Instruction: Generate impression based on medical findings.

Input: History of cirrhosis. Presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The liver is normal in size and signal intensity. No suspicious lesion. No biliary ductal dilatation. Normally distended gallbladder. Small volume perihepatic ascites. SPLEEN: Mild splenomegaly measuring 13 cm in craniocaudal dimension. Note is made of a 2.3 splenic artery pseudoaneurysm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal simple cyst.RETROPERITONEUM, LYMPH NODES: IVC filter is noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis without suspicious liver lesion.2.Approximately 2.3 cm splenic artery pseudoaneurysm. Endovascular evaluation for possible treatment is recommended.


Instruction: Generate impression based on medical findings.

Input: History of hepatitis C and cirrhosis presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No specific stigmata of portal hypertension.No biliary ductal dilatation. The vessels are patent.New segment 4A 7 mm and segment 2 8-mm T2 hyperintense lesions with associated restricted diffusion but no arterial enhancement or washout.Several punctate and peripheral wedge-shaped foci of arterial enhancement without washout or associated signal abnormality are likely perfusional anomalies, mostly unchanged.Normally distended gallbladder with small gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cysts.RETROPERITONEUM, LYMPH NODES: Mildly prominent periportal lymph nodes are nonspecific in the setting of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two new subcentimeter T2 hyperintense restricting lesions do not meet imaging criteria for HCC as they have no arterial enhancement or washout. Short-interval follow-up imaging is recommended to ascertain stability of these new lesions.


Instruction: Generate impression based on medical findings.

Input: 29-year-old male with ulnar sided pain A skin marker was placed along the ulnar aspect of the wrist, without underlying abnormality evident.The exam is limited to due to patient motion.LIGAMENTS: The intrinsic scapholunate and triquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC appears grossly intact. There is a small amount of fluid within the distal radioulnar joint, within normal limits.TENDONS: The extensor and flexor tendons are intact without evidence of tenosynovitis. BONES: The bone marrow signal is within normal limits.ADDITIONAL

Output: Suboptimal exam due patient motion with grossly intact triangular fibrocartilage complex. If there is high clinical suspicion for TFCC injury, magnetic resonance arthrogram may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 41 days old, ex 28 weeker with history of presumed meningitis, now with poor head growth. Hemosiderin staining is evident along the germinal matrices bilaterally. Hemosiderin staining is also evident within the occipital horn of the left lateral ventricle. A small focus of susceptibility effect is demonstrated in the left cerebellar hemisphere.The corpus callosum is fully formed and intact. The pituitary region is within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable.No restricted diffusion is seen. The ventricular margins are smooth and symmetric. Ventricular size is within normal limits. No areas of parenchymal signal abnormality, edema or mass effect are observed.  The degree of cerebral gyration is appropriate for the corrected gestational age. White matter myelination is slightly delayed for the corrected gestational age.

Output: 1.Sequelae of mild bilateral germinal matrix hemorrhages are seen. In addition, there is evidence of hemosiderin staining within the left lateral ventricle which would imply some degree of intraventricular hemorrhagic extension. Ventricular size, however, remains within normal limits.2.A small focus of susceptibility effect within the left cerebellum is nonspecific. This could be artifactual or could represent a small area of chronic microscopic hemorrhage.3.No evidence of any large acute or chronic ischemic injury.4.The degree of gyral development is appropriate for the corrected gestational age. White matter myelination is slightly delayed for corrected gestational age.


Instruction: Generate impression based on medical findings.

Input: Possible choledocholithiasis on CT. Evaluate biliary ductal system. Patient with abdominal pain and acute pancreatitis. LUNG BASES: Mild dependent atelectasis.ABDOMEN:LIVER, BILIARY TRACT: There is moderate intrahepatic biliary ductal dilatation. The common bile duct is dilated to 9 mm with a rounded filling defect just proximal to the ampulla consistent with choledocholithiasis. There are numerous small gallstones in a distended gallbladder with a small amount of pericholecystic fluid suggesting mild acute cholecystitis.Mild loss of liver parenchymal signal on out of phase images suggests fatty infiltration.No focal hepatic lesion is evident.SPLEEN: No significant abnormality noted.PANCREAS: Mild diffuse restricted diffusion of the distal pancreatic body and tail which appears edematous/focal. There is minimal peripancreatic fluid. These findings are compatible with acute pancreatitis. No discrete fluid collection. Limited noncontrast evaluation for vascular complications shows no abnormality.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: Mild left lateral abdominal wall subcutaneous edema.OTHER: No significant abnormality noted.

Output: 1.Choledocholithiasis resulting in intra and extrahepatic biliary ductal dilatation.2.Numerous small gallstones within a distended gallbladder. Small amount of pericholecystic fluid. Again these findings suggest mild cholecystitis.3.Mild restricted diffusion of the pancreatic body and tail which appears full with mild peripancreatic nonloculated fluid compatible with mild pancreatitis, especially given the setting of elevated lipase.


Instruction: Generate impression based on medical findings.

Input: 69 year old man with history of smoldering myeloma and recent diagnosis of renal amyloidosis (AL type), currently under evaluation for autologous stem cell transplant candidacy. He was referred for cardiac MRI to evaluate for possible cardiac amyloidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 68 g/m2 (normal range 85+/-15), and the LV mass is 141 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is mild-moderate asymmetric left ventricular hypertrophy (septal thickness 12-13mm; posterior wall thickness7mm). Within the hypertrophied segment, the native myocardial T1 relaxation time is mildly elevated (1105ms). In the remainder of the myocardium, the native myocardial T1 relaxation time is within normal limits. There is late gadolinium enhancement in a "mid-wall stripe pattern" involving the basal inferior wall which is atypical for infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The extracellular volume fraction is elevated at 46% (normal 20-30%), which speaks to a diffuse infiltrative or fibrotic process. However, the gadolinium kinetics are not suggestive of overt cardiac amyloidosis. Left AtriumThe left atrium is moderate-severely dilated. The interatrial septum is aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 204 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet and opens widely with no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is posterior mitral annular calcification.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild atherosclerosis in the descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 62%) with evidence of asymmetric hypertrophy. 2. There is late gadolinium enhancement in a "mid-wall stripe pattern" involving the hypertrophied basal inferior wall. This pattern is not consistent with prior myocardial infarction. The finding suggests the presence of an underlying infiltrative or inflammatory process. There is additionally a focal area of increased myocardial T1 relaxation time within the hypertrophied segment. This regional variation in hypertrophy and T1 relaxation time is not classically seen in cardiac amyloidosis and may rather represent an another infiltrative process such as myocarditis, sarcoidosis, etc. However, there is significant global increase in extracellular volume fraction, which raises the possibility that these findings may potentially represent early cardiac amyloidosis. 3. The right ventricle is normal in size with normal systolic function (RVEF 54%).4. Moderate posterior mitral annular calcification. 5. Biatrial dilation. 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: Reason: Endometrial cancer compare to last MRI and measure 1) vaginal cuff mass, 2) left inguinal node and 3) r. common iliac node History: post SBRT and 4 cycles of immunotherapy PELVIS:UTERUS, ADNEXA: Status post TAH/BSO.At the vaginal cuff, a previously seen soft tissue mass measuring 4.6 x 8.0 cm (601:46) now measures 4.6 x 8.0 cm (1301:38). Again, the mass is ill-defined with numerous satellite nodules and peritoneal extension with additional peritoneal implants with reflecting carcinomatosis. There is extension throughout the parametrial fat with implants close to but not immediately associated with the sidewall (601/45). Tumor is present along the peritoneal reflection of the bladder. The mass also abuts the rectosigmoid colon (1301:39). There is enhancing tissue along the anterior surgical scar which also likely represents tumor.BLADDER: See above.LYMPH NODES: Previously enlarged left inguinal node measuring 2.3 x 1.7 cm (601/31) now measures 0.5 x 0.9 cm (1301:23). There are multiple enlarged pelvic lymph nodes with an enlarged right common iliac node measuring 2.1 x 1.4 cm (601/57), now measuring 1.2 x 1.0 cm (1301:48).BOWEL, MESENTERY: Large volume ascites causing dielectric artifact limiting evaluation. This ascites has layering low intensity on T2 images (1301:29) suggesting some proteinaceous/hemorrhagic component. BONES, SOFT TISSUES: Mild anasarca.OTHER: There is a large amount of abdominal ascites.

Output: 1.Grossly stable infiltrative soft tissue mass at the vaginal cuff with extension into the parametrial soft tissue, along the peritoneum, and with abutment of both the bladder and rectosigmoid colon. Measurements above. Grossly stable numerous peritoneal implants and extensive ascites.2. Interval decrease in size of reference lymph nodes as described above.


Instruction: Generate impression based on medical findings.

Input: History of persistent pelvic pain after vulvar surgery. PELVIS:UTERUS, ADNEXA: There are multiple ovarian follicles bilaterally which are peripherally distributed, unchanged from the prior. The right ovary measures 3.8 x 2.1 cm, the upper limits of normal. The left ovary measures 2.4 x 1.8 cm. These findings are likely physiologic for this patient but may be seen in the setting of polycystic ovarian syndrome or ovarian hyperstimulation syndrome.IUD is noted. The endometrial thickness is normal as is the junctional zone.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace pelvic free fluid is within physiologic limits.BONES, SOFT TISSUES: There are small Bartholin cysts bilaterally with the larger left-sided one measuring up to 6 mm.OTHER: No significant abnormality noted.

Output: No specific findings to account for the patient's persistent pelvic pain. See additional findings above.


Instruction: Generate impression based on medical findings.

Input: 33 year old man with aortic root dilation on echo, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is upper limits of normal with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 296 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 138 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 154 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.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is upper limits of normal size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 122 ml/m2 (normal range 82+/-16), the RVEDV is 339 ml (normal range 142+/-31), the RV end systolic volume index is 60 ml/m2 (normal range 31+/-9), and the RVESV is 167 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. No evidence of mitral valve prolapse.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root (ie, sinus of Valsalva) is moderately dilated; however, there is no effacement of the ST junction. No evidence of aortic dissection or coarctation. The thoracic aortic measurements are as below:Sinus of Valsalva - 45x47mmSinotubular junction - 37x37mmAscending Aorta - 36x36mmProximal Aortic Arch - 33x33mmMid Aortic Arch - 28x30mmDescending Aorta - 27x28mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is upper limits of normal size with low normal systolic function (LVEF 54%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Right ventricle is upper limits of normal size with low normal systolic function (RVEF 51%).3. The aortic root (ie, sinus of Valsalva) is moderately dilated; however, there is no effacement of the ST junction. Beyond the Sinus of Valsalva, the thoracic aorta looks unremarkable. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with pain, evaluate for TFCC tear LIGAMENTS: Evaluation of the intrinsic ligaments of the wrist is limited due to lack of intra-articular contrast. No discrete fluid-filled tear of either ligament is evident.TRIANGULAR FIBROCARTILAGE COMPLEX: No fluid-filled tear is evident. However, there is intermediate signal along the undersurface of the disc suggesting degeneration. Heterogeneity of the fibers of the TFCC adjacent to the ulnar styloid is suggestive of degeneration and/or synovitis.TENDONS: Mild surface irregularity of the tendons of the first dorsal compartment with minimal fluid surrounding the tendons may reflect partial tearing and/or tenosynovitis of questionable current clinical significance. Increased signal along the extensor digitorum tendons dorsal to the the radius may reflect mild tenosynovitis, also of questionable current clinical significance. Volar bowing of the flexor retinaculum probably reflects prior carpal tunnel release.BONES: Small cysts are noted within the proximal pole of the scaphoid and trapezium, likely degenerative. ADDITIONAL

Output: 1.Findings suggestive of degeneration/proximal surface fraying of the TFCC articular disk without discrete fluid-filled tear.2.Mild synovitis and other findings as above.


Instruction: Generate impression based on medical findings.

Input: There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Minimal posterior osteophyte disc complex without stenosis.C3/4: Posterior osteophyte disc complex effaces the anterior CSF and causes slight anterior cord flattening without intrinsic cord signal abnormality. There are no significant stenoses.C4/5: Posterior osteophyte disc complex effaces the anterior CSF and causes slight anterior cord flattening without intrinsic cord signal abnormality. There are no significant stenoses.C5/6: Posterior osteophyte disc complex effaces the anterior CSF and causes slight anterior cord flattening without intrinsic cord signal abnormality. There are no significant stenoses.C6/7: Mild posterior osteophyte disc complex with a small right paracentral disc extrusion that extends slightly above the disc level, causing mild proximal and focal right neural foraminal stenosis, abutting adjacent traversing nerve roots.C7/T1: Unremarkable

Output: 1.C6/7: Mild posterior osteophyte disc complex with a small right paracentral disc extrusion that extends slightly above the disc level, causing mild proximal and focal right neural foraminal stenosis, abutting adjacent traversing nerve roots.2.Cervical spondylytic changes elsewhere as described in detail above without significant associated stenoses.


Instruction: Generate impression based on medical findings.

Input: 17 year-old male with hydrocephalus, status post ventriculoperitoneal shunt Stable in size of the ventricles is observed when compared to the prior examinations on coronal view images. The slightly increased in size represent on axial view may be secondary to acquisition position difference between the studies. Right frontal ventriculostomy catheter is unchanged in position, with distal tip at the level of the third ventricle. The fourth ventricle remains dilated, with bilateral cerebellar encephalomalacia, which is stable. Suboccipital craniotomy, with adjacent dystrophic calcifications is also stable. Redemonstration of the encephalomalacia in left frontal periventricular white matter, consistent with previous instrumentation change. No evidence of acute intracranial hemorrhage, midline shift or hydrocephalus. Gray-white matter differentiation is preserved. The visualized paranasal sinuses and mastoid air cells are well-pneumatized. There is redemonstration of C1 congenital platybasia.

Output: 1. Interval stable in size of the supratentorial ventricular system, as described above. The slightly increased in size represent on axial view may be secondary to acquisition position difference between the studies. 2. Stable in position of the right ventriculostomy catheter. Postsurgical changes, and stable encephalomalacia in the posterior fossa.


Instruction: Generate impression based on medical findings.

Input: History of lung carcinoma with left facial droop and seizure. Evaluate for stroke versus metastases. There is redemonstration of a 5 x 5 mm left lateral temporal extra-axial enhancing lesion causing minimal focal mass effect on the adjacent left inferior temporal gyrus cortex. There is associated T2/flair hyperintensity. There is no acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses are clear. The skull and extracranial soft tissues are unremarkable.

Output: No significant interval change in a 5 mm left lateral temporal extra-axial enhancing lesion presumably represents a tiny meningioma. Minimal adjacent mass effect on the adjacent cortex. Otherwise, no abnormal parenchymal or meningeal enhancement is seen to suggest metastatic disease. No evidence of acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: A 5 mm focus of T2 hyperintensity with associated mild enhancement and restricted diffusion is again seen in the left centrum semiovale, unchanged from the previous study. A similarly sized right parietal lobe nonenhancing T2 hyperintense lesion without restricted diffusion is also unchanged from the previous study.Patchy enhancing T2 hyperintensity that was present on the previous studies involving the left medial temporal lobe, lateral thalamus and basal ganglia also shows no significant interval change. Single voxel spectroscopy of this lesion demonstrates decreased NAA, decreased choline, and decreased creatine relative to the contralateral normal side. rCBV imaging shows reduced cerebral blood volume correlating to all the above noted lesions.Streaky enhancement in the right parietal lobe is seen in a peri-venular pattern, unchanged. No new signal abnormality or pathologic enhancement is detected. No evidence of hemorrhage, mass effect, or edema is seen. The ventricular size is normal with no midline shift.

Output: 1. No change in the appearance of the high T2/FLAIR signal and enhancing lesions in the left temporal lobe, right parietal lobe, and the left centrum semiovale.2. Spectroscopic pattern of the dominant left temporal lesion is compatible with parenchymal injury and argues against an aggressive or highly proliferative neoplastic process.3. There is a reduced cerebral blood volume within the described lesions that also argues against an aggressive neoplastic process.4. Differential diagnosis favors inflammatory or granulomatous conditions such as sarcoidosis or lupus, post inflammatory auto-immune phenomena, and atypical demyelinating disease.


Instruction: Generate impression based on medical findings.

Input: Worsening clinical symptoms of C6 bilateral weakness. Please evaluate for cervical myelopathy and compare to old outside MRI's from 2013. There is straightening of the cervical spine with mild retrolisthesis of C3 on C4. The vertebral body heights are preserved. There is loss of disc height at C3-C4 through C6-C7 with endplate degenerative changes. The vertebral bone marrow signal is mildly heterogeneous with increased STIR signal at the anterior inferior aspect of the C6 vertebra, which is unchanged from 2013. The spinal cord displays normal signal characteristics. The paravertebral soft tissues are unremarkable.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Disc bulge, uncinate spurs, thickening of the ligamentum flavum and facet arthropathy, contributing to flattening of the ventral cord, severe spinal canal and mild right and moderate left foraminal stenosis, without significant interval change.C4-C5: Posterior disc-osteophyte complex, uncinate spurs, thickening of the ligamentum flavum and facet arthropathy, contributing to flattening of the ventral cord, mild spinal canal and mild bilateral foraminal stenosis, without significant interval change.C5-C6: Posterior disc-osteophyte complex, uncinate spurs, thickening of the ligamentum flavum and facet arthropathy, contributing to flattening of the ventral cord, severe spinal canal and severe bilateral foraminal stenosis, without significant interval change.C6-C7: Posterior disc-osteophyte complex, uncinate spurs, thickening of the ligamentum flavum and facet arthropathy, contributing to mild spinal canal and mild bilateral foraminal stenosis, without significant interval change.C7-T1: Small central disc protrusion and bilateral uncinate spurs, contributing to mils bilateral foraminal stenosis. No significant spinal canal stenosis. T1-T2: Small central disc protrusion with slightly increased left foraminal disc protrusion, contributing to moderate left foraminal stenosis. No significant spinal canal or right foraminal stenosis.

Output: 1. Advanced degenerative cervical spondylosis, most prominent at C3-C4 and C5-C6 with severe spinal canal stenosis and flattening of the ventral cord at these levels without definite abnormal spinal cord signal. 2. Slightly increased left foraminal disc protrusion at T1-T2, contributing to moderate left foraminal stenosis. Otherwise, no significant interval change since 9/19/2013.3. Nonspecific increased STIR signal at the anterior inferior aspect of the C6 vertebra is unchanged and likely represents degenerative endplate edema. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old, with mild erosion of the calvarium. An extra-axial mass with a broad base of dural attachment is seen along the left paramedian vertex measuring up to 21 mm in AP length and up to 13 mm in thickness. The lesion is mildly enhancing. The lesion barely contacts the underlying brain parenchyma causing no significant parenchymal edema. It does, however, appear to infiltrate the overlying calvarial bone, permeating through the inner table and thinning but not definitely eroding through the outer table.No additional enhancing lesions are seen intra or extracranially. Scattered nonspecific foci of T2 hyperintensity are seen within the cerebral hemispheres without significant mass effect. No restricted diffusion is seen. No intracranial hemorrhage or abnormal extra-axial fluid collections are detected. The ventricular system is normal in size and morphology.

Output: A small extra-axial mass is seen along the left vertex with invasion into the overlying skull. The differential diagnosis would include meningioma, perhaps an atypical variant given the osseous erosion. Other mesenchymal tumors including hemangiopericytoma and hemangioendothelioma can be considered. Although metastasis would be unusual without a known primary, this would technically be in the differential as well.


Instruction: Generate impression based on medical findings.

Input: Male; 70 years old. Reason: prostate cancer s/p surgery now with detectable PSA. evaluate for local recurrence History: none PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.BLADDER: Mild circumferential bladder wall thickening, suggestive of hypertrophy from chronic outlet obstruction.LYMPH NODES: Scattered subcentimeter bilateral inguinal lymph nodes, but no enlarged lymph nodes by size criteria.BONES, SOFT TISSUES: Pagetoid changes of the pelvic bones, right greater than left, similar to prior CT. No definite osseous metastatic disease.OTHER: No significant abnormality noted.

Output: No evidence of residual or recurrent disease. Consider bone scintigraphy for evaluation of osseous metastatic disease, which may be more sensitive.


Instruction: Generate impression based on medical findings.

Input: Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm [E05.20], Reason for Study: ^Reason: staging, newly diagnosed lung cancer History: newly diagnosed lung cancer There is about 5 mm sized ring-enhancing lesion on the right corpus callosum body without significant mass effect. The lesion shows restricted diffusion with FLAIR high signal intensity. There are also multiple FLAIR high signal intensity lesions located on subcortical white matter and deep white matter but those lesions do not show any evidence of enhancement.Diagnostic possibilities include demyelinating disease such as multiple sclerosis with active plaque, subacute ischemic infarction and considering the patient history of primary malignancy (lung cancer), the diagnosis of metastatic lesion cannot be excluded. There is no other abnormal enhancing lesion is seen.There is no evidence of acute hemorrhagic or ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Single ring enhancing lesion with restricted diffusion at the right corpus callosum body with multiple FLAIR high signal intensity lesions as described above. Diagnostic possibilities include demyelinating disease such as multiple sclerosis, subacute ischemic infarction and metastatic lesion.No evidence of acute hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: Right knee pain MENISCI: There is an oblique tear through the body of the lateral meniscus, extending to the tibial surface with adjacent parameniscal cysts. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There are bone contusions in the medial femoral condyle, tibial plateau and to a lesser degree the lateral femoral condyle. There is mild fissuring of the articular cartilage of the lateral femoral condyle, otherwise the articular cartilage is intact.LIGAMENTS: The anterior cruciate ligament is chronically torn. The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Chronic tear of the ACL.2.Oblique tear through the body of the lateral meniscus. 3.Bone contusions in the distal femur and proximal tibia.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate nodules on dorsum of L hand History: painful nodules on ulnar dorsum of L hand x 3 months, no trauma Note is made of 2 skin markers overlying the dorsal aspect of hand and wrist. Underlying these markers are 2 prominent superficial veins. There is decreased signal intensity centrally within the aforementioned prominent vessel along the dorsal aspect of the fifth metacarpal which may represent a small central thrombus. Otherwise no masses are identified. The imaged musculature of the wrist and hand is normal in appearance. No bone marrow signal abnormality is identified.

Output: Slightly prominent superficial veins along the dorsum of the hand. There is central low intensity within the prominent superificial vein along the dorsal aspect of the fifth metacarpal which is nonspecific but may represent superficial venous thrombosis. This could be further evaluated with ultrasound examination with Doppler interrogation if clinically warrented.


Instruction: Generate impression based on medical findings.

Input: Six rule female with history of intracranial METs, now with right-sided headache. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse periventricular and subcortical white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Noncontrast evaluation is limited for evaluation of tumor.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute change.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer. On active surveillance. Pathology dated 4/3/2015 shows a left mid gland prostate cancer with a Gleason grade of 3+3 PELVIS:PROSTATE:Prostate Size: 3.4 x 5.5 x 5.8 cmPeripheral Zone: 6 x 5 mm focus in the left mid gland (series 4 and 3/304) with restricted diffusion and corresponding subtle T2 hypointensity.Central Gland: No focal suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 6 x 5 mm left mid gland lesion is compatible with the patient's known pancreatic cancer.No additional suspicious lesions.


Instruction: Generate impression based on medical findings.

Input: There is no significant change in the size or appearance of a non-enhancing focus of susceptibility effect in the right postcentral gyrus measuring 1 to 2mm in diameter. There are no new intracranial lesions. There is unchanged confluent cerebral white matter T2 hyperintensity, which is likely related to radiation therapy. There is no abnormal intracranial enhancement or diffusion abnormality. There is no evidence of intracranial hemorrhage or acute infarction. The ventricles, sulci, and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no midline shift. There is scattered mild paranasal sinus mucosal thickening, as well as persistent fluid signal within the bilateral mastoid air cells.

Output: Unchanged appearance of a punctate focus of susceptibility effect in the right postcentral gyrus, and no evidence of new metastatic 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: Male, 74 years old, with cognitive decline and poorly defined lesion in the left temporal lobe on prior exam. Image quality is slightly reduced by motion artifact. Furthermore, the patient was unwilling to receive IV contrast and therefore only noncontrast imaging was obtained.T2 hyperintensity is redemonstrated within the left amygdala and hippocampal head. As before, this abnormal tissue seems to contain one or two small cystic spaces. There is no associated mass effect. No susceptibility or restricted diffusion is seen. Cystic spaces in the adjacent temporal stem likely represent dilated perivascular spaces. No significant change is seen in the size or morphology of this abnormal tissue when compared to both prior examinations.Elsewhere in the brain, numerous foci of white matter T2 hyperintensity are redemonstrated, similar in number and distribution to the prior exam. No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricular system is normal in size and morphology.

Output: Abnormal signal involving the left amygdala and hippocampal head is again seen without significant interval change. Notably, this lesion is associated with no mass effect or other concerning secondary features.The lesion remains nonspecific, but given the absence of mass effect and its stability dating back to January 2015, chronic sequela of prior parenchymal injury or inflammation is favored over an active inflammatory or neoplastic process. If continued follow-up is desired on clinical grounds, a longer interval (at least 6-12 months) would probably be appropriate.Elsewhere, numerous foci of cerebral white matter signal abnormality are seen which statistically most likely reflect chronic small vessel ischemic disease. No definite acute intracranial abnormalities are seen.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with pain and swelling in the right index finger. Evaluate for tenosynovitis versus chronic fluid collection or osteomyelitis There is nonspecific soft tissue edema involving the index finger with slight thickening of the skin. There is edema and enhancement of the underlying subcutaneous fat. There is also enhancement of the nail bed. There are small foci of low signal intensity within the soft tissues along the radial aspect of the distal phalanx which are nonspecific but could represent small foreign bodies, which were not seen recent radiographs. Mild enhancement of the synovium of the flexor tendon apparatus is suggestive of mild tenosynovitis. There is mild enhancement of the synovium of the PIP joint of the index finger suggestive of mild synovitis, although we see no frank fluid within the joint. We see no frank fluid collection nor do we see bone marrow signal abnormality to suggest osteomyelitis.

Output: Nonspecific inflammatory changes of the finger as described above. Small foci of low signal intensity within the soft tissues adjacent to the phalanx could represent foreign bodies but were not seen on recent radiographs and could also represent small foci of gas or small foci of hemosiderin from prior bleeding. We see no abscess or osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Solitary fibrous tumor of the left maxillary sinus and orbit, status post partial resection. There is no significant interval change in size of the mass centered within the left orbit with extension into the adjacent paranasal sinuses, premaxillary space, and masticator space. Overall, the tumor measures approximately 45 mm in width, 50 mm in height, and 40 mm in length. However, the tumor has grown gradually since June 2015, at which time it measured up to approximately 45 mm in greatest dimension. There is marked left proptosis and compression of the optic nerves and most of the extraocular muscles, with relative sparing of the superior rectus. There are postoperative findings in the left maxillary sinus, with moderate mucosal thickening. The right orbit is unremarkable. There is no evidence of intracranial extension of tumor. There is a subcentimeter cystic lesion in the left superficial parotid tumor.

Output: No appreciable interval change in size of the solitary fibrous tumor involving the left orbit with extension into the adjacent paranasal sinuses, premaxillary space, and masticator space. However, the tumor has grown gradually since June 2015.


Instruction: Generate impression based on medical findings.

Input: Ms. Muzzareli is a 65 year old female with a history of right mastectomy in April 2013 for IDC and recent reduction surgery in the left breast. She received radiation chemotherapy and hormonal therapy. History of breast reduction in July 2014. Family history of breast cancer in her sister (diagnosed at age 50), maternal cousin (diagnosed at age of 40), maternal aunt and two paternal aunts. There is heterogeneous amount of fibroglandular tissue in left breast. Left breast appears smaller in size and different distribution pattern as compared to prior exam cocnsistent with recent history of reduction surgery. Mild parenchymal enhancement is noted in left breast. Patient is status post right mastectomy with reconstruction.Multiple enhancing foci in the left breast, none of them are uniquely enhancing. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region. Seroma cavity in right axillary region is smaller in size from recent MRI study.

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


Instruction: Generate impression based on medical findings.

Input: History of Crohn's ileitis. Evaluate extent of disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel is adequately distended with oral contrast. Approximately 8 cm of the distal and terminal ileum demonstrates two fixed strictures of T2-weighted hypointense circumferential wall thickening with intervening skipped segments of small bowel demonstrating normal wall thickening and mild pseudosacculation (series 5, image 19 through 21). Along the dorsal aspect of this segment of bowel (series 5 image 21) the focal outpouching may represent pseudosacculation and less likely tethered adjacent small bowel. There is no significant associated postcontrast enhancement, adjacent mesenteric inflammatory changes or restricted diffusion to suggest acute inflammation. The proximal small bowel is normal in caliber, wall thickness and enhancement. No free or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suspected chronic fibro-stenotic disease affecting approximately 8 cm of the distal and terminal ileum with focal strictures and intervening pseudosacculated spared bowel segments without evidence of acute inflammation.


Instruction: Generate impression based on medical findings.

Input: History of sarcoidosis and rheumatoid arthritis with left eye pain and headache. Evaluate for neurosarcoid involvement, mass, blood, or other. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There are no areas of abnormal signal or pathological enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Previously seen Tornwaldt's cyst is no longer appreciated. Limited evaluation of the orbits is unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage, mass effect, or acute infarct.2.No abnormal intracranial enhancing lesion to suggest active neurosarcoid.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: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex causes slight anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy. There is mild central, mild left neural foraminal, and moderate to severe right neural foraminal stenosis.C4/5: Trace retrolisthesis C4 on C5, posterior osteophyte disc complex causing slight anterior cord flattening without intrinsic cord signal abnormality, and bilateral uncinate hypertrophy. There is mild central, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.C5/6: Trace retrolisthesis C5 on C6, posterior osteophyte disc complex causing slight anterior cord flattening without intrinsic cord signal abnormality, and bilateral uncinate hypertrophy. There is mild central, severe left neural foraminal, and mild to moderate right neural foraminal stenosis.C6/7: Minimal posterior osteophyte disc complex and left uncinate hypertrophy. There is mild left neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C3/4: Mild central, mild left neural foraminal, and moderate to severe right neural foraminal stenosis.2.C4/5: Mild central, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.3.C5/6: Mild central, severe left neural foraminal, and mild to moderate right neural foraminal stenosis.4.C6/7: Mild left neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Low back pain radiating to the left lower extremity. There is mild degenerative spondylosis of the lower lumbar spine, with mild bilateral L4-5 and left L5-S1 neural foraminal stenosis, but no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are bilateral physiologic ovarian cysts.

Output: Mild degenerative spondylosis of the lower lumbar spine, with mild bilateral L4-5 and left L5-S1 neural foraminal stenosis, but no significant spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Craniocervical junction appears within normal limits. Vertebral body heights are within normal limits. Alignment is grossly maintained. Bone marrow signal is benign. There is diffuse narrowing of the upper and mid cervical spinal canal on a congenital basis primarily related to pedicle hypoplasia. Neural foramina are diffusely narrowed on a congenital basis as well.There is focal increased signal within the cord at C5-C6 at the site of a disc extrusion which is suspected to represent edema. Individual levels as below:C2-C3: Mild to moderate right neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis. C3-C4: Moderate left greater than right neural foraminal narrowing. Mild to moderate spinal canal narrowing on a congenital basis.C4-C5: Mild to moderate left neural foraminal stenosis and mild right neural foraminal stenosis. There is mild to moderate spinal canal stenosis on a congenital basis. C5-C6: There is a disc extrusion causing moderate to severe narrowing of the spinal canal. There is moderate to severe left and moderate right neural foraminal stenosis. Abnormal T2 signal noted in the bilateral cervical cordC6-C7: Mild to moderate right and minimal left neural foraminal narrowing. No significant spinal canal narrowing.C7-T1: No significant spinal canal stenosis. Moderate left and mild right neural foraminal narrowing.Focus of low signal posterior to the thecal sac at T2-T3 seen only on the sagittal sequences is suspected to represent ligamentous calcification and causes mild narrowing of the spinal canal.

Output: 1.Disc extrusion at C5-C6 results in moderate to severe spinal canal narrowing and T2 hyperintensity involving the cervical cord which is suspected to represent edema. There is also moderate to severe neural foraminal narrowing on the left and moderate on the right.2.Congenital narrowing of the upper and mid cervical spinal canal as well as of the neural foramina. There are mild superimposed degenerative changes with resulting stenoses as detailed above. 3.Focus of low signal posterior to the thecal sac at T2-T3 may represent a focus of ligamentous calcification and causes mild narrowing of the thoracic canal.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: Head of pancreas mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity, size and enhancement.Several small rim-enhancing lesions are compatible with metastatic disease the largest being a segment 2/3 lesion measuring 1.7 x 1.3 cm (series 1203/43) lesion. Additional lesion in segment 5. Several posterior segment lesions are too small to definitively characterize but demonstrate mild T2-weighted hyperintensity and restricted diffusion. The vessels are patent.Severe extra and moderate intrahepatic biliary ductal dilatation with common duct measuring 1.8 cm. The duct abruptly transitions at the level of the pancreatic head mass.SPLEEN: The spleen is normal in size morphology and signal intensity.PANCREAS: Heterogeneous pancreatic head mass measuring approximately 3.8 x 3.2 cm (series 5/14). There is mild pancreatic parenchymal atrophy distally and main pancreatic ductal dilatation up to 4 mm which is displaced dorsally.The GDA is encased by tumor and is not clearly opacified distally. Otherwise the celiac trunk and its branch vessels are patent. The superior mesenteric artery is spared.The lesion abuts approximately 90 degrees of the superior mesenteric vein, however the portal vein confluence and splenic vein appears spared.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small peripancreatic and aortocaval lymph nodes, the largest measuring 1.0 x 0.7 cm (series 1201/82).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Head of the pancreas mass with bilobar hepatic metastases and vascular involvement as described above.Severe extrahepatic and moderate intrahepatic biliary ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: 55 years Male (DOB:6/5/1961)Reason: Re-evaluate for disease progression- known history of brain metastases with recent falls History: Stage IV melanoma with recent fallsPROVIDER/ATTENDING NAME: JASON JOHN LUKE JASON JOHN LUKE The patient status post right parietal craniotomy.There are numerous foci of the susceptibility effect scattered in both hemispheres of the brain and in the cerebellum without any significant contrast enhancement. Compared to the previous exam these do not appear to have changed one in the left parietal lobe currently measures 5 mm and previously measured the same.The patient is status post right-sided parietal craniotomy. There is encephalomalacia present along the right inferior parietal lobule extending to the right temporal lobe associated with susceptibility effect.There is redemonstration of diffuse periventricular and subcortical white matter confluent signal changes which were also present on the previous exams to a similar extent.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.There are multiple hemorrhagic type lesions scattered throughout the brain which appear relatively stable compared to the exam from July. The patient is known to have metastatic melanoma to the brain.2.Extensive and diffuse white matter signal changes have been present on prior exams and are most likely treatment related.


Instruction: Generate impression based on medical findings.

Input: 58-year-old man with history of new left lower pole renal cyst seen on ultrasound and chronic renal disease. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter cyst in the left lobe of the liver The liver appears otherwise normal. There is no intrahepatic biliary duct dilatation. The gallbladder is normal.SPLEEN: The spleen is normal.PANCREAS: There is mild prominence of the pancreatic duct in the pancreatic head. The pancreatic parenchyma is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a 17 x 16 mm simple renal cyst in the inferior pole of the left kidney. Innumerable additional bilateral renal cysts are identified.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited study with simple left lower renal pole cyst. Along with innumerable additional cysts bilaterally is likely related to hemodialysis.


Instruction: Generate impression based on medical findings.

Input: Low back pain, evaluate for lumbar stenosis. Please note for the purposes of numbering, there appear to be 6 nonrib-bearing lumbar type vertebral bodies. The most inferior well-defined disc space is labeled L6-S1. Vertebral body heights are grossly maintained without evidence of an acute compression fracture. There is minimal retrolisthesis of L2 on L3 and L4 on L5. Bone marrow signal is benign, with prominent edematous marrow signal changes noted involving the inferior L3 vertebral body and to a lesser degree involving the endplates more inferiorly related to degenerative disease. There is severe disc height loss affecting the L2-L3, L4-L5, and L5-L6 levels. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disc bulge and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is relatively mild bilateral narrowing of the neural foramina, however, the exiting right-sided nerve root may be impinged extra-foraminally related to prominent right lateral osteophyte.L3-L4: There is moderate to severe spinal canal stenosis related to disc bulge, facet arthropathy, ligamentum flavum thickening, and prominence of the dorsal epidural fat at this level. There is moderate to severe right and moderate left neural foraminal stenosis.L4-L5: Mild retrolisthesis and bilateral facet arthropathy contribute to partial effacement of the lateral recesses, right worse than left, but without significant central canal stenosis. There is severe right and moderate left neural foraminal stenosis.L5-L6: There is a dorsal annular fissure with tiny central protrusion superimposed on a mild bulge. There is bilateral facet arthropathy, more advanced on the right. There is mild effacement of the right lateral recess. No significant central canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis. L6-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues demonstrate some lower lumbar paraspinous muscular atrophy but are otherwise unremarkable.

Output: 1. Please note transitional anatomy with 6 presumed lumbar type vertebral bodies and the most inferior preserved disc space labeled L6-S1 for the purposes of this study.2. Degenerative changes throughout the lumbar spine with up to moderate to severe spinal canal stenosis at the L3-L4 level. Multilevel neural foraminal stenosis is also seen as detailed above.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female patient with idiopathic myopathy; hereditary with cramps and weakness. Question of myositis. Bone marrow signal is within normal limits. No abnormal signal or enhancement is noted within the visualized musculature. No discrete mass is identified. The visualized tendons are intact. The subcutaneous tissues are unremarkable.Imaging of the left knee is suboptimal, however, there does appear to be a small effusion and minimal enhancement of the synovium which may represent synovitis. The visualized pelvic structures are unremarkable.

Output: 1. No signal abnormality within the visualized musculature to suggest myositis. 2. Suboptimal evaluation of the knee though with minimal enhancement of the synovium which may represent synovitis; please refer to prior dedicated MR knee report.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with a history of bilateral breast cancer s/p right lumpectomy and radiation 12/2013 and left mastectomy in 06/2014. Status post left mastectomy and retropectoral silicone implant placement.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Stable intramammary lymph node is present in the right posterior 9:00 position. No abnormal enhancement is seen in right breast or in the left reconstructed breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: 50 year old man with heart/kidney transplant on 10/22/15, referred for screening of cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. There is borderline left ventricular hypertrophy (wall thickness10mm). The overall LV ejection fraction is 66%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 155 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 52 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 96 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. Qualitatively, the myocardial to skeletal T2-enhancement ratio is 1.6, which is in the normal range. The global relative enhancement is 1.68, which is in the normal range. The native myocardial T1 time in the interventricular septum is 1200 ms, which is significantly elevated and can represent edema or interstitial fibrosis. The extra-cellular volume fraction (ECV) is 37%, which is elevated. Left AtriumThe left atrium is consistent with transplant.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 62 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 59 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsSternal wires are present. There is significant iron overload of the liver and spleen. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%.2. The myocardial to skeletal T2 ratio and global relative enhancement are normal. There is no late gadolinium enhancement. These findings all speak against acute rejection. The native myocardial T1 time and the extracellular volume fraction are both elevated which could suggest rejection; however, these values would also be expected to be elevated early after heart transplantation. The earliest reported native T1 time for post-transplant myocardium was measured at 6-7 weeks and was 1100ms with a steady decline over the subsequent months. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%.4. Significant iron overload of the spleen and liver.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: 29-year-old male with history of NF1, known plexiform tumor in the pelvis. Evaluate plexiform neurofibroma. Again seen are innumerable masses of high signal intensity on STIR images, many having a target appearance, within the skin as well as within the subcutaneous and deep soft tissues of the pelvis compatible with nerve sheath tumors and the known history of neurofibromatosis type I. Plexiform neurofibromas involve the lumbar and sacral nerve roots as well as both sciatic nerves, extending beyond the field-of-view of this study. There are also plexiform neurofibromas involving both femoral nerves, slightly prominent on the right. Additional neurofibromas are noted within the pelvis as well as the surrounding musculature but there is no single dominant lesion to suggest malignancy, within the limitations of this noncontrast examination. Previously referenced lesion along the lateral aspect of the right abductor musculature is not included in its entirety on the current study, however is not significantly changed measuring 2.2 x 1.1 cm, previously 2.2 x 1.3 cm (series 301, image 24). Additional previously referenced lesion within the left rectus femoris muscle belly measures 0.8 x 0.8 cm, previously 0.8 x 0.8 cm (series 301, image 20). The bone marrow signal intensity is within normal limits. The hip joints, sacroiliac joints and pubic symphysis are unremarkable.

Output: Findings compatible with neurofibromatosis with plexiform neurofibromas overall stable in size.


Instruction: Generate impression based on medical findings.

Input: Female, 16 years old, with headaches, pseudotumor cerebri, punctate periventricular white matter lesions, yearly follow-up examination. MRI brain:Ill-defined small foci of T2 hyperintensity within the white matter along the left frontal horn are unchanged. No new parenchymal signal abnormality is detected. No edema or mass effect is seen. Diffusion-weighted images are normal. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is stable and normal in size.MRV brain:The dural venous sinuses and the major deep cerebral veins are patent.MRI cervical spine:Alignment is anatomic. Vertebral body morphology and signal characteristics are normal. Minimal prominence of the central canal of the spinal cord beginning at C4 is unchanged and within normal limits. The spinal cord otherwise shows normal morphology and signal characteristics. No epidural abnormalities are seen. No compromise of the spinal canal or neural foramina is suspected.MRI thoracic spine:Alignment is anatomic. Vertebral body morphology and signal characteristics are normal allowing for focal fat within the T6 vertebral body. Mild prominence of the central canal of the spinal cord is again seen, unchanged and within normal limits. No epidural abnormalities are seen. No compromise of the spinal canal or neural foramina is suspected.

Output: 1.Small foci of white matter signal abnormality along the left frontal horn are unchanged. No new or significant intracranial findings.2.No evidence of dural venous sinus thrombosis.3.Evaluation of the cervical and thoracic spine shows no significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Right lower extremity pain. Right sciatica. Evaluate for radiculopathy. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. A benign hemangioma is evident in the L3 vertebral body. There is mild-to-moderate disc space narrowing at L5-S1, otherwise disc heights are preserved. Endplate edema at L5-S1. The conus medullaris appears normal and terminates at the L1-2 level.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: Mild facet hypertrophy and mild bilateral foraminal narrowing. No significant spinal canal stenosis. L5-S1: Mild facet arthropathy and bilateral mild-to-moderate neural foraminal narrowing. Broad-based disc bulge with osteophytic ridging. No significant spinal canal stenosis.

Output: Facet hypertrophy and bilateral foraminal narrowing at L4-5 and L5-S1 as described above.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female status post right TKA with history of CVA. As increased irritability and decreased responsiveness. Rule out subdural hematoma or infarction. The examination demonstrates some periventricular hypodensity consistent with small vessel ischemic disease. In the left temporal region there is an area of hypodensity which may or present area of acute ischemia. The appearance is somewhat atypical however with a central area of relative hyperdensity. I cannot exclude the possibility of prior hemorrhage or even underlying mass lesion.. No significant mass-effect is seen. I would recommend obtaining an MRI of the brain with contrast to further evaluate this region.Bone windows reveal no osseous abnormality.

Output: Small vessel disease an area of atypical density along the left temporal lobe. Possibilities include an area of subacute ischemia versus evolving hematoma (possibly evolution of hemorrhagic transformation of an infarct) or less likely mass lesion. MRI of the brain with contrast is recommended to fully evaluate.


Instruction: Generate impression based on medical findings.

Input: 50 years Female (DOB:8/30/1965)Reason: new onset tremor, left arm resting tremor as well as action tremor bilaterally History: new onset tremor, left arm resting tremor as well as action tremor bilaterallyPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. Exam is mildly degraded due to patient motion.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No abnormal mass lesions are appreciated within the brain parenchyma to explain the patient's symptoms. Exam is mildly degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on medical findings.

Input: Abdominal discomfort, acholic stool and 20 pounds weight loss. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The liver is normal in morphology, size and signal intensity. No focal lesion biliary ductal dilatation or vascular abnormality.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: Moderate fatty atrophy of the pancreas without pancreatic ductal dilatation. No focal lesion is identified.There is a small subcentimeter branch type IPMN at the level of pancreatic head versus minimal side branch ectasia/dilatation versus . Normal intrinsic T1-weighted signal intensity of the pancreas. No evidence of acute inflammation. Following secretin administration there is normal dilatation of the main pancreatic duct and excretory function.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: Moderate fatty atrophy of the pancreas without pancreatic ductal dilatation or focal lesion. No specific evidence of acute or chronic inflammation.Probable subcentimeter branch type IPMN at the level of the pancreatic head versus minimal side branch ectasia/dilatation.


Instruction: Generate impression based on medical findings.

Input: 3-year-old female with retrognathia and oligoarticular JIA with knee and ankle swelling Right temporomandibular joint: Limited study with the patient under sedation limiting ability to obtain dedicated open and closed mouth views. The meniscus of the right TMJ is appropriately situated between the mandibular condyle and the articular eminence on the closed mouth view. The meniscus remains appropriately situated between the condyle and articular eminence on the limited open mouth view. Minimal enhancement of the synovium of the TMJ may reflect a very mild synovitis although this is equivocal. No erosions or abnormal marrow signal is evident. Partial opacification of right mastoid air cells with enhancement indicating inflammation.Left temporomandibular joint: Limited study with the patient under sedation limiting ability to obtain dedicated open and closed mouth views. The meniscus of the right TMJ is appropriately situated between the mandibular condyle and the articular eminence on the closed mouth view. The meniscus remains appropriately situated between the condyle and articular eminence on the limited open mouth view. Minimal enhancement of the synovium of the TMJ may reflect a very mild synovitis although this is equivocal. No erosions or abnormal marrow signal is evident.

Output: 1.Limited examination as described above.2.Minimal enhancement of the TMJs bilaterally may reflect a very mild synovitis, but this is equivocal. No erosions or bone marrow enhancement.3.Opacification/inflammation of the right mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: Female 58 years old with Hx of R-ear hearing loss, bifrontal headaches worse when lying supine, periods of sweating and blurred vision, evaluate for structural abnormality. There is a lobulated suprasellar mass, measuring 15 mm craniocaudal x 10 mm transverse x 13 mm anteroposterior dimension, which enhances homogeneously and is situated along the right optic tract/chiasm. It appears to have a dural attachment along the posterior planum sphenoidale and projects into the suprasellar cistern with impingement on the right optic nerve and chiasm, displacing it posteriorly. Although it enhances similarly to the pituitary gland, it appears separate from the gland itself and is extra-sellar in origin. Although these are not dedicated pituitary images, the pituitary gland appears to be normal in morphology.No evidence of other enhancing intracranial lesions, hemorrhage, or restricted diffusion to suggest acute infarct. There are a few nonenhancing focal periventricular T2/FLAIR hyperintense lesions, which are nonspecific. 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.

Output: Lobulated dural based extra-axial mass situated along the planum sphenoidale just anterior and superior to the sella with no definite sellar involvement. The lesion impinges on the right optic nerve and chiasm. The pituitary gland itself appears unremarkable. The differential includes a meningeal-based tumor such as a meningioma or hemangiopericytoma. Additional considerations include germinoma and craniopharyngioma.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old, with Hashimoto's encephalopathy, assess for structural damage. Scattered foci of cortical restricted diffusion are seen involving both cerebral hemispheres. Since the prior examination, some previous lesions have diminished or resolved while other lesions are new. T2/FLAIR hyperintensity is evident correlating to these areas of restricted diffusion and as with the diffusion findings, many of these areas are new from prior. Of note, progressive T2 FLAIR signal abnormality is seen within the cerebral peduncles.Encephalomalacia affecting a majority of the right parietal, occipital and temporal lobes, as well as a portion of the left occipital and left parietal lobes is unchanged from prior. These findings result in ex vacuo dilatation of the ventricular atria.Minimal gyriform enhancement in the right temporal lobe is unchanged. No new parenchymal or extra-axial pathologic enhancement is seen.No evidence of any significant intracranial hemorrhage or abnormal extra-axial fluid is demonstrated. Ventricular size and morphology are not significantly changed.

Output: 1.Interval fluctuation of the size and number of cortical diffusion restricting lesions with interval decrease or resolution of some previously seen lesions and interval development of new lesions.2.Large areas of encephalomalacia are redemonstrated showing no significant interval change and representing sites of prior diffusion restricting disease.


Instruction: Generate impression based on medical findings.

Input: Right shoulder pain ROTATOR CUFF: No rotator cuff atrophy or tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No focal defect within the superior labrum suggests a SLAP tear. Minimal surface irregularity involving the superior labrum near the biceps anchor without discrete tear.BICEPS TENDON: Biceps tendon is normal in signal and morphology. ADDITIONAL

Output: Normal MR arthrogram of the right shoulder.


Instruction: Generate impression based on medical findings.

Input: History of tethered cord release with history of syringomyelia. Evaluate syrinx. There is dilatation of the central spinal canal that extends from the level of T4-T5 to the conus medullaris, which terminates at the level of L1-L2. The central canal with the cord is again dilated, and measures up to 10 x 9 mm at the level of T7-T8, previously 10 x 9 mm, and 5 x 5 mm at the level of T12, previously 5 x 5 mm. There is no significant change in the extent or size of the syrinx. There is appropriate ventral motion of the cord with prone positioning. There is no evidence of filar T1 hyperintensity or filar thickening. The vertebral column alignment is within normal limits. The vertebral body and disk space heights are preserved. There is no worrisome bone marrow signal. There is no significant spinal canal stenosis, disc herniation, or neural foraminal narrowing.

Output: 1. Stable size of the thoracolumbar syrinx. 2. No MR evidence of cord tethering.


Instruction: Generate impression based on medical findings.

Input: Progressive multiple sclerosis. Worsening lower extremity weakness. Cervical: Artifacts and slight differences in technique make assessment difficult however compared to 10/13/2012, there appears to be increase in patchy T2 signal abnormality in the cervical cord at the C2 level as well as in the mid to lower cervical cord extending into the thoracic cord. Vertebral body heights are maintained. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise maintained. There is mild spinal canal stenosis at the C6-C7 level. No high-grade spinal canal stenosis. There is mild to moderate left C4-C5, moderate left greater than right C5-C6, and moderate left and mild right C6-C7 neural foraminal stenosis related to uncovertebral hypertrophy.Thoracic: No recent thoracic MRI is available for comparison but compared to 10/13/2012, there appears to be interval increase in patchy areas of T2 hyperintensity in the upper, mid, and distal thoracic cord. Although slight differences in technique limit comparison, overall findings are suspicious for progression. There is T2 hyperintensity involving the ventrolateral aspects of the cord suggesting Wallerian degeneration along the lateral corticospinal tracts. Artifacts on the post gadolinium sequences limits assessment, but there is suggestion of mild enhancement in the distal thoracic cord, sagittal series 19 image 11.Vertebral body heights and alignment in the thoracic spine are normal. No significant spinal canal or neural foraminal stenosis is appreciated. Bone marrow signal is benign.

Output: Although artifact and differences in technique limit comparison, there is overall suggestion of progression of demyelinating disease in the cervical and thoracic cord compared to 10/13/2012. There is also suggestion of mild enhancement in the lower thoracic cord which may be related to recent active demyelination.


Instruction: Generate impression based on medical findings.

Input: Female 25 years old Reason: Multiple right hip dislocation, history of hip arthroscopy, labral repair, evaluate labrum ACETABULAR LABRUM: Small cleft in the right superior labrum could be due to prior surgery, or perhaps a re-tear. The superior labrum is diminutive, likely post surgical in etiology.ARTICULAR CARTILAGE AND BONE: Bony prominence of the head neck junction of the right femoral head consistent with cam deformity.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Small cleft in the superior labrum which could be due to prior surgery or perhaps a re-tear.2.Diminutive superior labrum, likely postsurgical in etiology.3.Cam deformity of right femur.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis with history of HCC status post resection and RFA. ABDOMEN:LIVER, BILIARY TRACT: Relatively stable segment 6 ablation cavity measures approximately 5.8 x 5.7 cm, compared to 5.8 x 4.8 cm previously, and contains T1 weighted hyperintense proteinaceous/hemorrhagic debris.Relatively stable segment 5 ablation cavity measures approximately 3.9 x 3.7 cm (series 11/124), compared to 3.6 x 2.5 cm previously and contains T1 weighted hyperintense proteinaceous/hemorrhagic debris.No evidence of residual or recurrent disease along the ablation margin.The segment 8 arterial enhancing focus in the right hepatic dome measures approximately 1.1 x 0.8 cm (series 11/19) without evidence of washout on portal venous or delayed phase imaging. This may represent a perfusional anomaly. Attention to this lesion on subsequent surveillance imaging is recommended.Cirrhotic liver morphology with mild fibrotic changes. No intrahepatic or extrahepatic biliary ductal dilatation. The vessels are patent. Cholelithiasis without evidence of cholecystitis.SPLEEN: The spleen is normal in morphology without a focal lesion. The spleen measures 12 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes at the level of the right-sided Spigelian hernia repair.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver with relatively stable postablation zones without evidence of recurrent or residual marginal lesion.2.Stable enhancing focus in segment 8 is unchanged and may represent a perfusional anomaly, attention to this on subsequent surveillance imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: History of inflammatory bowel disease on treatment presents with disease flare and rectal pain. Evaluate for perianal disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple prominent mesorectal lymph nodes are likely reactive given the colonic inflammation.BOWEL, MESENTERY: The visualized rectosigmoid and rectum is featureless and has diffuse mild circumferential wall thickening and mucosal hyperenhancement compatible with acute inflammation. Intrinsic T1-weighted submucosal signal also reflects submucosal fat deposition related to chronic inflammation as well. The inflammation is most severe near the anterior anorectal region where there is a fistulous tract originating from approximately the 11:00 position of the anus (series 501/29). The tract extends inferiorly within the right intersphincteric space and communicates with a right ischioanal fossa fluid collection measuring 1.9 x 1.3 x 2.4 cm. Extensive adjacent subcutaneous inflammation and skin thickening. The inflammation extends superiorly superficial to the external sphincter without a discrete fluid-filled tract.Small volume of right lower quadrant ascites. Possible inflammation of additional bowel loops which are partially imaged.BONES, SOFT TISSUES: Diffuse low T1 weighted signal intensity of the bone marrow likely reflects anemia.OTHER: No significant abnormality noted.

Output: 1.Intersphincteric fistula with an abscess in the right ischioanal fossa near the right gluteal cleft measuring up to 2.4 cm.2.Severe active inflammation of the visualized rectosigmoid colon.


Instruction: Generate impression based on medical findings.

Input: Previous immediate postoperative changes have resolved. Postoperative changes from prior third ventriculostomy are not well visualized on this exam. The previous left parietal approach ventriculostomy catheter has been removed. The right ventricular catheter has been replaced, now coursing along the lateral margin of the right lateral ventricle, with tip in the right anterolateral frontal lobe parenchyma. A small amount of fluid is identified along the scalp and upper neck along the subcutaneous portion of the catheter tract, with associated enhancement. Surrounding the tip, there is prominent susceptibility with evidence of a small air-fluid level on axial T2-weighted images which may relate to recent catheter manipulation. A small amount of enhancement is noted following contrast demonstration along the proximal intracranial portion of the catheter, which likely is postprocedural. No other pathological enhancement is appreciated.The sulci are increased in prominence since the prior MRI, consistent with slight interval increased parenchymal volume loss. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is trace layering susceptibility in the left occipital horn, likely relating to post procedural blood products. A few other new foci are seen along the left lateral ventricular margin. A small area of FLAIR hyperintense encephalomalacia is present underlying the prior left parietal burr hole. Degree of myelination is difficult to assess secondary to relative paucity of white matter.Other previously described developmental abnormalities are unchanged. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Fluid is noted within the mastoid air cells and middle ears bilaterally which is nonspecific.

Output: 1.Essentially stable ventricular size with continued diffuse dilatation although slight interval increased parenchymal volume loss compared to remote MRI brain.2.Interval removal of left sided ventriculostomy catheter with replacement of right, which is noted abutting the lateral wall of the right lateral ventricle with tip in the right frontal lobe parenchyma, surrounded by a small air-fluid level which may relate to recent catheter manipulation. Fluid is also identified within the subcutaneous tissues tracking along the catheter course. Please correlate with physical exam.3.No significant abnormal enhancement to suggest infection, although enhancement is noted along the portion of the catheter in the lung the proximal intracranial portion which may be postprocedural. Please correlate clinically.Dr. Yang discussed these findings over the telephone with Dr. Castanda (PICU) on 1/29/2016 6:30 AM.


Instruction: Generate impression based on medical findings.

Input: Female 41 years old Reason: New vision changes s/p LV ablation History: vision changes. No evidence of diffusion restriction to suggest an infarct. There is no evidence of intracranial hemorrhage or mass. There are a few scattered nonenhancing foci of T2/FLAIR hyperintensity in subcortical white matter of the frontal lobes, which is nonspecific. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. No specific findings to account for patient's vision changes.


Instruction: Generate impression based on medical findings.

Input: Right thumb pain Tendons: The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: The ulnar collateral ligament and radial collateral ligament are intact.Bones: The bone marrow signal is normal. There is no fracture or contusion. There is no marrow replacing lesions. There is no joint effusion. There is no significant arthrosis.Muscles: There is no tear or atrophy of the visualized musculature.Other: There is an ovoid signal intensity structure identified within the carpal tunnel seen on series 3 image 1 which demonstrates fat signal intensity on all sequences and likely represents a small lipoma.

Output: Normal MRI of the thumb. Specifically, there is no evidence of ulnar collateral ligament injury.


Instruction: Generate impression based on medical findings.

Input: Recurrent medulloblastoma. There are postoperative findings related to prior right suboccipital craniotomy. There is a heterogeneous mass in the right cerebellar hemisphere treatment bed, which measures up to nearly 4 cm. There is no evidence of other intracranial lesions. The ventricles are unchanged in size and configuration, including partial effacement of the fourth ventricle, but no evidence of hydrocephalus. The cerebellar tonsils are mildly low-lying, but there is no midline shift. There are skin fiducial markers.

Output: Preoperative planning MRI demonstrates a mass in the right cerebellar hemisphere treatment bed, which likely represents recurrent neuroblastoma.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with metastatic renal cell carcinoma and possible metastases ABDOMEN:LUNG BASES: Small left-sided pleural effusion and dependent atelectasis. Calcified mediastinal lymph nodes.LIVER, BILIARY TRACT: Bilateral extensive liver metastases. An index lesion in the left lobe measures 3.3 x 2.7 cm, image number 51, series number 3.Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: The tail of the pancreas is diffuse the hypodense. A solid neoplasm in the distal body and tail cannot be excluded. Further evaluation with MRI of the pancreas is recommended. Splenic vein is not well seen. There are venous collaterals around the stomach.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys.Small hypodense lesions in the left kidney which are too small to accurate characterize.Right kidney is very heterogeneous with multiple scars. Multiple cysts in the upper pole. Lower pole of the right kidney has lobulated contours with ill-defined heterogeneous density. These findings may represent postsurgical changes, however, a solid lesion cannot excluded with this single phase study.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. Index portacaval node measures 15 by 11 mm on image number 55, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not well visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Extensive hepatic metastatic disease.Diffusing hypodense tail of the pancreas. A solid neoplasm cannot be excluded. Further evaluation with MRI of the pancreas is recommended.Cholelithiasis.Bilateral atrophic kidneys. Lower pole of the right kidney is heterogeneous with lobulations. Possibility of a solid lesion in the lower pole of the right kidney cannot be excluded. Follow-up imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: Clinical question: R/O acute stroke. Signes and symptoms: Aphasis. Pre and post enhanced brain MRI:No evidence of acute intracranial finding including acute ischemic stroke.There is very extensive confluent foci of flair/T2 hyperintensity in the periventricular and subcortical white matter of the cerebral hemispheres, bilateral basal ganglia ( L> R ), thalami and the pons. Findings represent advanced chronic small vessel ischemic disease. There is resultant ex vacuo dilatation of the supratentorial ventricular system and prominent of the cortical sulci. Small chronic cortical stroke in right posterior parietal is also noted.Susceptibility MRI images demonstrate multiple small foci of microhemorrhages in the subcortical and periventricular white matter of cerebral hemispheres. The signal void of the major intracranial vasculature is identified.No abnormal enhancement of brain parenchyma, leptomeninges, calvarium, scalp or the orbits.Unremarkable calvarium, scalp, orbits, paranasal sinuses and the mastoids air cells.

Output: 1.No acute intracranial finding.2.Advanced chronic small vessel ischemic strokes, some with evidence of chronic hemorrhage.3.Small chronic right posterior parietal cortical stroke.4.No abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: 4-year-old male with recent seizure-like activity, ex-28 week premature gestation Several sequences are degraded secondary to artifact induced by the patient's ventricular shunt reservoir. Given this caveat:Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. There has been interval increase in size of the dysmorphic lateral ventricles. The third and the fourth ventricles are unchanged in size. Left hemispheric dysmorphism is unchanged.A previously demonstrated prominent left extra-axial fluid space which has been becoming more hypodense on CT demonstrates mid intensity on T1, hyperintensity on T2, with diffuse enhancement. This extends to also involve the tentorium and falx, as well as to a lesser extent the right hemispheric dura. Overlying this is a second area of crescentic abnormality measuring up to 6 mm in maximal depth over the parietal-occipital region which is nonenhancing, lower intensity on T1and T2 when compared to the overlying process, yet appearing hyperintense on T1 and T2 compared to CSF.Hemosiderin staining along the epididymal surface of the lateral ventricles is not as well demonstrated as previously. Redemonstrated is residual from germinal matrix hemorrhage. Previously demonstrated hemorrhagic debris in the right occipital horn as well as hemorrhagic foci within the posterior fossa are not visualized secondary to the aforementioned artifact.There is no midline shift or basal cistern effacement. Myelination within the uninvolved brain appears mature. Redemonstrated is thinning of the corpus callosum and volume loss in the white matter.Major intracranial flow voids appear present. Paranasal sinuses are completely opacified. Mastoid air cells and middle ear cavities are clear. Orbital contents are unremarkable.

Output: 1.Redemonstrated is a right parietal approach ventriculostomy catheter which crosses the midline with its tip terminating at the lateral aspect of the left lateral ventricle, unchanged in position. 2.There has been interval increase in size of the dysmorphic lateral ventricles. 3.Diffuse dural enhancement is present, especially notable along the left hemisphere, however also involving the falx, tentorium, and to a lesser extent the right hemisphere. There is a superimposed crescentic abnormality measuring up to 6 mm in maximal depth over the parietal-occipital region which is nonenhancing as described in detail above. The enhancing aspect is most likely secondary to dural reaction from changes of ventricular sizes and intracranial pressures. The nonenhancing crescentic portion most likely represents an evolving hemorrhage within the dura.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old, with vertigo, history of basilar occlusion. Due to patient agitation and discomfort, a very limited examination was obtained consisting of sagittal T1, axial diffusion and axial susceptibility images only. No restricted diffusion is seen. No evidence of significant generalized edema or mass effect is seen. On the basis of T1-weighted imaging, no abnormal collections are detected. There are no findings on the susceptibility weighted images to suggest significant intracranial hemorrhage.

Output: Very limited examination which nevertheless shows no evidence of acute ischemia, mass effect or significant intracranial hemorrhage.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with history of gastric cancer with possible liver lesion seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: No definite focal hepatic lesion corresponding to previously seen CT finding in the left hepatic lobe. No additional suspicious hepatic lesions. No biliary ductal dilation. SPLEEN: No significant abnormality noted.PANCREAS: Stable atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable thinning and cortical scarring of the left kidney upper pole. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstration of postsurgical changes from gastrectomy with esophagojejunostomy. Small ventral abdominal wall hernia containing nonobstructed bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No definite focal hepatic lesion corresponding to previously seen CT finding in the left hepatic lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old, with neck pain, cervical spondylosis and myelopathy. Since the prior examination, anterior instrumented fusion has been performed from C4 through C7.Spinal alignment is anatomic. Where not obscured by the presence of orthopedic instruments, the morphology and signal characteristics of the vertebral bodies are within normal limits.The visualized spinal cord demonstrates normal signal intensity and morphology.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Progression of right facet hypertrophy. Progression of posterior disc osteophyte and right uncovertebral hypertrophy. The right lateral aspect of the spinal canal is effaced to a greater degree than on the prior examination. The right neural foramen is also narrowed to a greater degree. C4-5: Improvement in the previously seen right paracentral disc protrusion. No significant spinal canal stenosis. No significant neuroforaminal narrowing.C5-6: Mild disc osteophyte formation/uncovertebral hypertrophy appearing similar to prior. Mild lateral recess encroachment but no significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing is unchanged. C6-7: Mild disc osteophyte and uncovertebral hypertrophy more so on the right, unchanged. No significant generalized spinal canal stenosis. Mild right foraminal narrowing is unchanged. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. A small disc protrusion at T2-3 appears similar to priorA 12 mm T2 hyperintense lesion within the right thyroid lobe is unchanged.

Output: 1.Interval anterior instrumented fusion from C4 through C7.2.Improvement in the previously seen right paracentral disc protrusion at C4-5.3.Progression of right-sided uncovertebral and facet hypertrophy at C3-4 with slightly progressed narrowing of the right lateral recess and right neural foramen.4.No significant change in degenerative findings at other levels as above.