enhancement seen on MRI.

Output: 1. Two adjacent masses in the lower inner right breast as described above, one correlating with the patient's biopsy-proven malignancy, the other correlating with the finding on recent MRI examination. This second mass is amenable to ultrasound-guided biopsy as warranted clinically.2. No definite sonographic correlate for the additional right breast non-mass enhancement seen on MRI. If breast conservation therapy is desired, MRI biopsy is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Reason: intracranial stenosis History: right face and left arm weakness MRI of the brainThere are five to eight 2-8 mm size foci of diffusion restriction are present along the right precentral and postcentral gyri. There are a couple 2mm sized foci of diffusion restriction along the right precuneus and cuneus.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional similar appearing lesions present in the brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.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 approximately 40% narrowing of the mid basilar artery.There is mild narrowing at the origins of the superior and inferior divisions of the right middle cerebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is small The posterior communicating arteries are not readily visualized. The left vertebral artery is very small.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is high-grade stenosis present the origin of the left vertebral artery. Left vertebral artery is small compared to the right vertebral artery throughout its cervical course.

Output: 1.Small foci of acute infarction are present in the right parietal lobe, right pre-and postcentral gyri and right occipital lobe. The vascular distributions include right posterior cerebral artery territory and the right middle cerebral and territory. The posterior communicating arteries are tiny.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Punctate lesions in the pons and midbrain are most likely vascular related.4.There is mild narrowing at the origins of the superior and inferior divisions of the right middle cerebral artery.


Instruction: Generate impression based on medical findings.

Input: Reason: meniscus injury History: pain and swelling MENISCI: There is a complex tear of the posterior horn of the medial meniscus including a large horizontal and longitudinal component which extends to both the tibial and femoral articular surfaces. The lateral meniscus appears intactARTICULAR CARTILAGE AND BONE: There is blistering of the articular cartilage along the medial facet of the patella. There is relative sparing of the articular cartilage along the medial and lateral tibiofemoral compartments. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the medial meniscus with both longitudinal and horizontal components.2. Moderate-sized joint effusion and Baker's cyst. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 41 year old female with right shoulder pain. Evaluate for labral tear. Evaluation is slightly limited due to the inability to properly position the patient.ROTATOR CUFF: There is mild increased signal intensity of the supraspinatus and infraspinatus tendons, suggesting mild tendinosis. Additionally, gadolinium appears to undercut the articular surface fibers of the rotator cuff at its insertion, in particular, the posterior fibers of the supraspinatus and anterior fibers of the infraspinatus. This may represent partial thickness stripping of the articular surface fibers from the bone, however, there is no full-thickness rotator cuff tear. There is perhaps mild undersurface fraying of the subscapularis tendon. We see no evidence to suggest a full-thickness tear.SUPRASPINATUS OUTLET: There is perhaps a trace amount of fluid within the subacromial subdeltoid bursa, but we see no evidence of frank bursitis. Intra-articular gadolinium does not enter the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint with thinning of the articular cartilage of the glenoid, particularly along its anterior and superior aspect with a full-thickness articular cartilage cleft identified. Gadolinium enters the superior labrum, indicating a SLAP tear, which does not definitively extend to involve the tendon of the long head of the biceps. The anterior superior labrum appears at least partially detached from the glenoid which may represent extension of the labral tear. There is fraying of the anterior inferior glenoid labrum.BICEPS TENDON: There is a small focus of low signal intensity within the tendon sheath which may represent a loose body, but the tendon of the long head of the biceps is otherwise normal.

Output: 1. SLAP tear as described above with additional tearing/fraying of the anterior glenoid labrum.2. Moderate osteoarthritis affects the glenohumeral joint.3. Probable stripping of the undersurface fibers of the supraspinatus and infraspinatus tendons from the greater tuberosity but no full-thickness rotator cuff tear is evident.4. Loose body in biceps tendon sheath.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma with known brain metastasis treated with stereotactic RT. There is interval decrease in size of the left occipital lobe lesion, which now measures up to 10 mm, previously 19 mm. The lesion now contains intrinsic T1 hyperintensity and susceptibility effect, compatible with subacute blood products. There is no significant residual surrounding vasogenic edema or evidence of new intracranial tumors. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval decrease in size of the left occipital lobe metastasis containing subacute blood products, as well as interval resolution of the associated vasogenic edema.


Instruction: Generate impression based on medical findings.

Input: 45 years, Female, trigeminal neuralgia, rule out brainstem lesion. Brain parenchyma appears within normal limits. Specifically no lesions within the brainstem are appreciated. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is moderate mucosal thickening involving the left sphenoid sinus. Bone marrow signal and extracranial soft tissues are within normal limits. Noted is an enhancing, likely small venous structure, coursing along the superior aspect of the cisternal segment of the right trigeminal nerve as well as along the medial aspect of the trigeminal nerve as it enters the Meckel's cave.

Output: 1. No brain parenchymal signal abnormalities or intracranial mass.2. There is an enhancing, likely small venous structure, coursing along the superior aspect of the cisternal segment of the right trigeminal nerve as well as along the medial aspect of the right trigeminal nerve as it enters the Meckel's cave. Finding is of uncertain significance and can be correlated with symptomatology (per EMR, patient's symptoms are left sided). Also note examination was performed per routine brain MRI protocol and additional high-resolution sequences of the trigeminal nerve including its extracranial course can be obtained if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with recently diagnosed right breast cancer (IDC with DCIS), staging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is a 10 x 8 x 11 mm (AP X ML X CC) area of non mass enhancement at the 3:00 position, middle depth, consistent with biopsy-proven breast cancer. There are postprocedural findings related to recent biopsy, including associated clip artifact and biopsy tract. The mass resides approximately 4 mm from the skin. There is an additional focus of enhancement located 14 mm posterolateral to the mass. The total extent of the non mass enhancement, and additional enhancing focus is approximately 2.6 cm.LEFT BREAST:No abnormal enhancement is seen in the left breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region.

Output: Biopsy tract and 11 mm non-mass enhancement consistent with biopsy-proven breast cancer at the 3:00 position of the right breast. Additional enhancing focus approximately 14 mm posterolateral to the index cancer is noted. If breast conservation therapy is planned, generous excision posterior and lateral to the mass is suggested; otherwise, MR guided biopsy can be considered for definitive diagnosis.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: There are multiple segmentation anomalies throughout the cervical spine including butterfly and hemivertebrae as well as multiple vertebrae that are shortened in the AP dimension but are only partially imaged on the counting scout view. There is also 4 level segmentation anomaly involving the mid thoracic spine with 2 hemivertebra. There is a mild apex rightward curvature centered at the cervicothoracic junction and there appear to be 12 ribs bilaterally. Please note that the presence of multiple segmentation anomalies makes accurate level counting difficult and close attention on follow-up imaging and any future potential procedures is recommended. There is a single midline pelvic kidney. There are postoperative findings related to prior cord untethering. When counting from below, the conus terminates at the inferior L2 level. The filum measures 3 mm in thickness and demonstrates T1 hyperintensity extending from L3 through L4 (again when counting from below). There is anterior translation of the conus upon prone positioning. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: 1.Multiple partially imaged cervical as well as mid thoracic segmentation anomalies without associated cord abnormality. Please note these anomalies limit accurate level counting.2.Postoperative findings related to prior cord untethering. There is filar thickening and fibrofatty infiltration but anterior translation of the conus upon prone imaging. The conus terminates at the inferior L2 level when counting from below.3.Single pelvic kidney.


Instruction: Generate impression based on medical findings.

Input: 83-year-old male patient with grade III oligodendroglioma status post resection, RT, and TMZ. There are stable post-operative changes of a right anterior temporal lobectomy with unchanged T2 signal abnormality surrounding the resection site extending to the right basal ganglia. There is no abnormal enhancement surrounding the right temporal resection cavity. Two new small foci of enhancement within the left paramedian cerebellar hemisphere which demonstrate correlating T2 hyperintensity. No other new or pathologic intracranial enhancement is seen. There is no restricted diffusion. Encephalomalacia involving the left anterior frontal lobe, and to a lesser degree the right inferior frontal lobe, appears similar to the prior study. Scattered periventricular and subcortical abnormal T2 signal may represent chronic small vessel ischemic disease and/or post-treatment related white matter changes. A focus of susceptibility within the left frontal lobe white matter is unchanged. The ventricles are unchanged in size. There is no midline shift or herniation. The major cerebral flow voids are intact. There are scattered tiny maxillary sinus mucous retention cysts.

Output: 1. Stable post-operative changes of a right anterior temporal lobectomy without definite evidence of tumor recurrence.2. Two new foci of enhancement within the left paramedian cerebellar hemisphere are non-specific and could potentially be vascular/ischemic in nature; attention on close follow up imaging is suggested.3. Stable periventricular and subcortical T2 signal abnormality which may represent chronic small vessel ischemic disease and/or post-treatment related white matter changes.4. Areas of frontal lobe encephalomalacia appearing similar to the prior study.


Instruction: Generate impression based on medical findings.

Input: Reason: bilateral shoulder pain History: bilateral shoulder pain ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus tendon near its in insertion on the greater trochanter, which is consistent with tendinopathy and appears unchanged from prior. There is no evidence of tearing. The infraspinatus, subscapularis and teres minor muscles and tendons are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears grossly intact and the glenohumeral joint is within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Supraspinatus tendinopathy, not significantly changed from the prior exam.2. Acromioclavicular joint osteoarthritis.


Instruction: Generate impression based on medical findings.

Input: 33 year old female with genetic cardiomyopathy s/p transplant 10/24/16 admitted for concern for acute rejection. Patient referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 100 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 77 g/m2 (normal range 67+/-11), and the LV mass is 115 g (normal range 114+/-24). There is mild concentric left ventricular hypertrophy (~12-13 mm myocardial thickness at the mid wall). 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. The pre-contrast native myocardial T1 relaxation time (of the septal and lateral wall) is mildly elevated (~1100 ms). The T2-STIR edema ratio is elevated (2.14, normal <2) and the extracellular volume fraction is normal (19%, normal <30%). The global relative enhancement ratio is within normal limits (<4). Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 130 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 65 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant.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 suboptimally assessed, but there is no gross 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 FindingsSternal wires present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 60%).2. The right ventricle is normal in size and systolic function (RVEF 50%). 3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. The pre-contrast native myocardial T1 relaxation time (of the septal and lateral wall) is mildly elevated (~1100 ms). The T2-STIR edema ratio is elevated (2.14, normal <2) and the extracellular volume fraction is normal (19%, normal <30%). The global relative enhancement ratio is within normal limits (<4).


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with lymphoma and persistent altered mental status. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse, mild, confluent, thin, high T2 signal along the bilateral ventricles, with a more focal area of increased T2 signal along the posterior horn of the left lateral ventricle. There is also a focus of increased T2 signal in the left cerebral hemisphere, which measures up to 8 mm. There is a right choroid fissure cyst. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are innumerable enhancing lesions distributed throughout the calvarium, which correspond to lytic lesion seen on the prior CT examination. There is high T2 signal in the bilateral mastoid air cells, suggestive of effusions. The orbits and scalp soft tissues are grossly unremarkable.

Output: 1. Innumerable enhancing lesions throughout the skull are consistent with lymphoma.2. Small lesions in the left cerebellar hemisphere and left periventricular white matter are nonspecific, but may represent sequelae of treated central nervous system lymphoma, prior infection, or chronic ischemia.3. No evidence of intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on medical findings.

Input: Reason: Cognitive decline following cardiac surgery History: memory impairment and visuospatial difficulty. There is mild prominence of the ventricles as well as sulcal prominence predominantly involving the perirolandic areas and parietal lobes with relative sparing of the occipital and temporal lobes. The basal cisterns remain patent. There is no midline shift or mass effect. There are several punctate foci of increased T2/FLAIR signal within the subcortical and periventricular white matter which are nonspecific but compatible with minimal chronic small vessel ischemic changes. 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. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is trace mucosal thickening within the paranasal sinuses. The mastoid air cells are clear.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Mild brain atrophy localized to the perirolandic regions and parietal lobes with sparing of the remainder of the brain parenchyma which is nonspecific, however, corticobasal degeneration has been reported to present in a similar fashion.3.Minimal chronic small vessel ischemic changes.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is mild dilatation of the central canal within the thoracic spinal cord spanning from approximately mid T6 through the superior aspect of T9, not significantly changed from prior exam. The tiny syrinx measures up to 2 mm in the axial dimension. The thoracic spine is in normal alignment. The vertebral body heights are well-maintained. There is mild to moderate loss of disc height throughout the thoracic spine. There are unchanged scattered T1 hyperintense foci in the thoracic spine, which likely represent focal fatty replacement and/or fat-containing hemangiomas. Small Schmorl's nodes are seen involving the inferior endplates of T9 and T10. Minimal disc bulge at T10-T11 and T11-T12 with mild degenerative changes are unchanged. There is no significant spinal canal or foraminal stenosis within the thoracic spine. The thoracic spinal cord is otherwise within normal limits.

Output: 1. Compared to 1/30/2010, no significant interval change in mild dilatation of the central canal/small syrinx within the thoracic spinal cord.2. Mild degenerative changes of the thoracic spine without significant spinal canal or foraminal stenosis at any level.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: 44 year old female with stroke. Non-infused CT of brain.A focal area of lucency in the white matter of left frontal lobe extends from the level of floor of the anterior cranial fossa superiorly to the high convexity. This produces no definitive evidence of mass effect and is believed to represent an area of encephalomalacia. No definitive evidence of any cortical component is detected. There are no old films available for comparison. The size and distribution of this lesion is unusual for a subcortical stroke. Further evaluation with an MRI is recommended. CT examination of brain is otherwise unremarkable.CTA of the neck.There is good visualization of bilateral common carotid arteries, carotid bifurcations and bilateral internal carotid arteries in the cervical region. No evidence of any stenosis at any of these locations is detected.A dominant right vertebral artery and slightly smaller left vertebral artery is demonstrated and appear normal throughout their course and across the skull base. No pathology is Limited images of the aortic arch and the origins of the great vessels as well as the right brachia cephalic and bilateral subclavian arteries are unremarkable. The basilar artery and its branches are also visualized on reformatted coronal images and are within normal limits. Both supraclinoid internal carotid arteries and bilateral anterior cerebral arteries and middle cerebral arteries are also demonstrate no areas of a stenotic lesion.

Output: 1.Focal area of subcortical left frontal lucency as detailed double. Further evaluation with an MRI is recommended.2.Essentially unremarkable CTA examination of the cervical region and intracranially.3.4.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male complaining of syncopal episode. Patient has history of CVA. Foci of hypoattenuation in the left cerebellar hemisphere compatible with known infarcts seen on MRI. Periventricular hypoattenuating foci are consistent with minimal ischemic small vessel disease, age indeterminate.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: ? meniscal injury History: Knee pain. MENISCI: Complex tear of the posterior horn of the medial meniscus. This consists of a large radial component involving the inner two thirds of the meniscus. Lateral to this the root of the posterior horn appears unusually large which likely represents displaced adherent meniscal tissue. Additional signal is noted more medially within the posterior horn. The anterior horn and body of the medial meniscus is relatively preserved. There is slight medial extrusion of the body. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the weight-bearing portion the medial femoral condyle with possible full-thickness degeneration along the medial tibial plateau. Mild subchondral edema type signal within the far medial aspect of the medial femoral condyle is likely degenerative in etiology. The articular cartilage of the lateral compartment is relatively preserved. There is a subcentimeter full-thickness defect of the articular cartilage of the medial facet of the femoral trochlea. A subcentimeter linear focus of intermediate signal intensity that appears to arise from the superior aspect of the trochlear cartilage may represent a displaced trochlear cartilage flap.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Cartilage defect/degeneration as described above.3. Moderate size joint effusion and small Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: 77 years, Male, evaluate meningioma, history of resection, postop 3 months.. Again seen are postoperative changes of right frontotemporal craniotomy for meningioma resection. Compared to 11/18/2015, evolution of postsurgical changes are seen including evolution of blood products within the right basal ganglia, right inferior frontal lobe, and along the right frontotemporal craniotomy. There has been development of volume loss involving the right frontal periventricular white matter and right basal ganglia with ex vacuo dilatation of the right lateral ventricle. There is enhancement surrounding the residual hematoma at the level of the right caudate head which can be expected. FLAIR hyperintensity related to gliosis extends to the surface of the right frontal lobe. Again seen is residual extra-axial tumor along the anterior medial aspect of the right middle cranial fossa and extending into the right cavernous sinus. Medial extension along the planum sphenoidale and crossing the midline is also noted. Residual mass measures approximately 3.6 x 3.2 x 2.6 cm, series 11 image 62 and series 1101 image 119. Compared to prior there is no evidence of tumor progression. Scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter are compatible with mild chronic small vessel ischemic disease. No new mass or mass effect. No midline shift or herniation. No hydrocephalus. The mass is again noted to circumferentially involve the right cavernous and supraclinoid internal carotid artery segments and is also intimately associated with the M1 segment of the right middle cerebral artery.

Output: Evolution of postsurgical changes related to subtotal resection of meningioma as described above. Residual tumor which involves the right middle cranial fossa, extends into the right cavernous sinus, and along the planum sphenoidale is not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Metastatic head and neck caner with suspicious lesion on head CT. There are at least six bilateral cerebral hemisphere nodular and ring-enhancing lesions with minimal to mild vasogenic edema. For example, the largest measures up to 9 mm in the left middle frontal gyrus, which appears to be smaller and associated with diminished edema compared to the prior CT, accounting for difference in technique. There is also a punctate enhancing lesion in the left cerebellar hemisphere. In addition, there are multiple enhancing lesions within the skull, the largest of which measures up to 25 mm in the occipital bone with minimal associated enhancement of the overlying subgaleal tissues, but no evidence of epidural extension. There is no evidence of acute intracranial hemorrhage or cerebral infarction. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is minimal fluid within the left mastoid air cells. The orbits are unremarkable.

Output: 1. Several subcentimeter supratentorial and infratentorial subcentimeter lesions are compatible with metastases.2. Multiple skull lesions are also compatible with metastases.


Instruction: Generate impression based on medical findings.

Input: Spina bifida without mention of hydrocephalus, lumbar region Other specified congenital anomaly of spinal cord Backache, unspecifiedClinical question: history of Lipomyelomeningocele, tethered cord release , pt with new back pain, eval for retethereing,Signs and Symptoms: abnormal neurological exam(gait, pain) eval for changes MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is redemonstration of a lipomyelomeningocele with tethering of the cord. The lipoma extends from L3 to L5. The cord joins the lipoma at L3. From supine to prone there is forward movement of the spinal cord above the level of the lipoma. Since the prior exam there appears to be more fat accumulation within the intrathecal portion of the lipoma. The AP dimension of the lipoma is 22mm on the current and 17 mm on the prior exam. A cystic lesion along the right posterior aspect of the spinal canal at the L3 and L4 vertebral levels has rearranged relative to this fat accumulation. There is accumulation of significantly more subcutaneous fat since the prior exam. Interestingly at L4-5 a previously present Schmorl's node is smaller on the current exam and the disk space height has increased by a couple millimeters. The lumbar lordosis on the other hand is exaggerated relative to the prior exam. There is spina bifida present.The patient is status post lumbar spine surgery. At L5-S1 there is no significant compromise to spinal canal or neural foramina. The distorted configuration of the thecal sac is unchanged and the intrathecal nerve roots are displaced peripherally in similar positions as on the prior exam. 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: 1.Since the prior exam from 2010, there has been fatty accumulation within the spinal canal at the L3 and L4 levels but otherwise no change in the lipomyelomeningocele. Movement of the cord from supine to prone is unchanged.


Instruction: Generate impression based on medical findings.

Input: Left upper extremity numbness and weakness. There are postoperative findings related to right transfrontal biopsy of the medullary and upper cervical spinal cord lesion, which has decreased in size and demonstrated considerably less enhancement. There is high T2 signal and enhancement along the biopsy tract in the right frontal lobe, but no additional lesions within the brain, There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The paranasal sinuses and orbits are unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Interval decrease in size and enhancement of the medulla and upper cervical spine cord lesion.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female who had abdominal wound breakdown 4 months ago. Presenting with increasing pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right renal stone, unchanged from previous study. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described metallic density is unchanged and is located in the hepatic flexure. This likely represents a metallic structure impacted in colon. Correlation with history of previous capsule study history is recommended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Postsurgical changes at result. Status post hysterectomy and oophorectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes in the anterior pelvic wall has almost completely resolved. Small amount of fat stranding persists.There is some residual soft tissue density in the lower pelvic anterior abdominal wall. Pelvic MRI may be helpful for better characterization of this soft tissue density and to rule out endometrioma, if clinically indicated.OTHER: No significant abnormality noted

Output: Interval resolution of postsurgical changes in the pelvis and anterior abdominal wall. There is some residual soft tissue density in the lower pelvic anterior abdominal wall. Pelvic MRI may be helpful for better characterization of this soft tissue density and to rule out endometrioma, if clinically indicated.Persistent metallic linear density in the hepatic flexure. Correlation with previous ingestion of capsule or other metallic structures recommended.


Instruction: Generate impression based on medical findings.

Input: 49 old woman with transient left-sided weakness since morning an ongoing left weakness. There is no evidence of intracranial hemorrhage, mass or edema. No CT findings of acute stroke. However if acute stroke is of clinical concern, recommend MRI.The ventricles and basal cisterns are normal in size and configuration. A partially empty sella, a nonpathologic finding, is noted.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT findings of acute intracranial abnormality. If stroke is a clinical concern recommend MRI.


Instruction: Generate impression based on medical findings.

Input: DDD, HNP: History of low back sprain 10/13/16. There are small central disc protrusions at L4-5 and L5-S1 with loss of disc space height and fluid signal and mild spinal canal, as well as mild neural foraminal stenosis bilaterally at L5-S1. There is no significant spinal canal or neural foramen stenosis at T12 through L4. There are bilateral L5-S1 pars interarticularis defects and approximately 5 mm of L5 upon S1 anterolisthesis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Degenerative spondylosis at L4-5 and L5-S1 with mild spinal canal. 2. Bilateral L5-S1 pars interarticularis defects and approximately 5 mm of L5 upon S1 anterolisthesis, which contributes to bilateral neural foraminal narrowing at this level.


Instruction: Generate impression based on medical findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: Stroke activation 10/18/16 History: Left sided weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Mucosal thickening on bilateral maxillary sinuses with retention cyst on the right maxillary sinus and sphenoid sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

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


Instruction: Generate impression based on medical findings.

Input: Olfactory groove meningioma status post subtotal resection on 2/17/15. Re-evaluation after stage II resection of olfactory groove meningioma on 2/25/15. The patient also experiences diplopia. There are postoperative findings related to recent bifrontal craniotomy with areas of susceptibility along the margins of the resection cavity and diffuse scalp and face swelling. There is nodule enhancement in the posterior aspect of the resection cavity, adjacent to the anterior cerebral arteries, that measures up to 20 mm and is compatible with represent residual tumor. There also appears to be nodular enhancement along the left planum sphenoidale that measures up to 10 mm and may represent residual tumor. Otherwise, there is diffuse linear enhancement along the margins of the resection cavity, which likely represent granulation tissue, as well as diffuse regional reactive dural enhancement. The left optic nerve abuts this dural enhancement proximal to the optic strut. The optic apparatus and orbits otherwise appear intact. There is extensive residual edema in the deformed bilateral frontal lobes. The ventricles are unchanged in size and configuration. There is no evidence of territorial infarction.

Output: Postoperative findings related to olfactory groove meningioma resection with evidence of residual tumor in the posterior aspect of the resection cavity and perhaps along the left planum sphenoidale and extensive residual edema in the bilateral frontal lobes.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with periorbital swelling. Please evaluate for signs of orbital cellulitis. Limited intracranial images show no evidence of intracranial hemorrhage or edema. Ill-defined focus of increased attenuation within the sella seen throughout the noted images may be related to volume averaging. With appropriate clinical history a dedicated pituitary MRI may be considered.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.ORBITS: Mild preseptal and periorbital soft tissue inflammatory changes are noted without evidence of discrete focal fluid collection to suggest abscess. The retro-orbital fat remains intact without evidence of infiltration. Optic nerve sheath complex appears unremarkable.

Output: Preseptal and periorbital mild soft tissue swelling without evidence of retro-orbital extension.


Instruction: Generate impression based on medical findings.

Input: 50 -year-old male with metastatic melanoma with multiple brain metastases and intracranial hemorrhage. There is no significant interval change in the size of the left thalamic hematoma to the 2.8 x 2.1 x 3.7 cm (AP x TR x CC image 14; series 4) from 2.7 x 2.2 x 3.4 cm. The hematoma extends into the midbrain. There is no significant interval change in the amount of vasogenic edema in the surrounding area even allowing for technique differences: Edema and hematoma measure together 4.2 cm in diameter (15; series 4), previously 4.2 centimeters. There is mass effect on the superior cerebellar peduncle as well as the fourth ventricle. Additionally, there is distortion and rightward displacement of the third ventricle which is stable. There is no significant interval change in the previously described slight enlargement of the lateral ventricles bilaterally. The temporal horn of the left lateral ventricle measures 9 mm, previously 9 mm. There is narrowing of the basal cisterns which appears unchanged when compared to the previous study. There is no evidence of frank brain herniation. There is no evidence of extra-axial fluid collection. Multiple mass lesions within the cerebral hemispheres are noted, some of them hyperdense consistent with petechial hemorrhage or mineralization. Findings are consistent with known metastatic lesions and appear grossly stable. The area of dominant left frontal lobe and right cerebellar hypoattenuation also appear grossly similar to the recent brain MRI. No new parenchymal lesions or hematomas are noted. The visualized mastoid air cells and paranasal sinuses are clear. The visualized orbits are unremarkable.

Output: 1. No significant interval change in left thalamic hematoma with extension into the midbrain. No significant interval change in the amount of vasogenic edema in the surrounding area. Stable distortion of the third ventricle and stable enlargement of the lateral ventricles bilaterally without evidence of frank brain herniation. 2. Redemonstration of multiple metastatic intraparenchymal brain lesions better visualized on recent MRI examination. No evidence of new parenchymal lesions or sites of hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Bilateral arm and neck pain (right arm also extremely tender with tingling pain). Also, hyperreflexia in the legs. Clinical suspicion for compressive or demyelinating c-spine disease versus brain process. Brain:There is a moderate burden of scattered/patchy T2 hyperintensity in the frontoparietal white matter. The temporal white matter is very mildly involved. This is not associated with diffusion restriction, or susceptibility effect or abnormal contrast enhancement. There is no involvement of the juxtacortical white-matter or of the corpus callosum, which shows preserved morphology, volume and signal characteristics. The brainstem and cerebellum are also spared. The lesions are not associated with brain volume loss. The CSF-containing spaces are normal in size. There is no mass affect, midline shift or herniation. There is no intracranial hemorrhage. The major intracranial vessels are patent.The orbits are normal. The right maxillary sinus is small and shows osseous wall thickening and minimal mucosal thickening which may reflect chronic sinusitis. The paranasal sinuses and the mastoid air cells are clear.Cervical Spine:Cervical alignment is notable for minimal reversal of the normal lordosis, which may relate to patient position. Vertebral body heights are preserved. Marrow show no suspicious focality, accounting for degenerative change adjacent to the endplates, most pronounced at C6-C7. The cervical spinal canal is diffusely, congenitally small. In addition, degenerative disease at multiple levels contribute to the narrowing which is most pronounced at C5-C6 as described below. There is no abnormal signal is the spinal cord.C2-C3: There is mild canal narrowing by disc-osteophyte complex which is slightly more pronounced on the left. There is moderate right and mild left foraminal narrowing by uncovertebral/facet arthropathy.C3-C4: There is moderate spinal canal narrowing by disc-osteophyte complex. There is mild right and left neural foraminal narrowing by uncovertebral/facet arthropathy. Dorsal annular fissure.C4-C5: There is moderate spinal canal narrowing by disc-osteophyte complex. There is mild-to-moderate left and minimal right neural foraminal narrowing by uncovertebral/facet arthropathy.C5-C6: The disc-osteophyte complex has a central disc protrusion component moderately narrowing the spinal canal and mildly deforming the spinal cord. This is associated with moderate right neural foraminal narrowing caused by uncovertebral and facet arthropathy. The left neural foramen is not narrowed.C6-C7: Disc-osteophyte complex moderately narrows the spinal canal while uncovertebral/facet arthropathy cause moderate right worse than left neural foraminal narrowing.C7-T1: Disc-osteophyte complex cause no significant spinal canal narrowing. There is right worse than left moderate bilateral neural foraminal narrowing by facet/uncovertebral arthropathy.

Output: 1.Moderate patchy cerebral white matter abnormality is nonspecific and most likely related to moderate chronic small vessel ischemic disease. There are no specific features to suggest demyelination.2.Degenerative changes in the cervical spine with moderate spinal canal stenosis at C3-C4, C4-C5, C5-C6 (worst at C5-C6) with mild cord deformity. No cord signal abnormality. In addition, there is variable neural foraminal narrowing (moderate-to-severe). There are no findings to suggest demyelination.


Instruction: Generate impression based on medical findings.

Input: 73 years Male (DOB:6/30/1942)Reason: DDD History: back painPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK TARIQ MUSLIM MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a disc bulge present at this level associated with mild facet and ligamentum flavum hypertrophy.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with superimposed disc extrusion. Extruded disc material extends behind the L4 vertebral body. Extruded material was not present on the prior exam. There is bilateral facet and ligamentum flavum hypertrophy present at this level which is more on the left the right side. There is left lateral disc present at this level which extends into the left neural foramen and mildly encroaches on the left-sided exiting nerve root within the left neural foramen. T2 signal hyperintensity along the left facet joint within the ligamentum flavum is suspected to represent a ligamentum flavum cyst. There is effacement of the fat at the lateral recess at this level bilaterally but more on the left compared to the right side. Overall there is a moderate degree of spinal stenosis present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Since the prior examination the patient is developed a matted disc extrusion at the L4-5 level. There is a moderate degree of spinal stenosis present at L4-5 which appears slightly worse on the current exam compared to the prior exam as detailed above. There is some mild encroachment on the left-sided exiting nerve root at L4-5 due to disc disease.


Instruction: Generate impression based on medical findings.

Input: History of cirrhosis with abnormal ultrasound, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. A TIPS is again noted connecting the right portal vein and hepatic vein. The hepatic arteries and portal venous system are patent. There is a new lesion within segment 7/8 of the liver (series 501, image 413) measuring 2.3 x 2.4 cm which corresponds to that seen on recent ultrasound. The lesion demonstrates increased T1 signal with loss of signal on out of phase images compatible with microscopic fat content. The lesion also demonstrates increased T2 signal. Evaluation of enhancement characteristics is limited by early timing of arterial phase imaging. No additional new suspicious hepatic lesions are identified. No biliary ductal dilatation.SPLEEN: Splenomegaly. The spleen measures 20 cm in craniocaudal dimension, similar to the prior examination. Multiple collateral vessels are seen in the splenic hilum.PANCREAS: Cystic lesions in pancreatic head and uncinate process, compatible with side branch IPMNs. The larger lesion measures 19 x 12 mm (series 1001, image 17), not significantly changed from the 2012 measurement of 19 x 10 mm. The smaller anterior lesion measures 9 x 9 mm (series 1001, image 17), unchanged from 9 x 9 mm previously. No significant pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small simple renal cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: Enlarged para-aortic lymph nodes are not significantly changed.BOWEL, MESENTERY: Esophageal and gastric varices, unchanged. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal pelvic ascites, new from prior.

Output: 1.New 2.4 cm segment 7/8 liver mass with features highly suspicious for HCC. Lesion was also described on 11/4/2015 ultrasound at which time findings were communicated to Dr. G. Reddy.2.Cirrhotic liver morphology with sequela of portal hypertension. 3.New mild-moderate ascites.4.Side branch IPMNs in the pancreatic head and uncinate process, unchanged.


Instruction: Generate impression based on medical findings.

Input: 50 years Female (DOB:7/9/1965)Reason: Rule out fracture, disc herniation History: painPROVIDER/ATTENDING NAME: GABRIELLA L BORRELLI THOMAS J KELLY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present at this level with some mild narrowing of the right neural foramen. There are small uncovertebral osteophytes present this level contributing to neural foramina narrowing.At C4-5 there is no significant compromise to the spinal canal. There is a broad-based right lateral recess disc protrusion associated with some uncovertebral osteophytes and narrowing of the right neural foramen. There are some encroachment of the right-sided exiting nerve roots. This was also present on the prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine worse at C3-4 and C4-5 where there is mild encroachment of the right-sided exiting nerve roots at C3-4 and moderate encroachment of the right-sided exiting nerve roots at C4-5.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old, with pain in the neck, arms and legs, with hand weakness since car accident. A mild reversal of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. No worrisome marrow replacement or evidence of marrow edema is seen. Fusion of the right C3-4 facets is noted.The visualized spinal cord illustrates normal signal intensity and morphology throughout.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Minimal if any cord impingement. No foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Minimal if any cord impingement. Mild left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C7-T1: Unremarkable.

Output: 1.Degenerative disc disease at C4-5 and C5-6 resulting in mild spinal canal stenosis and minimal if any cord impingement. No abnormal cord signal is detected.2.No other significant findings are seen, and in particular, no evidence of any posttraumatic injury is detected.


Instruction: Generate impression based on medical findings.

Input: Reason: mass under the inferior border of both scapular History: mass under the inferior border of both scapulae. There are crescentic masses deep to both scapular tips between the serratus anterior and the underlying rib cage. The masses are predominantly isointense to muscle but contain small foci of high signal intensity on T1 weighted images compatible with fatty elements, are slightly hyperintense to skeletal muscle on fluid sensitive sequences, and show enhancement following gadolinium administration. The location, morphology, and signal characteristics are compatible with elastofibromas. The right mass measures approximately 7 x 2 cm in the transverse dimension and approximately 8 cm in the craniocaudal dimension. The left mass measures approximately 6.5 cm x 1.5 cm in the transverse dimension and 8 cm in the craniocaudal dimension. There is a lesion within segment 8 of the liver which demonstrates increased signal intensity on T1 and STIR sequences and shows mild peripheral enhancement on postcontrast sequences. This is nonspecific and incompletely characterized/imaged on this examination. After consult with the abdominal imaging section, a triple phase MRI of the liver is recommended for further evaluation. Moderate degenerative disc disease is identified throughout the visualized cervical and thoracic spine. There are fluid collections along the anterior aspect of the subscapularis muscles, bilaterally, that we suspect represent bilateral subcoracoid bursitis. There also appears to be osteoarthritis of the acromioclavicular joints as well as a full-thickness rotator cuff tear on the right.

Output: 1. Bilateral elastofibromas as described above. 2. Incompletely characterized segment 8 liver lesion for which further evaluation with a dedicated triple phase MRI examination of the liver is recommended.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female 92 years old with intrahepatic and extrahepatic dilatation seen on CT in in September. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and contour. No enhancing liver lesion is identified. The hepatic vasculature appears patent.There is a low insertion of the common bile duct. The common bile duct measures 17 mm in diameter and the common hepatic duct measures 13 mm in diameter. There is suggestion of a luminal filling defect within the distal common duct (series 4, image 32). There are a few mildly dilated intrahepatic biliary ducts within the right lobe of the liver.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is dilated in the pancreatic head measuring duct to 8 mm. A smooth area of narrowing seen within the pancreatic body and the pancreatic duct in the distal body and tail is normal in caliber. No discrete pancreatic or ampullary mass is identified. The morphology of the pancreas is appropriate for age.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple bilateral T2 hyperintense, circumscribed, nonenhancing renal lesion consistent with a cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dilation of the common hepatic duct, common bile duct, and pancreatic duct as described above suggests obstruction at the level of the ampulla. This may be due to ampullary stenosis. A small filling defect within the distal common bile duct may represent debris. This could be further evaluated with endoscopic ultrasound if indicated based on the clinical symptoms and the patient's age.


Instruction: Generate impression based on medical findings.

Input: 67 years, Female, ataxia. Rule out ischemia. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. 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. Mild global parenchymal volume loss is evident, with relatively greater involvement of the bilateral parietal lobes. Major flow-voids are preserved.Empty sella is incidentally noted with prominent expansion of the sella. There is also enlargement of the Meckel's caves which are CSF filled. Right lens implant. There is mild scattered paranasal sinus opacification including mucous retention cysts in the bilateral maxillary and left frontal sinuses.

Output: 1. No evidence of acute infarct, intracranial hemorrhage, or mass. 2. Mild chronic small vessel ischemic disease.3. Empty sella which is enlarged as well as enlarged CSF spaces in the Meckel's caves. These findings are nonspecific but can be seen with intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old Reason: evaluate for recurrence of prostate cancer; s/p prostatectomy with PSA now 0.17 History: none PELVIS:PROSTATE:Prostate Size: Status post prostatectomyPeripheral Zone: Status post prostatectomyCentral Gland: Status post prostatectomySeminal Vesicles: Status post prostatectomyExtracapsular Extension: N/ABLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific evidence for recurrent disease. Please note the study was ended early per patient's request.


Instruction: Generate impression based on medical findings.

Input: Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: pre op to use for navigation History: planning left suboccipital craniotomy for resection of cerebellar tumor The purpose of this imaging scan is preoperative localization using STEALTH protocol.Multiple fiducial markers attached on the scalp.There is a large [51.5 mm(RL) x 39.4 mm(AP) x 33 mm(CC)] posterior fossa likely extra axial mass with mass effect toward the left cerebellar hemisphere. The fourth ventricle appears to be deformed due to mass effect, with a slightly prominent ventricular system.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 51.5 mm(RL) x 39.4 mm(AP) x 33 mm(CC) sized left side posterior fossa likely extra axial mass with mass effects.