Instruction: Generate impression based on medical findings.

Input: Left temporal skull mass and pain. History of neurofibromatosis type I. There is a well-circumscribed, lobulated left temporal scalp mass. The mass is closely related to or within the temporalis muscle. The main bulk of the mass is composed of multiple smaller nodules that are peripherally T2 hyperintense and centrally T1-hypointense (target sign). The nodules show intense, heterogeneous contrast enhancement. The main bulk of the mass collectively measures in the axial plane 4.9 cm x 1.6 cm and craniocaudally 4.4 cm. Smaller similar masses are present superficial to the temporalis muscle. In addition to this well-circumscribed component, the left temporalis muscle shows diffuse abnormal signal and contrast enhancement which tapers distally, perhaps though not definitively reflective of infiltration. While the underlying skull is not infiltrated/invaded, the mass extends inferiorly to cause chronic remodeling of the lateral aspect of the temporal bone without deep infiltration. It causes mass effect on the external auditory canal as well. The brain shows no abnormality but this is a limited assessment. The dural venous sinuses are patent. Major intracranial arteries are patent as well. There is no orbital abnormality. There are no signs of sphenoid wing dysplasia. The paranasal sinuses are clear.

Output: Left temporal scalp mass as described above compatible with neurofibroma. In addition to the main component of discrete nodular lesions, there is an infiltrative pattern of enhancement which tapers more distally in the left scalp. This could represent subtle tumor infiltration or a reactive phenomenon. While there is no gross osseous invasion, there is chronic remodeling of the mastoid air cells as described above.


Instruction: Generate impression based on medical findings.

Input: Moderately extensive periventricular and subcortical white matter FLAIR lesions compatible with demyelinating disease. Prominence of the ventricles and sulci likely due to volume loss. There are no enhancing lesions or other findings to suggest acute demyelination. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Evidence of demyelinating disease with no enhancing lesions to suggest active demyelination.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with abdominal pain and loss, evaluate. History of thyroid cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is nondilated. There is a cystic lesion in the uncinate measuring 3.1 x 2.0 cm (8/32) which likely communicates with an accessory duct. There are multiple additional subcentimeter cysts in the pancreatic head which appear to communicate with the main pancreatic duct. There is a cystic lesion of the pancreatic neck measuring 2.2 x 1.9 cm (8/25) with apparent ductal communication. A large cystic lesion involving the pancreatic tail measures 2.5 x 3.1 cm (8/21) sheath to hypointense walls, possibly reflecting prior hemorrhage. No enhancement is present within any of these lesions.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: Multiple cystic lesions throughout the pancreas measuring up to 3.1 cm likely represent side branch IPMN's. No enhancement or main pancreatic ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Multiple fiducial markers on scalp for the purpose of localization.There is 21.6mm x 23.5mm sized well circumscribed extra axial mass on the right CP angle extending into the left internal auditory canal. The mass demonstrated inhomogeneous low signal intensity on T2 images, low signal intensity on T1 images and showed intense enhancement on Gad infusion. The MR characteristics are consistent with vestibular schwannoma. The differential diagnosis include meningioma and facial nerve schwannoma. Brainstem at the level of middle cerebellar peduncle appears to be compressed due to mass, however, there is no abnormal brain parenchymal signal abnormality.Although the 4th ventricle also appears to be slightly deformed, there is no evidence of ventricular enlargement. The gray-white matter differentiation is normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Left CP angle tumor most likely left vestibular schwannoma with differential diagnosis of meningioma, facial nerve schwannoma and metastasis.2. Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 43 year-old female with a history of fatty liver. Rule out liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Note is made of multiple foci of signal loss in the right lobe of the liver on out of phase sequences, consistent with focal fatty infiltration. Additionally, note is made of focal fatty sparing along the gallbladder fossa. No evidence of intra-or extrahepatic biliary ductal dilation. No enhancing mass lesions are identified. Mild hepatomegaly.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter foci of fluid signal intensity are identified in the kidneys bilaterally, which are too small to characterize, but likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild wall thickening affecting a loop of jejunum in the left hemiabdomen. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Fatty infiltration of the liver without evidence of a focal mass lesion, as clinically questioned.2. Nonspecific wall thickening of a loop of jejunum in the left hemi-abdomen. Differential considerations include infectious and inflammatory etiologies. These findings can also be seen with chronic NSAID use related strictures. Neoplasm cannot be completely excluded and clinical correlation is indicated.


Instruction: Generate impression based on medical findings.

Input: History of partial gastrectomy and Billroth II complicated by pancreatico-cutaneous fistula with bile duct dilatation on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size measuring 16 cm in craniocaudal dimension.It is normal signal intensity. There is marked extrahepatic biliary ductal dilatation with the common bile duct measuring 2.1 cm with moderate intrahepatic biliary duct dilatation. The common bile duct tapers smoothly at the level of the ampulla without an obstructing stone or mass evident.Distended gallbladder without acute inflammation.Small perihepatic fluid collection adjacent to segment 6 is unchanged.SPLEEN: Normal splenic size and morphology without focal lesion.PANCREAS: The pancreatic duct is irregularly dilated up to 8 mm and narrowed, with a moderate stricture at the body tail junction. The dilated main pancreatic duct extends anteriorly and does not clearly communicate with the common bile duct which inserts into the major papilla. The main pancreatic duct appears to merge with a smaller duct in the uncinate process and extends anteriorly where it enters the more proximal duodenum at the minor papilla and communicates with the complex fistulous tract. On postcontrast imaging there is a persistent complex fistulous network deep to the incision site compatible with patient's known pancreatico-cutaneous fistula with no discrete fluid collection is evident.Moderate parenchymal atrophy with decreased intrinsic T1 signal intensity and postcontrast enhancement compatible with parenchymal dysfunction.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Tortuous abdominal aorta with infrarenal aneurysmal dilatation better evaluated on the recent prior CT.BOWEL, MESENTERY: Postsurgical changes from Billroth procedure.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large bilateral pleural effusions with compressive atelectasis.

Output: 1.Marked extra and moderate intrahepatic biliary ductal dilatation to the level of the ampulla without a discrete stone or obstructing mass evident.2.Irregular beaded appearance of the pancreatic duct likely related to chronic pancreatitis. The main pancreatic duct appears to merge with a smaller duct in the uncinate process and extends anteriorly where it may enter the more proximal duodenum at the minor papilla (possible pancreas divisum) and communicates with the complex fistulous tract, compatible with the patient's known pancreatic-cutaneous fistula. No discrete fluid collection.3.Large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Cervical spondylosis with arm pain, evaluate stability of spine. There is severe multilevel degenerative disc disease from C3 through C7. The upper cervical spine is slightly kyphotic. There are minimal retrolistheses of C4, C5, and C6, but I see no frank instability between the flexion, neutral, and extension views.

Output: Severe degenerative disc disease.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: 73 years Female (DOB: 4/17/1943)Reason: r/o stenosis History: neck painPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. 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 or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes present this level associated with disc desiccation and loss of disc space height. There is encroachment of the right-sided exiting nerve roots related to osteophytes and disc material. There is mild ligamentum flavum hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal. There is right-sided facet hypertrophy present at this level as well as endplate and uncovertebral osteophytes with some narrowing of the right neural foramen.. There is ligamentum flavum hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Along the right anterior chest wall there appears to be a large T1 signal hyperintense mass which suppresses on the fat suppressed images. This is not entirely included on this exam. It displaces adjacent structures including the thyroid gland being displaced towards the left and displaces the right sternocleidomastoid muscle anteriorly. The subclavian artery and subclavian vein are deep to the lesion.

Output: 1.There are degenerative changes present in the cervical spine with encroachment of right-sided exiting nerve roots at C5-6.2.Fatty lesion possibly a lipoma is present along the right anterior chest wall and lower right neck which is located underneath the sternocleidomastoid muscle is not adequately included on this exam. It appears to displace adjacent structures. Please correlate with physical findings on clinical exam.


Instruction: Generate impression based on medical findings.

Input: 60-year-old man status post nephrectomy in 2014 for chromophobe RCC, now with right flank pain, left thigh numbness, and periportal lymphadenopathy. ABDOMEN:LIVER, BILIARY TRACT: There is mild fatty infiltration of the right lobe of the liver. The gallbladder appears normal. There is no intra or extra hepatic biliary duct dilatation. SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The patient is status post right nephrectomy and there is no evidence of local recurrence or abnormal enhancing mass. The left kidney appears normal.RETROPERITONEUM, LYMPH NODES: Subcentimeter portacaval lymph nodes are noted. Subcentimeter retroperitoneal lymph nodes are also noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: There is a small fat-containing umbilical hernia. There is an L3 Schmorl's node, please see concurrent MR L-spine report for complete description.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post right nephrectomy without local recurrence or lymphadenopathy.2.Please see concurrent MR L-spine report for additional findings.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of brain and spinal cord [198.3], Reason for Study: ^Reason: adenoid cystic carcinoma w/ L orbital involvement. History: Eval extent of tumor and change from prior imaging. Orbit MRIThere are T2 low to intermediate signal intensity and T1 low signal intensity with inhomogeneously enhancing mass at the left pterygopalatine fossa which ascends through the left inferior orbital fissure and the left temporal lobe. The enhancing mass encases left optic nerve and appears to be involving the anterior aspect of the left cavernous sinus.Prior scan obtained out side hospital is available but cannot be compared directly due to different technical parameters and motion artifacts, however, it appears to be grossly no significant interval change in terms of the extent of the disease.The right side globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. Brain MRI There is evidence of intra axial mass with surrounding edema on the left temporal lobe with irregular margined enhancing mass which appears to be connected to the mass on the posterior aspect of orbit, anterior and lateral aspect of the left cavernous sinus. There is also enhancing lesion on the left side foramen ovale which is connected to the left middle cranial fossa.There is also acute/subacute ICH on the left frontal lobe with subtle mass effects.Underlying brain shows multiple scattered high signal intensities on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no restricted diffusion/acute ischemia.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Opacifications of the left ethmoid sinus, sphenoid sinus and frontal sinus were seen.

Output: 1. Extension of extracranial mass through the left inferior orbital fissure and left side foramen ovale toward posterior aspect of the left orbit, anterolateral aspect of the left cavernous sinus and left anteromesial temporal lobe. 2. Left frontal subacute/acute ICH.3. Non specific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 62 year old with biopsy proven right breast invasive carcinoma presents for MRI evaluation. Family history of breast carcinoma in her sister. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The proven carcinoma is demonstrated as an enhancing oval mass at posterior 1:00 position, measuring 11 x 14 x 13 mm (AP x LR x CC), in the right breast. A marker clip is identified within the mass.Multiple enhancing foci are present in both breast, but none of them are uniquely enhancing. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal biopsy proven right breast cancer.2. No abnormal enhancement in left breast.3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 58 year-old the female status post craniotomy for epilepsy, complaint of headache There is post craniotomy change at the right temporal region. Images demonstrate subcutaneous soft tissue edema, small amount of extra axial fluid collection and pneumocephalus along the surgical incision, and patchy hyperattenuation blood and low attenuation air bubbles in the right temporal lobe surgical site. Hypodense signal in the right temporal lobe is likely a mixture of surgery cavity and vasogenic edema secondary to the surgical manipulation. All are expecting post surgery change. There is no evidence of large hematoma formation or hydrocephalus. The findings are similar to the MRI study done on 9/21/11.The gray-white matter differentiation is preserved in the remainder structure. However, the cortical sulci of the right cerebral hemisphere is effaced when compared to the contralateral side. There is minimal midline shift to the left approximately 3mm and mild compression of the right lateral ventricle. The findings are suggestive of parenchyma edema on the right, which is relative new when compare to previous MR study. In addition, there is small patchy hypoattenuation in the right frontal lobe cortex (image 18,19). This can be secondary to positioning, however, small ischemic change can not be completely excluded.There is large calcification along the anterior interhemispheric falx and the right frontal dura. The superior sagittal sinus appears hypoattenuation in density, which may secondary to blood loss. Except for craniotomy, the remainder calvarium is unremarkable. Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are unremarkable.

Output: 1. Effacement of the cortical sulci with preserved gray-white matter differentiation of the right cerebral hemisphere, minimal midline shift and partial compression of the right lateral ventricle. The findings are suggestive of parenchyma edema.2. Expected post surgery change as detailed above.3. There is small patchy hypoattenuation in the right frontal lobe cortex. This can be secondary to positioning, however, small ischemic change can not be completely excluded. Non-infusion CT is not sensitive to detect early parenchyma ischemia. If cortical ischemia is suspected on clinical setting, a MRI study may help further evaluate.


Instruction: Generate impression based on medical findings.

Input: A 53 year old male with history of heart, kidney and pancreas transplant in 2006. Referred to cardiac MRI to evaluate rejection. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 73%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 149 ml (normal range 142+/-34), the LV end systolic volume index is 19 ml/m2 (normal range 25+/-9), the LVESV is 39 ml (normal range 47+/-19), the LV mass index is 60 g/m2 (normal range 85+/-15), and the LV mass is 124 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.The GRE (global relative enhancement) value is normal (1.90).The T2 STIR ER (edema ratio) value is normal (1.70).The EVF (extracellular volume fraction is above normal (36.6%).No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 169 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsSternal wires were noted. Bilateral pleural effusions, mild on the right and trace on the left. Rounded atelectasis at the posterior basal segment right lower lobe. Postsurgical findings compatible with cardiac transplant.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function, the LVEF is 73%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The GRE (global relative enhancement) value is normal (1.90). The T2 STIR ER (edema ratio) value is normal (1.70). The EVF (extracellular volume fraction is above normal (36.6%). These findings are basal numbers for future follow up.4. No findings that support heart transplant rejection.5. The left atrium is mildly dilated. 6. The right ventricle is normal in size with normal systolic function, the RVEF is 61%.7. Mild tricuspid regurgitation.


Instruction: Generate impression based on medical findings.

Input: Weakness and paresthesia, new diagnosis neuroendocrine small cell lung cancer with metastasis. Rule out cord compression. Again seen is patchy marrow replacement involving many of the vertebral bodies of the spine concerning for diffuse metastatic disease. However, there is no significant loss of vertebral body height. At the C5-6 and C6-7 level there is substantial T2 hypointensity within the ventral epidural space which causes displacement and compression of the spinal cord. There is evidence of a small amount of cord signal abnormality at the C7 level which is confirmed on the recent previous outside hospital MRI exam of the spine. The signal characteristics involving the ventral epidural space at the C5-6 and C6-7 level suggests disc extrusion although the adjacent vertebral bodies are infiltrated by metastatic disease and therefore the possibility of disc mixed with tumor can be considered. Dedicated contrast enhanced exam of the cervical spine may provide additional information on this.Prominent disc herniation at the L5-S1 level with degenerative endplate changes causes moderate spinal canal stenosis at that level. There is no other significant spinal canal stenosis elsewhere in the cervical, thoracic or lumbar spine. Incidental note is made of thyroid gland enlargement and a left thyroid nodule.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2.Extensive patchy marrow replacement involving the majority of the spine consistent with extensive osseous metastatic disease.3.Low T2 intensity material in the anterior epidural space at the C5-6 and C6-7 level causing cord compression and possibly cord edema. The signal characteristics suggest disc extrusion although the adjacent vertebral bodies are infiltrated by metastatic disease and this could possibly be due to disc mixed with tumor. Dedicated contrast enhanced cervical spine imaging is pending which may provide additional information.4.Prominent disc herniation at the L5-S1 level with endplate degeneration causes moderate spinal canal stenosis at that level.


Instruction: Generate impression based on medical findings.

Input: Status post ERCP for hilar obstruction (presumed metastatic ovarian cancer) with bilateral stenting, but with persistent conjugated hyperbilirubinemia - rule out dilated intrahepatic ducts. History: rule out dilated (undrained) intrahepatic bile ducts ABDOMEN:LIVER, BILIARY TRACT: There is ill-defined soft tissue encasing the hepatic hilum without discrete measurable mass. The hepatic veins appear patent. There is attenuation of the main portal vein at the bifurcation (4/238) and also attenuation of the central bile ducts. There is bilateral intrahepatic biliary ductal dilatation which is most prominent in the posterior segment of the right hepatic lobe (segment 6) which measures up to 7 mm. The common bile duct is nondilated. The gallbladder is mildly distended. There is a dependent filling defect within the gallbladder which is favored to reflect sludge or stones and does not demonstrate enhancement.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal parenchymal signal intensity and enhancement. The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are several enlarged retroperitoneal lymph nodes as seen on recent CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Ill-defined soft tissue at the hepatic hilum suspicious for metastasis with associated narrowing of the central portal veins and bile ducts as well as moderate intrahepatic biliary ductal dilatation bilaterally (up to 7 mm) despite biliary stents. 2.Layering debris within the gallbladder which is favored to reflect sludge/cholelithiasis rather than focal wall thickening as questioned on prior ultrasound.


Instruction: Generate impression based on medical findings.

Input: Reason: Left medial sided knee pain, hx lateral tibial plateau fx, evaluate for cause of pain History: above ARTICULAR CARTILAGE AND BONE: There is a comminuted intra-articular fracture of the proximal tibia. The fracture predominantly involves the lateral tibial plateau with downward sloping of the plateau posteriorly, resulting in approximately 1 cm of depression relative to the level of the medial tibial plateau. The fracture also extends in a sagittal plane into the anterior portion of the medial tibial condyle, but we see no depression or displacement of the medial condyle. There is signal abnormality within the articular cartilage overlying the posterior half of the lateral tibial plateau likely representing a combination of degeneration and tearing. The articular cartilage of the lateral femoral condyle appears relatively intact. We see no fluid-filled defects of the articular cartilage of the medial tibial plateau. Although the articular cartilage of the medial femoral condyle appears intact, there is subchondral edema within the weightbearing portion of the medial femoral condyle, which is associated with plaque-like low signal intensity along the subchondral bone plate. This is nonspecific and could reflect pre-existing degenerative changes, a healing impaction/stress fracture, or mild osteonecrosis. Other than mild superficial fraying of the articular cartilage along the medial facet of the patella, the patellofemoral articular cartilage appears normal.MENISCI: There is poorly defined increased signal intensity along the inferior aspect of the posterior horn of the medial meniscus indicating an undersurface tear involving both the central and peripheral portions of the meniscus. In addition, the body of the medial meniscus appears attenuated which may represent additional fraying or tearing. There is a 5 mm poorly defined low signal intensity focus along the medial aspect of the medial tibial plateau beneath the periphery of the body of the medial meniscus which may represent a small extruded meniscal fragment. The anterior horn appears intact. The anterior horn and body of the lateral meniscus appear intact. The majority of the posterior horn appears intact, although there is increased signal intensity within the root of the posterior horn extending to the superior margin of the meniscus which could represent partial-thickness tearing. The popliteomeniscal fascicles are also indistinct with intermediate signal intensity immediately posterior to the posterior horn of the lateral meniscus which may represent scar tissue.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The distal patellar tendon is slightly thickened with intrasubstance foci of high signal intensity likely reflecting tendinosis and perhaps interstitial tearing.ADDITIONAL

Output: 1. Comminuted intra-articular fracture of the proximal tibia with depression of the posterior aspect of the lateral tibial plateau and extension of the fracture into the medial tibial condyle as described above.2. Subchondral edema of the medial femoral condyle is nonspecific, but could reflect pre-existing degenerative changes, healing impaction/stress fracture, or mild spontaneous osteonecrosis.3. Medial meniscus tear as described above with possible displacement of a small flap of meniscal tissue into the medial gutter.4. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for effusion vs lipoma at the left knee History: pain, swelling at left knee There is intrasubstance degeneration of the posterior horn of the medial meniscus. Some of the signal extends to the tibial articular surface with associated deformity of the posterior horn indicating degenerative tearing. The lateral meniscus appears intact. No full-thickness or near full-thickness articular cartilage defects are identified. There is a large fluid collection anterior to the patella with foci of low signal intensity internally which likely represents a prepatellar bursitis although a hematoma could be considered, particularly if there is a history of trauma. There are multiple internal septations. There is a small amount of fluid within the deep infrapatellar bursa which is not necessarily of any clinical significance.

Output: Findings indicating a prepatellar bursitis. Other findings as described.


Instruction: Generate impression based on medical findings.

Input: Thoracic back pain with radiation to the legs. Alignment of the thoracic and lumbar spine is unremarkable. No acute fracture or dislocation is seen. At L5 -- S1 intervertebral level, there is suggestion of an epidural lesion at the central and left central location, causing effacement of the thecal sac and impingement of the left S1 nerve root. This can be seen on series 11, image number 153. It is uncertain whether this represents image artifact, disk extrusion, or other epidural lesions. Further imaging can be obtained with CT myelogram or MRI.The spinal canal and neural foramina at the other levels appear patent.A 12-mm gallstone is noted.

Output: 1. Possible epidural lesion at L5 -- S1 level, effacing the thecal sac and impinging the left S1 nerve root. Further imaging can be obtained with CT myelogram or MRI.2. 12-mm gallstone.Dr. Eileen Wang (page # 2992) was paged at time of reporting of the study, but she was not available. A note to alert the physician of the availability of the final report was left on the paging.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with HCV and alcoholic cirrhosis, NASH. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Stigmata of portal hypertension including splenomegaly and esophageal/splenic varices.In hepatic segment 3, there is a 1 x 1 cm lesion that is hyperintense in arterial phase and demonstrates washout on the delayed phase (axial series 9 images 51, 243) (axial series 100 image 52, axial series 101 image 52). This central enhancing lesion is faintly T2 hyperintense and demonstrates restricted diffusion (axial series 4 image 94), and these characteristics are consistent with an HCC. The peripheral aspect of this focus demonstrates T1 hyperintense signal (axial series 8 image 52), no enhancement, and remains isointense to the hepatic parenchyma on portal venous and delayed phases. The imaging characteristics of this peripheral component is most compatible with a high-grade dysplastic nodule. The combined appearance of these 2 foci are characteristic of a "nodule within a nodule".Small focus of persistent hyperenhancement in hepatic segment 8 is of unclear etiology (axial series 100 image 35, axial series 101 image 44).SPLEEN: Mild splenomegaly measuring 14 cm in length.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: Small fat-containing ventral hernia.OTHER: No significant abnormality noted.

Output: 1."Nodule within a nodule" appearance of hepatic segment 3 HCC. The 1 cm central focus with arterial enhancement and washout is consistent with HCC. The peripheral crescentic T1 hyperintense component has imaging characteristics most consistent with a high-grade dysplastic nodule.2. Small focus of persistent hyperenhancement in hepatic segment 8 could be perfusional. Attention to this region is recommended on subsequent imaging.3. Cirrhotic liver morphology with sequela of portal hypertension.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old, with history of HPV positive T3 N2b left tonsil or scar cell carcinoma, status post radiotherapy. No evidence of any mucosal masslike lesion is seen. No pathologic adenopathy is detected by size criteria. The salivary glands and thyroid are unremarkable. Mild cervical spondylosis is demonstrated. Bone marrow signal characteristics are unremarkable. Mucosal thickening is demonstrated in the paranasal sinuses, similar to that seen previously. Limited views of the brain and spinal cord are unremarkable.

Output: No evidence of recurrent mucosal tumor or pathologic adenopathy.


Instruction: Generate impression based on medical findings.

Input: Demyelinating disease: right sided numbness and hyperreflexia. Brain: Thre are multiple, greater than 10, supratentorial and infratentorial T2 hyperintense white matter lesions. A lesion in the right superior frontal gyrus demonstrates patchy enhancement and a lesion in the right corona radiata demonstrates open ring enhancement directed away from the ventricle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There are subcentimeter T2 hyperintense lesions within the spinal cord involving the bilateral dorsal columns at C3-4 and in the left hemicord at C6. There is straightening of the cervical spine alignment in the sagittal plane, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Multiple intracranial white matter lesions are compatible with demyelinating disease, such as multiple sclerosis, with signs of active inflammation is a few lesions.2. Lesions in the cervical spinal cord are also compatible ith demyelinating disease, such as multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: 47 years Male (DOB:4/21/1969)Reason: 3 t scaner s/p resection History: surveillancePROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE The patient is status post left craniotomy and left temporal lobe surgery for removal of a left temporal lobe mass known to represent a glioblastoma. Since the prior exam postoperative effects on the left temporal lobe have regressed. There is adjacent dural enhancement. There is no clear evidence of residual enhancing neoplasm. There is a small nodular enhancement in the periphery inferiorly of the left temporal lobe which is suspected to represent meningeal reaction adherence to the pia matter. There is associated ex vacuo effect on the left lateral ventricle temporal horn.Incidental note is made of a developmental venous anomaly in the right frontal lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the left mastoid air cells which are hypoplastic.. The visualized portions of the orbits are intact.

Output: Since the prior examination postoperative effects in the left temporal lobe have regressed. There is no convincing evidence for tumor. Curran's at this time. A punctate focus of nodular enhancement at the inferior aspect of the left temporal lobe is suspected to represent postoperative change, follow-up exam would help confirm this.


Instruction: Generate impression based on medical findings.

Input: Ulcer on right lateral malleolus. Osteo-? Markers were placed along the lateral aspect of the lower leg and ankle denoting the area of interest. Please note that the field-of-view was adjusted accordingly, and the inferior margins of the talus and calcaneus are not included on the field-of-view of this study. There is ulceration of the soft tissues along the lateral aspect of the distal fibula. A collection of nonenhancing tissue, perhaps representing pus, extends from the skin defect to the underlying fibular cortex. There is edema and enhancement surrounding this collection indicating inflammation, but I see no signal abnormality within the underlying fibula to indicate osteomyelitis. The nonenhancing collection continues tracks deep to the peroneal tendons along the posterior margin of the fibula. The peroneal tendons themselves, however appear intact and I see no tenosynovitis. There is diffuse subcutaneous edema, as well as mild edema and enhancement of the musculature of the ankle indicating inflammation, but I see no discrete rim-enhancing fluid collection to indicate a drainable abscess.

Output: Soft tissue ulceration and inflammatory changes of the right ankle as described above, including a sinus tract/phlegmon that extends from the skin surface to the fibula; however, I see no bone marrow signal abnormality to indicate osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Evaluate right thigh opacity seen on CT. History of psoas abscess status post drainage by IR. History of pancreatic cancer and falling hemoglobin. There is a complex rim-enhancing fluid collection involving much of the quadriceps musculature extending along nearly its entire length with sparing of the rectus femoris. The collection consists of multiple pockets of nonenhancing fluid/tissue that we suspect intercommunicate. Proximally, the collection extends along the posterior margin of the greater trochanter as well as into the adductor musculature of the hip and the iliopsoas muscle. The collection is of heterogeneous signal intensity on T2-weighted images with components that are both hyperintense and isointense relative to skeletal muscle. There is also heterogeneity on T1-weighted images with curvilinear foci of hyperintensity. This heterogeneity raises the possibility of blood products of varying ages and perhaps myonecrosis although we cannot exclude an abscess.There is edema of the adjacent musculature and the surrounding subcutaneous fat. The bone marrow signal is normal without evidence of osteomyelitis. There is a small knee joint effusion. There is no hip joint effusion. A few small inguinal lymph nodes are noted.Note is made of a filling defect in the right femoral vein at the level of the subtrochanteric femur, representing partially occlusive thrombus.

Output: Complex rim-enhancing collection involving much of the quadriceps musculature along its length extending into the adductor musculature of the hip, the iliopsoas muscle, and posterior to the greater trochanter. Heterogeneity of signal on the T1 and T2 images suggests the possibility of blood products of varying ages and possibly myonecrosis but an abscess cannot be excluded.These findings were communicated to Dr. Khattak by telephone at 9:30 AM on 9/28/2016.


Instruction: Generate impression based on medical findings.

Input: The patient is a 68-year-old male with history of lung cancer status post resection and brain mets status post resection presenting with two days of confusion. In the area of the known posterior parietal lobe metastatic lesion seen on the comparison MRI, there is a 2.8 x 1.6 cm area of high attenuation consistent with hemorrhagic conversion of this lesion. Edema appears increased from the time of the comparison study. Effacement of the sulci is increased from the MRI secondary to the increase in edema, metastasis and subdural fluid. The second left parietal metastatic lesion is not well visualized on this examination.There are bilateral subdural hematomas, larger on the right. A high density component to the right sided subdural hematoma is consistent with an acute component to this subdural hemorrhage.The patient has undergone two craniotomies. Encephalomalacia and bony defects are seen in the right frontal and left parietal regions.The calvaria and skull base are radiographically normal except for the postsurgical changes. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Progression of metastatic disease with hemorrhagic conversion of the left posterior parietal lesion.2. Subdural hematomas with acute component seen on the right.3. Increased edema and effacement of the sulci, but no herniation.


Instruction: Generate impression based on medical findings.

Input: Episodic loss of balance; no falls; look for occult cerebrovascular disease. There is no evidence of intracranial hemorrhage or acute infarct. There is a nonspecific punctate focus of high T2 signal in the right peritrigonal white matter and minimal more diffuse periventricular white matter T2 hyperintensity bilaterally. There is heterogeneous enhancement of the pituitary gland, which is otherwise not particularly enlarged. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small retention cysts in the left maxillary sinus. There is a punctate Thornwaldt cyst in the nasopharynx.

Output: 1. Nonspecific punctate focus of high T2 signal in the right peritrigonal white matter and minimal more diffuse periventricular white matter T2 hyperintensity bilaterally, which may represent chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage or acute infarct. 2. Apparent heterogeneous enhancement of the pituitary gland may be attributable to an underlying pituitary microadenoma, for example. Follow up with dedicated pituitary MRI may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: There is no suspicious intracranial enhancement. There is no acute infarct, mass effect or midline shift. There are scattered T2 signal abnormalities in the periventricular and subcortical white matter, nonspecific. There is no extra-axial fluid collection. The flow voids at the skull base are intact. There is mild retroflexion of the tip of the dens causing mild effacement of the ventral CSF space without significant stenosis of the lower brainstem/upper cervical cord. There is a left lens implant.

Output: No evidence of intracranial metastases.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: 25 years year-old Female. Per EMR: recent urinary retention, initially after endometrial ablation, then worsened after lumbar puncture. Evaluate for demyelinating disease.INDICATIONS: Reason: Eval for demyelinating disease History: urinary retention and paresthesias. Brain: Examination is limited to sequences per demyelinating disease protocol. No FLAIR hyperintense lesion is seen in the brain parenchyma to suggest demyelinating disease. Brain parenchyma appears grossly unremarkable. No intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small right maxillary retention cyst. The orbits, skull, and scalp soft tissues are grossly unremarkable.Cervical spine: There is no cord signal abnormality to suggest demyelinating disease. The craniovertebral junction appears within normal limits. There is mild loss of usual lordosis of the cervical spine, which could be secondary to positioning. Alignment is otherwise maintained. The cervical vertebral bodies and disc spaces are appropriate in height. There is no significant spinal canal or neural foraminal stenosis at any level. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: No evidence of demyelinating disease in the brain or cervical cord.


Instruction: Generate impression based on medical findings.

Input: Female 17 months old with right thyroid mass present for at least 4 months and slowly growing. Evaluate for goiter or thyroglossal duct cyst.EXAMINATION: Sonogram thyroid 4/14/2016 RIGHT LOBE MEASUREMENTS: Not accurately measurableLEFT LOBE MEASUREMENTS: 2.0 x 0.6 x 1.2 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: There is a 4.2 x 2.4 x 3.1 cm hypoechoic multiloculated structure filled with echogenic debris which appears to be surrounded by a rim of thyroid tissue. It is noncompressible and has no flow on color Doppler images.LEFT LOBE: Normal echogenicity, no discrete nodule.ISTHMUS: Normal echogenicity, no discrete nodule.PARATHYROID GLANDS: Not identified.LYMPH NODES: Normal appearing cervical lymph nodes bilaterally.OTHER: No significant abnormality.

Output: The multiloculated lesion appears to be within the right thyroid lobe. Differential considerations include lymphatic malformation, branchial cleft cyst remnant and thymic cyst. It is not typical for thyroglossal duct cyst and unlikely an abscess.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old, with history of MS and paresthesias. Multiple, approximately 15, T2 hyperintense lesions are redemonstrated scattered through the cerebral hemispheres and the brainstem. There has been no significant interval change in the size or number of these lesions. The lesions in most cases correlate with moderate to marked T1 hypointensity which has also not significantly changed.Hyperintensity on the 3-D FLAIR sequences along the floor of the anterior cranial fossa is artifactual as it was not duplicated on a conventional 2-D FLAIR sequence. Susceptibility imaging demonstrates marked artifact in this region probably arising from air in the paranasal sinuses. A 4 x 4 millimeter focus of dural thickening is seen along the left petrous apex projecting into the CP cistern, without significant interval change. No parenchymal edema or mass effect is detected. The ventricles are normal in size and morphology.

Output: 1.Stable size and number of lesions compatible with multiple sclerosis.2.Small area of nodular dural thickening along the left petrous apex may represent an incidental meningioma and in any event is unchanged.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Please do CT guided bx of left parapharyngeal space mass. Compared to the prior CT scan a ring-enhancing lesion in the left parapharyngeal space measuring 24 x 15 mm on the prior exam is no longer ring-enhancing and currently measures 11 x 6 mm axial dimensions.

Output: 1.Since the prior exam the patient's left parapharyngeal space mass is significantly regressed in size. It's possible that this had represented an infection or a dilated parotid duct. As a result the procedure was aborted. If clinically appropriate a follow-up MRI of this area may be of further benefit to evaluate this.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female, status post laparoscopic total proctocolectomy for Crohn's disease. Status post ileostomy takedown and intravesical fistula repair of bladder in 10/09. Persistent pelvic pain with periodic drainage. Evaluate for abscess or other abnormality. ABDOMEN:LUNG BASES: Clear lung bases. No infiltrates, nodules or effusions.LIVER, BILIARY TRACT: Cholelithiasis. No biliary duct dilatation or obstruction. The anterior branch of the right portal vein is patent and the previous noted portal vein thrombosis has resolved. Otherwise, hepatic vasculature remains patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes status post total proctocolectomy and end ileostomy in the right lower quadrant. Moderate amount of soft tissue inflammation and fat stranding surrounding the ileostomy site has resolved. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: New 2.2 cm diameter left adnexal cyst has an enhancing rim at image 117 of series 3. This may represent a small abscess that can be imaged with transvaginal ultrasound or pelvic MRI, if indicated. This uniloculated cyst may be physiologic, as there is no adjacent fat stranding, excess free fluid or lymphadenopathy. BLADDER: Moderate thickening of the posterior bladder wall is likely postoperative status post takedown of the iliovesicular fistula with bladder wall repair.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The presacral percutaneous right pelvic drain has been removed. No acute abnormality was found. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Percutaneous pigtail drain in presacral region has been removed. New left adnexal cyst has an enhancing rim. Transvaginal ultrasound or pelvic MRI exam may be helpful for further evaluation. 2. Thrombosis of the anterior branch of the right portal vein has resolved. Cholelithiasis. 3. Otherwise, stable postoperative changes.


Instruction: Generate impression based on medical findings.

Input: Right face arm and leg numbness. There is a focal restricted diffusion on the left medial aspect of the thalamus indicate acute ischemic infarct without evidence of hemorrhagic transformation.There is evidence of chronic hemorrhage on the left anterior aspect of basal ganglia probably adjacent to anteriorly of left internal capsule.There are multifocal variable sized tissue lordosis indicating chronic lacunar infarcts.In addition, multiple high signal intensities on FLAIR imaging on periventricular white matters indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Focal acute ischemic infarct, left mesial aspect of the thalamus without evidence of hemorrhagic transformation.Multifocal chronic lacunar infarct with nonspecific small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with questionable brain metastases with improved creatinine. Evaluate for brain metastasis in the presence of contrast enhanced exam. MRI brain:Redemonstrated is a mildly contrast-enhancing, slightly intrinsically T1 bright lesion in the left medial temporal lobe which measures 7 x 6 mm and remains suspicious for a metastasis. The lesion is associated with strong susceptibility effect. Within the limitations of some motion degradation, and absence of the 3-D T1 postcontrast images, no additional intracranial enhancing lesions are seen. There is unchanged nonspecific mild scattered cerebral white matter T2/FLAIR hyperintensity. 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, skull, and scalp soft tissues are grossly unremarkable. There is fluid in the bilateral ethmoid sinuses. MRI C-spine:The C4 vertebral body is expanded and enhancing secondary to tumor involvement. There is prominent extension of tumor into the anterior epidural space which causes moderate spinal canal stenosis at the C4-5 level. Enhancing tumor is also seen within the neural foramina at the C4-5 level bilaterally including surrounding the foramina transversaria as well as extending into the prevertebral soft tissues anterolaterally. Additional paraspinal tumor is suspected only partially visualized on the right at T1 and corresponds with abnormal FDG avid activity on a prior PET/CT from 7/15/2016.The craniovertebral junction appears within normal limits. There is slight reversal of the cervical lordotic curvature There are multilevel degenerative changes of the cervical spine most prominently involving the C5-6 level where there is disc height loss, minimal retrolisthesis of C5 on C6, a small disc osteophyte complex, left foraminal disc protrusion, and facet arthropathy, which contribute to the spinal canal stenosis and moderate left neuroforaminal narrowing at this level. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact.

Output: Redemonstration of a subcentimeter lesion in the left hippocampus which enhances and is suspicious for metastasis, possibly containing blood product.Expansile enhancing C4 vertebral body metastatic lesion extending into the anterior epidural space, contributing to moderate spinal canal stenosis at this level, along with the degenerative changes. Tumor involves the C4-5 neuroforamina, encases the foramina transversaria and extends into the lateral anterior paraspinal soft tissues. An additional paraspinal tumor is suspected but only partially visualized on the right at T1 and corresponds with abnormal FDG avid activity on a prior PET/CT from 7/15/2016.


Instruction: Generate impression based on medical findings.

Input: 17-year-old female with hypothyroidism transferring care to University of Chicago.EXAMINATION: Sonogram thyroid 12/21/2016 RIGHT LOBE MEASUREMENTS: 4.9 x 1.5 x 1.3 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.1 x 1.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Two predominantly hypoechoic lesions are visualized of which neither demonstrate calcification. The first is non-vascular and measures 0.5 x 0.4 x 0.5 and may be extrathyroid in location. The second lesion is hyperechoic centrally and demonstrates central vascularity and measures 0.9 x 0.3 x 0.7 cm. Background glandular heterogeneity and somewhat ill-defined areas of hyperechogenicity.LEFT LOBE: A round mildly hypoechoic mass is seen posteriorly with medial extension measuring 1.4 x 0.5 x 0.5 cm. There is mild peripheral vascularity. Background glandular heterogeneity and somewhat ill-defined areas of hyperechogenicity.ISTHMUS: Background glandular heterogeneity and somewhat ill-defined areas of hyper echogenicity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Predominantly hypoechoic lesion within the right lobe of the thyroid may be extrathyroidal in location. Correlation with prior outside imaging is recommended to assess for change.2. The second right thyroid lesion appears morphologically compatible with lymph node.3. Hypoechoic mass within the left thyroid is of unclear etiology, but could represent a parathyroid gland. Correlation with serum calcium and PTH levels may be obtained.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old. Pain. ROTATOR CUFF: There is mild to moderate tendinopathy of the supraspinatus tendon without discrete tear identified. The infraspinatus and teres minor tendons and muscles are intact. Mild tendinopathy affects the subscapularis tendon. The subscapularis muscle is intact. There are small subchondral cysts at the humeral head.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is marked small subchondral cysts within the inferior aspect of the glenoid both anteriorly and posteriorly. Internal signal involving the inferior labrum is consistent with degeneration.BICEPS TENDON: The tendon of the long head of the biceps is visualized within the bicipital groove, but it is not visualized in the rotator interval, compatible with a tear. ADDITIONAL

Output: 1.Nonvisualization of the long head biceps in the rotator interval, compatible with a tear.2.Rotator cuff tendinopathy particularly involving the supraspinatus and subscapularis tendons, without discrete tear identified.


Instruction: Generate impression based on medical findings.

Input: Right ethmoid/nasal mass with possible bony erosion: epistaxis. There is a heterogeneously enhancing mass in the posterior right nasal cavity and ethmoid sinuses, which measures up to 5 cm. The tumor extends to the right medial cribriform plate, where there is a dehiscence demonstrated on CT. Otherwise, there is no discernible intracranial extension of tumor. There are trapped secretions and/or hemorrhage in the right sphenoid, ethmoid, and bilateral maxillary sinuses and surrounding recesses, with mild underlying mucosal thickening. There is sclerosis in the bone marrow surrounding the right sphenoid sinus. The orbits are unremarkable.

Output: A mass in the posterior right nasal cavity and ethmoid sinuses that measures up to 5 cm likely represents an neoplasm, such as an inverted papilloma, melanoma, or carcinoma, for example. The tumor extends to the right medial cribriform plate, where there is a dehiscence demonstrated on CT. Otherwise, there is no discernible intracranial or intraorbital extension of tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old, with bilateral hearing loss, right more than left, subacute. Images are distorted by artifact arising from the scalp and from motion. Within this limitation, the following observations are made.No definite evidence of restricted diffusion is seen, though the diffusion weighted images are particularly degraded superiorly.Patchy periventricular T2 hyperintensity is demonstrated in a bilateral symmetric pattern. No mass-effect or parenchymal edema is seen. No evidence of acute intracranial hemorrhage is detected, though again, susceptibility weighted images are particularly degraded.Without the benefit of IV contrast, the internal auditory canals are normal in caliber and the cochleas show relatively normal morphology. The remainder of the inner ear structures are not well appreciated due to artifact. The cranial nerves arising from the brain stem are also not well visualized.

Output: 1. Limited examination due to distortion along the scalp and motion.2. No definite evidence of an acute intracranial abnormality is seen. Patchy white matter signal abnormality is nonspecific but may reflect chronic small vessel ischemic disease.3. Dedicated imaging of the inner ear structures is fairly limited due to the artifact noted above. The internal auditory canals and cochleas seem to be normal. The remainder of the inner ear structures are not adequately visualized, nor are the brainstem cranial nerves.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with posterior fossa meningioma. Evaluate for mass change. Heterogeneous mass within the left posterior fossa extending into the upper cervical spine is seen. There is mass effect on the left cerebellar hemisphere and fourth ventricle with surrounding vasogenic edema corresponding to recent MRI. There is no significant hydrocephalus. The basal cisterns are normal in size and configuration. There is no evidence of intracranial hemorrhage. Extensive of subcortical lucencies consistent with small vessel ischemic disease is unchanged.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute change in left posterior fossa meningioma with no evidence of hydrocephalus2. Extensive small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: 69-year-old man with fall and head trauma. Questionable loss of consciousness. There is no evidence of intracranial hemorrhage or edema. Scattered areas of hypoattenuation are present in the subcortical, periventricular, and basal ganglia regions. These are consistent with age determined small vessel ischemic disease. No CT findings of acute stroke are present. Large vessel calcifications are noted in the carotid arteries.Fullness of the sella is noted. MRI is recommended to evaluate for the presence of a sellar mass.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base reveal no CT evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT evidence of intracranial hemorrhage or fracture.2. Sellar fullness is present. Recommend pituitary protocol MRI tube evaluate for presence of sella mass.3. Age-indeterminate small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Type II or unspecified type diabetes mellitus without mention of complication, not stated as uncontrolled [250.00], Reason for Study: CT evidence of acute ischemic stroke on the right temporal lobe. There is restricted diffusion on the left posterior aspect of the middle and inferior temporal lobe as well as left parietal lobe precuneus indicating acute to subacute ischemic infarction. On gradient echo images, the lesions show susceptibility artifacts indicating hemorrhagic transformation.There are other subtle restricted diffusion lesions including right frontal lobe middle frontal gyrus, right temporo-occipital gyrus, and left cerebellar hemisphere indicating subacute ischemic infarctions. Underlying brain show multifocal tissue defects on the right parietal lobe superior lobule, left thalamus and left cerebellar hemisphere indicating age indeterminate likely chronic ischemic infarction.There are mild non specific small vessel ischemic disease on FLAIR images.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The sphenoid sinus shows mucosal thickening.The right eyeball lens appears to be very thin indicating possible post-cataract surgery and the right eyeball shows elongated appearance indicating possible staphyloma.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.No intracranial arterial aneurysm was seen.No significant arterial luminal stenosis.

Output: 1. Left temporal and parietal lobes acute or subacute ischemic infarctions with hemorrhagic transformation involving left middle and inferior temporal gyrus, left parietal lobe precuneus.2. Multifocal bihemispheric subacute ischemic infarctions as described above.3. Underlying brain shows multifocal chronic ischemic infarctions and non specific small vessel ischemic disease. 4. No intracranial arterial aneurysm. No intracranial arterial luminal stenosis or occlusion.5. Possible post cataract surgery status on the left eye lens and staphyloma on the right eyeball.


Instruction: Generate impression based on medical findings.

Input: Altered mental status.. There is a chronic left thalamic lacunar infarct with susceptibility indicating chronic microhemorrhage in this region. Just posterior lateral to this is a punctate focus of restricted diffusion suspicious for acute ischemia with artifact a less likely possibility.Examination is severely motion degraded however there is no intracranial mass or mass effect. There is a periventricular and subcortical T2/FLAIR hyperintensity scattered in the periventricular and subcortical white matter which is nonspecific but compatible with chronic small vessel ischemic disease and similar to prior. Susceptibility-weighted sequence is motion degraded and multiple scattered small foci of chronic microhemorrhage are better seen previously. Foci of T2 hyperintensity in the bilateral subinsular region, right greater than left, are similar to prior and may represent prominent perivascular spaces or chronic lacunar infarcts. No midline shift or herniation. No extra-axial collections. No hydrocephalus. There is moderate degree of global parenchymal volume loss. Calvarium and extracranial soft tissues are grossly unremarkable within the limits of motion degradation.

Output: 1. Examination is moderately motion degraded. There is suggestion of punctate focus of acute infarct adjacent to a chronic hemorrhagic left thalamic infarct.2. Moderate chronic small vessel ischemic disease. No evidence of intracranial mass or mass effect.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: Muscle weakness (generalized) [M62.81] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: eval for stroke History: right sided weakness Brain MRIMotion artifact degraded image quality.There is focal restricted diffusion at the left frontal lobe precentral gyrus indicating acute ischemic infarction without evidence of hemorrhagic conversion.Encephalomalacia with volume loss were seen on bilateral occipital lobes indicating chronic ischemic infarcts. On gradient echo imaging, there are multifocal skeletal susceptibility lesions involving bilateral occipital lobes and parietal lobes on the left with encephalomalacia indicating chronic petechial hemorrhagic lesions.Multifocal chronic small lacunar infarctions on bilateral basal ganglia. Patchy T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no evidence of significant (more than 50%) luminal narrowing on bilateral ICAs, MCAs and ACAs. There is no evidence of intracranial arterial aneurysm. Vertebrobasilar system appears to be normal. Neck MRANoncontrast enhanced neck MR angiogram demonstrates forward flow through bilateral cervical segment of internal carotid arteries and vertebral arteries. However, due to significant motion artifacts and the low signal to noise ratio, precise evaluation for bilateral common carotid arteries, bilateral carotid bifurcations, and bilateral vertebral artery ostia are not possible. In fact, the Neck MRA is non-diagnostic.

Output: 1. Acute ischemic infarction without evidence of hemorrhagic transformation involving left frontal lobe precentral gyrus.2. Chronic ischemic infarction with chronic petechial hemorrhages involving bilateral occipital and parietal lobes.3. Non specific small vessel ischemic disease. Multiple lacunar infarctions on bilateral basal ganglia.4. No evidence of significant intracranial arterial luminal stenosis. No intracranial arterial aneurysm.5. Non diagnostic Neck MRA.


Instruction: Generate impression based on medical findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: brain mets History: surveillance Redemonstration of suboccipital craniectomy with left cerebellar hemispheric metastatic lesion resection status. Multiple susceptibility lesions within the surgical field are again seen, unchanged.Craniectomy site pseudomeningocele is redemonstrated, unchanged in terms of its size and MR signal intensity.Somewhat irregular and linear enhancements along the resection margin are again seen, unchanged in terms of extent and MR signal characteristics since prior scan. Multifocal bihemispheric parenchymal enhancing nodules are again seen, unchanged since prior scan.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post left suboccipital craniectomy with left cerebellar metastatic lesion resection status. Unchanged postoperative changes including surgical field products related susceptibility lesions and craniectomy site pseudomeningocele.2. No difference of left side resection site enhancements. No evidence of tumor recurrence or residual mass.3. Unchanged multiple enhancing metastatic nodules since prior scan. 4. No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: 65-year-old man with non-Hodgkin's lymphoma status post 16 cycles of chemotherapy. Thyroid uptake on PET scan. RIGHT LOBE MEASUREMENTS: 1.9 x 1.5 x 4.5 cmLEFT LOBE MEASUREMENTS: 1.4 x 1.4 x 4.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 3 mm nonspecific complex nodule laterally in the right lobeLEFT LOBE: 0.7 x 0.6 cm irregular nodule medially in the left lobe adjacent to the isthmus with a few microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Indeterminate 7 x 6 mm nodule in the medial left thyroid. On side to side comparison, this does not exactly match the uptake identified on prior PET CT (nodule appeared lateral rather than medial on that study) however it is possible this simply represents slight misregistration given the small size of the nodule. Findings discussed with Dr. Soni Smith at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Numbness, tingling. Rule out myelopathy. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis and suggestion of dextrocurvature. Alignment of the cervical spine is otherwise maintained. Bone marrow signal is benign. Examination is motion degraded however no evidence of high-grade spinal canal stenosis at any level is appreciated. The cervical spinal cord also has grossly normal signal characteristics. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal. Mild neural foraminal narrowing bilaterally related to uncovertebral hypertrophyC5-6: Small disc osteophyte complex without significant compromise to the spinal canal. Mild bilateral neural foraminal narrowing. C6-C7: No significant compromise to the spinal canal or neural foramina.C6-7: Small disc osteophyte complex and uncovertebral hypertrophy on the left. No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Mild nonspecific opacification of the left mastoid air cells which are partially imaged. Thoracic: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. No obvious cord signal abnormality. Post gadolinium images are severely motion degraded.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: Examination is limited to motion degradation. There is however no significant spinal canal stenosis in the cervical spine or thoracic spine. No obvious cord signal abnormality is appreciated. Post gadolinium sequences are particularly degraded but demonstrate no obvious abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of unspecified part of left bronchus or lung [C34.92] / Secondary malignant neoplasm of unspecified site [C79.9], Reason for Study: ^Reason: location and extent of spinal mets from met lung CA and any cord compression History: severe p Brain MRIThere are multiple scattered abnormal signal intensity lesions on skull including right parietotemporal area (series #1001, image #19/32) and left frontal area (series #1001, image #21/32), slightly increased in size of the lesions since prior scan.Since there was no post contrast images, intraparenchymal nodular enhancement cannot be evaluated, however, there is no evidence of space-occupying lesion or abnormal edema. Right C2 lesion is again seen, appears to be slightly increased since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.No change of right maxillary sinus retention cyst.Cervical Spine MRIThere is signal change of the C2 dens indicating infiltrative process. In addition, the right side body of the C2 shows 19.5mm x19.9mm x 25.6mm soft tissue mass. The lateral margin of the mass abuts right C2 neural foramen.At the level of T1-2, there are upper mediastinal right side paratracheal lymph nodes and left pleural effusion. Comparing to prior Chest CT scan, no significant interval change since prior scan.Spinal cord signal intensity is normal.Vertebral body alignment is normal with normal lordosis.Thoracic Spine MRIThere is about 10% compression fracture T11 vertebral body with disruption of anterior cortical margin. There is another small vertebral body lesion at T9 vertebral body close to its superior endplate.Spinal cord signal intensity is normal.There is no evidence of spinal canal stenosis.Thoracic neural foramen appear to be normal.

Output: 1. Interval increase in size of multiple skull metastasis and possibly C2 lesion since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. No evidence of brain parenchymal metastasis.4. C2 body right side metastatic mass as well as about 10% compression fracture of T11 metastasis lesion. 5. Focal metastatic lesion at T9 vertebral body superior endplate.6. No evidence of spinal cord compression, no spinal canal stenosis. 7. No abnormal spinal cord signal intensity.


Instruction: Generate impression based on medical findings.

Input: Evaluate labral versus cuff pathology. Pain and decreased range of motion. ROTATOR CUFF: The infraspinatus, supraspinous, teres minor and subscapularis are normal in appearance. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. Contrast is identified within the glenohumeral joint, without communication with the subacromial/subdeltoid bursa.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the right shoulder.


Instruction: Generate impression based on medical findings.

Input: Male 81 years old. CT demonstrated possible liver hemangiomas. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology.The segment 4B lesion demonstrates loss of signal on out of phase imaging consistent focal fat (series 901, image 274). The subcapsular segment 2 lesions are progressively enhancing, T2 hyperintense, T1 hypointense lesions compatible with hemangioma. An enhancing focus within segment 8 has no T2 correlate and is consistent with perfusional abnormality. There is a subcentimeter cyst in segment 4A. Additional hepatic lesions are too small to accurately characterize.No suspicious hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is not dilated. The pancreas enhances homogeneously.ADRENAL GLANDS: A small left adrenal nodule demonstrates loss of signal on out of phase imaging indicating benign adrenal adenoma.KIDNEYS, URETERS: There are a few bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is eccentric thickening of the gastric fundus measuring 4.0 x 3.3 cm (series 1005, image 284). Moderate hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesion.2.Eccentric thickening of the gastric fundus may represent the sequela of chronic gastric ulceration versus neoplasia. This can be further evaluated with endoscopy as clinically warranted.


Instruction: Generate impression based on medical findings.

Input: T4N0 nasopharynx adenoid cystic carcinoma, status post chemoradiation. There is a small amount of ill-defined enhancing soft tissue in the left nasopharyngeal region. There is mild scattered paranasal sinus mucosal thickening. There are also persistent left otomastoid effusions. There is no significant cervical lymphadenopathy. The thyroid and salivary glands appear unchanged. There is persistent fluid within the left mastoid air cells and middle ear. The orbits are unremarkable. There is no discernible residual intracranial mass.

Output: Minimal residual treated tumor in the left nasopharyngeal region.


Instruction: Generate impression based on medical findings.

Input: Clinical question: evaluate interval change. Signs and symptoms: Same. Unenhanced head CT:There is no evidence of intracranial hemorrhage, mass-effect, midline shift or hydrocephalus. Previously noted multiple foci of low attenuation of the cortex of bilateral posterior frontal lobes, bilateral basal ganglia are poorly visualized. There is only very subtle mass effect of the left high convexity posterior frontal area of cortical/subcortical edema. This is similar to prior MRI exam from 8 -- 4 -- 11. The ventricular system remain within normal range of size and unchanged since prior exam.

Output: 1.No evidence of an acute new findings on this nonfused portable head CT.2.Bilateral hemispheric foci of high signal intensity noted on prior MRI appear as foci of low-attenuation on CT and without any definitive appreciable interval change.


Instruction: Generate impression based on medical findings.

Input: 22-year-old woman with history of new onset daily headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There appears to be a punctate pars intermedia cyst. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small amount of bilateral mucosal thickening in the maxillary sinuses and right frontoethmoid region.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Small amount of fluid and mucosal thickening in the maxillary sinuses suggests sinusitis.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: MRI Brain:Images are somewhat limited by patient motion. There has been no significant interval change in appearance of the large peripherally T1 hyperintense right periventricular parenchymal hematoma, with associated surrounding residual vasogenic edema and localized mass effect. The leftward midline shift measuring 3 mm is unchanged. Trace T1 hyperintense intraventricular blood products are again seen along the left occipital horn. Posterior right cerebral sulcal effacement remains. There is no pathological enhancement.There are small scattered T2 hyperintense lacunar infarcts within the cerebellum bilaterally. A prominent chronic lacunar infarcts also seen along the right basal ganglia and the posterior aspect of the left basal ganglia. There are innumerable foci of susceptibility located throughout the cerebral hemispheres both centrally and peripherally. The extensive underlying periventricular and subcortical T2/FLAIR hyperintensities are consistent with chronic small vessel ischemic changes. The ventricular caliber is stable. The major cerebral flow voids are intact.MRA Brain: Severely motion limited exam. Within these limitations, there may be mild atherosclerotic irregularity within the M1 segments bilaterally. There is no significant intracranial stenosis. There is a mildly hypoplastic left A1 segment. The distal right V4 segment is developmentally diminutive. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is mild flattening of the carotid bulbs bilaterally. The common carotid arteries and cervical internal carotid arteries are otherwise normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion involving the cervical neck arteries. The right vertebral artery is smaller than the left.

Output: 1.Large evolving right intracerebral hemorrhage with localized mas effect, vasogenic edema and trace intraventricular hemorrhage, without significant change compared to the prior exam allowing for differences in technique.2.Extensive scattered punctate foci of susceptibility abnormality diffusely throughout the brain is most compatible with amyloid angiopathy and is may provide etiology for the underlying right sided hemorrhage.3.Extensive underlying chronic small vessel ischemic disease with multiple chronic lacunar infarcts.4.Limited MRA due to patient motion, although without definite flow-limiting stenosis.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 cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size measuring 17.8 cm in the craniocaudal dimension. There is mild fissural widening and an undulating liver contour compatible with cirrhosis. There is heterogeneous intrinsic T1 and T2-weighted signal intensity of the liver as well as diffusely heterogeneous post-contrast enhancement, including several peripheral wedge-shaped arterially-enhancing and subsequently iso-intense foci suggestive of perfusional anomalies in the setting of fibrosis. The hepatic veins are normal in caliber and the vessels appear patent.No discrete suspicious arterial enhancing lesion with associated wash-out on portal venous, equilibrium and/or delayed imaging phases.Gallstones within a normally distended gallbladder. Minimal gallbladder wall thickening/pericholecystic fluid is nonspecific in the setting of cirrhosis. Minimal perihepatic fluid. No intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is mildly enlarged measuring 13.7 cm in craniocaudal dimension without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter simple appearing bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous bone marrow signal intensity. Mild right sided gynecomastia. OTHER: No significant abnormality noted.

Output: 1.Cirrhotic hepatic morphology with stigmata of mild portal hypertension. No focal suspicious liver lesion. 2.Heterogeneous liver parenchyma on pre- and post-contrast imaging may represent underlying fibrosis and perfusional anomalies.


Instruction: Generate impression based on medical findings.

Input: History of left breast cancer status post mastectomy. There is scattered fibroglandular tissue in the right breast. The patient is status post left mastectomy and reconstruction. No contrast is seen on the post-contrast sequences. No abnormal axillary lymph nodes are identified in either axillary region.Stable high T2 signal right hepatic lobe lesion compatible with a cyst or hemangioma.

Output: Non-diagnostic exam due to lack of contrast. The exam should be repeated. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views.


Instruction: Generate impression based on medical findings.

Input: History of concussion now with abnormal olfactory sensation, bifrontal headaches, and vision abnormalities. No lesions are identified in the anterior skull base or anterior frontal lobes to suggest an etiology for the patient's symptoms. No suspicious intracranial mass or evidence of mass effect. No suspicious lesions on the postcontrast images. Incidentally noted is a left temporal-occipital developmental venous anomaly. There is a 13 mm pineal gland cyst without solid or enhancing components. No significant associated mass effect. There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Minimal mucosal thickening is present in the right anterior ethmoid air cells. There is a small left maxillary mucus retention cyst. Paranasal sinuses are otherwise clear. Calvarium and extracranial soft tissues are within normal limits.

Output: There is a 13 mm pineal cyst with a benign appearance and likely an incidental finding. MRI of the brain is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Patient with question of visual field defect. Rule out acute cause. Signs and symptoms: Visual field deficit? Transient? Acute. Signs and symptoms: Visual field defect? Transient? No definitive evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain essentially within normal for patient stated age. Further evaluation with an MRI is recommended. Calvarium, paranasal sinuses and mastoid air cells are within normal limits.

Output: Negative CT of brain.


Instruction: Generate impression based on medical findings.

Input: Fetal congenital cystic adenomatoid malformation. PELVIS:UTERUS, ADNEXA: Gravid uterus with one fetus in vertex position facing posteriorly. The placenta is along the posterior fundus and body of the endometrial canal. No evidence of placenta previa or accreta. The cervix appears closed. Normal volume amniotic fluid.The neural axis is unremarkable.The heart apex and stomach are left-sided. Note is made of several cyst like structures in the left lung base with the largest measuring 1.5 x 1.0 cm and 1.1 x 0.8 cm. No obvious communication between the cystic structures is demonstrable. The extent of the subtle signal abnormality associated with these larger cysts measures approximately 4.1 x 2.6 cm in the sagittal plane (series 1 301/15) and approximately 3.3 x 2.9 cm in the coronal plane (series 1 101/12). No findings to suggest an intralobular sequestration such as vascular supply from the systemic circulation. The diaphragm appears intact.Unremarkable kidneys bladder bowel liver gallbladder and spleen. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with stated history of congenital pulmonary adenomatoid malformation with several macrocystic components visualized on MRI. The extent of the left lower lobe signal abnormality measures approximately 4.1 x 2.6 cm which includes the smaller cystic components. No specific findings to suggest a hybrid/combined-type CCAM and intralobar sequestration lesion.No additional fetal abnormality is identified.


Instruction: Generate impression based on medical findings.

Input: Evaluate for cholangiocarcinoma. Recurrent PSC status post liver transplant. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant. The vessels are patent.There is mild intrahepatic biliary ductal irregular narrowing and dilatation compatible with recurrent primary coursing cholangitis. Mild extrahepatic bile ductal dilatation is unchanged. The hepaticojejunostomy anastomosis appearance is unchanged.In the periphery of segment 8 there is stable mild focal intrahepatic ductal dilatation which is now associated with a geographic perfusional abnormality without an obstructive lesion evident.No focal stricture or discrete mass.SPLEEN: Mild splenomegaly measuring 14.5 cm.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: Bilateral breast prosthesis.

Output: No dominant stricture or focal mass. Stable focal mild intrahepatic ductal dilatation in the periphery of segment 8 is now associated with a perfusional abnormality without an obstructing lesion evident.


Instruction: Generate impression based on medical findings.

Input: Clinical question: evaluate for bleed. Signs and symptoms: Altered mental status. Status post fall. Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage.Large area of low-attenuation involving the left posterior temporal and extending into the left occipital lobe and further superiorly into the parietal lobe. There is only suspected subtle mass effect and effacement of adjacent cortical sulci in particular in the parietal component. This finding although has the appearance of an old stroke possibility of a subacute component cannot be ruled out. There is no associated hemorrhage. Recommend further follow-up weighted and MRI exam to exclude acute/subacute stroke. One there is no evidence of hemorrhage midline shift or hydrocephalus.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are pneumatized and unremarkable.Debris within bilateral external auditory canals.CT of cervical spine:Images through the skull base are unremarkable. The articulation of C1 and C2 remains within normal no fracture is detected. Degenerative changes of cervical spine with multilevel neural foramina compromise is identified. There is however no evidence of cervical spinal fracture. The alignment the vertebral column is unremarkable. There is however scoliosis.No detectable soft tissue abnormality of the neck.CT of orbits:Examination demonstrates preseptal periorbital swelling likely result of recent trauma. There is no evidence of fracture. The retro-orbital fat is within normal limits. There is normal morphology and density of globes with intact lenses. The extraocular musculature is unremarkable. Visualized paranasal sinuses are unremarkable.

Output: 1.Negative CT of cervical spine for fracture. Degenerative disk disease is noted.2.Head CT demonstrates large area of low-attenuation in the left posterior temporal extending to occipital and left parietal lobe. Although large segment of this finding appears as an old cortical stroke there are suspected areas of effacement of cortical sulci in the parietal region may indicate an overlapping acute/subacute new stroke. Recommend further follow-up with an MRI. There is no evidence of posttraumatic intracranial abnormality.3.CT of orbits demonstrate right sided preseptal periorbital swelling likely result of recent trauma. No evidence of fracture or any abnormality in the retroseptal region.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of bone [C79.51] / Intrahepatic bile duct carcinoma [C22.1], Reason for Study: ^Reason: brain mets vs stroke History: slurred speech Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is a focal susceptibility lesion on the right basal ganglia (series 900, image 9), however the lesion is not associated with the surrounding edema or other evidence of acute hemorrhage, therefore, this is nonspecific likely represent focal parenchymal calcification or chronic petechial hemorrhage.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. The paranasal sinuses are clear.Focal opacifications of bilateral mastoid air cells are seen.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. No evidence of significant intracranial arterial luminal stenosis. No evidence of intracranial arterial aneurysm.

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


Instruction: Generate impression based on medical findings.

Input: Female, 10 years old, with bilateral optic disc swelling MRI brain and orbits:The dura of the tentorium is bilaterally thickened and enhancing. To a lesser degree, the dura of the interhemispheric falx is also thickened and enhancing. The remainder of the dura is unremarkable.Morphology of the brain is otherwise unremarkable. No structural abnormalities are seen. The brain parenchyma itself is free of pathologic signal, edema and mass effect. No abnormal parenchymal or leptomeningeal enhancement is seen. No cranial nerve enhancement is detected. There is no intracranial hemorrhage or abnormal extraaxial fluid. The ventricles are normal in size and morphology.Mild flattening of the posterior globes is seen at the optic nerve heads, a finding which can be related to increased intracranial pressure. The orbits are otherwise normal. The optic nerves in particular show no abnormal signal or enhancement. The pituitary infundibulum is thickened and enhancing. The pituitary gland itself is small giving the appearance of a partially empty sella, which may be normal for age but which could also indicate elevated intracranial pressure. The parotid glands are prominent and contain several small cysts or nodules. The partially visualized submandibular glands are also prominent.MRA and MRV brain:The intracranial arterial vasculature is unremarkable. No stenosis or occlusion is seen. No aneurysm or vascular malformation is detected. LIkewise, the dural venous sinuses and deep venous structures are patent.

Output: Dural thickening of the tentorium, and to a lesser degree of the interhemispheric falx, is seen. Also noted is a thickened and enhancing pituitary infundibulum. These findings taken together are very suggestive of neurosarcoid. Other granulomatous processes can be considered, but infection and neoplasia are considered unlikely.Findings are seen in the orbits and sella suggestive of elevated intracranial pressure, which in turn may be secondary to the intracranial process described above. No additional lesions of the orbits are seen. Evaluation of the intracranial arteries and veins is within normal limits. Incidentally noted is prominence of the salivary glands which can be seen in connective tissue diseases and in sarcoid.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female with hyperprolactinemia and amenorrhea. Evaluate for pituitary adenoma. The pituitary gland is within normal limits in size, signal intensity and enhancement. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable.  Limited images of the brain demonstrate no midline shift or mass effect. There are no areas of abnormal signal or pathologic enhancement. The ventricles and sulci are within normal limits. The midline structures and craniocervical junction are within normal limits.

Output: Unremarkable examination with no focal lesions identified.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with history of primary sclerosing cholangitis who presents for evaluation of stricturing/suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with characteristic morphological changes of advanced PSC including scattered biliary ductal dilatation/stricturing, subtle peripheral T2 hyperintensity, which is likely secondary to parenchymal atrophy and fibrosis. The gallbladder is dilated, likely related to cystic duct structures. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with characteristic morphological changes and biliary findings of advanced PSC as detailed.2.No dominant biliary stricture identified.