Instruction: Generate impression based on medical findings.

Input: 70-year-old male with prostate cancer status post prostatectomy with rising PSA PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically absent. T2 hypointense lesion demonstrating diffusion restriction in the region of the right seminal vesicles surrounding a surgical clip with extension across midline to the left. This lesion measures 2.3 x 1.7 cm and demonstrates early enhancement.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter 5 mm lymph nodes along bilateral external iliac chains. No lymphadenopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the region of the region of the right seminal vesicle measuring 2.3 x 1.7 cm extending across midline to the left highly suspicious for local recurrence.


Instruction: Generate impression based on medical findings.

Input: Bitemporal hemianopia. There is no evidence of pituitary or other sellar region lesions. The infundibulum is intact and positioned in the midline. The optic apparatus and cavernous sinuses are intact. There is a small left maxillary sinus retention cyst.

Output: No evidence of sella region mass lesions.


Instruction: Generate impression based on medical findings.

Input: The patient presents for a short term follow-up MRI for a benign appearing small mass in the left breast at lower outer quadrant. History of surgical excision of a benign papilloma the left breast in June 2009. History of benign biopsy of the right breast. Family history of breast cancer in her mother at age 49. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A small enhancing mass is unchanged in the lower outer left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: 22-year-old female with Ewing's sarcoma Left femur: Patchy and curvilinear signal abnormality and enhancement within the distal femoral metaphysis including ringlike foci with central fat appears decreased in extent compared with the MRI of the tibia and fibula dated 3/28/14 which included the distal left femur. We suspect these represent areas of bone infarction although treated metastasis is a possibility. The remainder of the signal intensity of the femur is within normal limits. The left femoral trochlea appears shallow suggesting trochlea dysplasia with slight lateral translocation of the patella. The soft tissues are unremarkable. Abnormal ringlike signal intensity seen on the large field-of-view images in the proximal right tibia may represent evolving infarction or treated metastases, also less prominent than on the prior exam.Right and left hips: We see no abnormal signal or enhancement in either the proximal femurs or pelvis. The hips and SI joints appear normal. There is no joint effusion or evidence of synovitis. Note that this exam was not protocoled for evaluation of the labrum. The soft tissues are within normal limits.

Output: 1. Normal hips and pelvis without evidence of metastatic disease.2. Foci of signal abnormality in the distal left femur and proximal right tibia as described above, which are less prominent than on the prior exam and we suspect represent evolving bone infarctions, although treated metastases are also considered.


Instruction: Generate impression based on medical findings.

Input: History of left retromolar trigone treated with CRT and salvage surgery, with recent biopsy proven tumor recurrence. There are post-treatment findings in the left upper neck and aerodigestive tract region. There is an infiltrative mass in the left oral cavity and masticator space with involvement of the left retromolar trigone, left floor of mouth, left oral tongue, posterior left buccal region along the pterygomandibular raphe, left medial pterygoid muscle, and left mandible. Overall, the tumor measures up to approximately 5 cm. There is no evidence of significant cervical lymphadenopathy. However, there are mildly prominent upper mediastinal lymph nodes. The remaining major salivary glands are unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is a small amount of fluid within the left mastoid air cells. The cervical spine is intact. The imaged intracranial structures and orbits are grossly unremarkable.

Output: Findings compatible with tumor recurrence involving the left oral cavity and masticator space. No evidence of significant cervical lymphadenopathy. However, the assessment is limited by the lack of intravenous contrast administration.


Instruction: Generate impression based on medical findings.

Input: Ms. Catalano is a 55 year old female with a personal history of left breast lumpectomy in 1997 for mucinous carcinoma. Patient had a biopsy for enlarged right axillary lymph nodes in 2004 which showed benign reactive changes. She has no current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Expected postoperative volume loss and scarring in the left breast is unchanged. Few scattered foci of enhancement are seen in the right breast, all of which appear stable when compared to prior examination. No new abnormal enhancement is seen in either breast. Multiple enlarged right axillary and subpectoral lymph nodes are stable. No new abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast and stable right axillary/subpectoral lymph nodes. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Reason: R knee pain and swelling History: limited ROM Condylar indentation on the lateral view. There is a trace joint effusion. No acute malalignment. If continued pain consider MRI.

Output: Condylar indentation on the lateral view. If continued pain consider orthopedic consultation and knee MRI.Findings discussed with ER charge nurse.


Instruction: Generate impression based on medical findings.

Input: No evidence of any pathologic parenchymal or extra-axial enhancement is seen. No findings to suggest focal parenchymal edema or mass effect are observed. Ill-defined fairly confluent and symmetric periventricular white matter T2 hyperintensity has become slightly more conspicuous when compared to prior examinations compatible with radiation related changes. Numerous scattered foci of susceptibility are again seen with the largest number clustered in the left parietal-occipital junction and these are unchanged. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricles are stable in size and morphology.

Output: No evidence of active or progressive intracranial 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: 48-year-old female with CF, status-post bilateral lung transplant, with worsening hypoxia, lethargy. Please evaluate for intracranial fungal infection or other potential etiologies of encephalopathy. Limited examination secondary to motion artifact and the use of portable scanner. Interval placement of nasoenteric tube and endotracheal tube.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection or acute hemorrhage. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses again demonstrate partial opacification in the maxillary sinuses, ethmoid air cells, and hypoplastic frontal sinuses and sphenoid sinuses. This appears increased compared to prior CT examination. Opacification of the right mastoid air cells also appears increased compared to prior CT examination, although similar to prior MRI brain. The visualized left mastoid air cells are clear.Atherosclerotic calcification again identified along the distal left acute artery and the distal internal carotid arteries.

Output: 1. Limited examination secondary to motion artifact and the use of portable scanner. Within this limitation, there is no evidence of acute intracranial abnormality. 2. Increased opacification of the right mastoid air cells and paranasal sinuses.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for intracranial hemorrhage, worsening metastases. Signs and symptoms: Seizures, history of cancer with brain metastases. Non-enhanced CT of brain:There is no detectable acute intracranial findings. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. The cortical sulci, ventricular system and all CSF cisterns as well as the gray white matter differentiation remains within normal. Further follow-up with an MRI is recommended. This examination is suboptimal due to motion artifact.

Output: No areas of acute intracranial findings and essentially unremarkable CT of brain and calvarium.


Instruction: Generate impression based on medical findings.

Input: History of ependymoma status post craniotomy and radiation therapy, now off therapy evaluation. Some of the sequences are degraded by patient motion. There are stable findings related to left frontal craniotomy with a resection cavity in the inferior left frontal gyrus, with unchanged confluent T2 hyperintensity and mild susceptibility effect along the surgical margins. There is also an unchanged punctate focus of T2 hyperintensity in the left peritrigonal white matter. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: No evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Right capsular stroke. Signs and symptoms: Left hemiparesis. Nonenhanced brain MRI:A small acute right basal ganglia lacunar infarct measuring at least at 6 x 13 mm in transaxial dimensions is again identified. This finding demonstrates a punctate focus of susceptibility (series 401 image 130) suspected of hemorrhage.Additionally exam demonstrate moderate chronic nonhemorrhagic small vessel ischemic strokes in the periventricular and subcortical white matter as well as bilateral basal ganglia and left thalamus.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.The signal void of all major intracranial arterial branches are identified and unremarkable.Images through the orbits demonstrate a chronic right lamina papyracea blowout fracture similar to prior CT examination and unremarkable orbits otherwise.Mild chronic right maxillary sinus disease and unremarkable other paranasal sinuses and mastoid air cells.

Output: 1.Acute right basal ganglia lacunar infarct (at least at 6 x 13 mm) with a punctate focus of susceptibility.2.Chronic nonhemorrhagic small vessel ischemic strokes of subcortical, periventricular white matter as well as bilateral basal ganglia.3.Chronic right lamina papyracea blowout fracture.4.Mild chronic right maxillary sinus disease and unremarkable sinuses otherwise.


Instruction: Generate impression based on medical findings.

Input: History of CNS lymphoma and pituitary adenoma status post resection/radiation therapy presents with syncope and confusion with concern for CNS lymphoma. There are postoperative changes related to remote transphenoidal hypophysectomy. This is not a dedicated pituitary study; however, there is a grossly stable appearance of enhancing soft tissue in the right sella and right cavernous sinus. Again noted is a heterogeneous appearance with cystic appearing components within the sphenoid bone. There is again a burr hole along the right frontal bone.The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are stable scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. There is otherwise no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. A small focus of susceptibility effect is again noted in the right basal ganglia, consistent with hemosiderin deposition.Normal flow-voids are demonstrated in the major intracranial vascular structures. The remainder of the midline structures and craniocervical junction are within normal limits. There is a diminutive right maxillary sinus.There is redemonstration of a nodule in the right parotid gland.

Output: 1. No findings to suggest recurrent CNS lymphoma. No evidence of acute ischemia or intracranial mass effect.2. Heterogeneous appearance of the sphenoid bone and perisellar region status post transphenoidal hypophysectomy. Findings are compatible with post-treatment changes and residual adenoma. No interval enlargement to suggest disease progression.3. Right parotid gland nodule again noted which may represent low-grade salivary gland neoplasm or pathologic lymph node.


Instruction: Generate impression based on medical findings.

Input: 55 year old man on dialysis referred for assessment of LV size and function, given abnormal echo. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 35.3%, the LV end diastolic volume index is 135 ml/m2 (normal range: 74+/-15), the LVEDV is 203 ml (normal range 142+/-34), the LV end systolic volume index is 87 ml/m2 (normal range 25+/-9), the LVESV is 131 ml (normal range 47+/-19), the LV mass index is 120 g/m2 (normal range 85+/-15), and the LV mass is 178 g (normal range 164+/-36). There is thinning and hypokinesis of the basal to mid inferior and inferolateral wall, consider prior myocardial infarction. There is otherwise circumferential mild left ventricular hypertrophy (IVSd=11mm). Based on SSFP scout imaging (not T2-star), there is probably no myocardial iron overload.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 55 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is likely significant hepatic and splenic iron overload. Thyroid enlargement is noted. Esophageal dilation is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation, mild LVH, and moderately reduced systolic function (LVEF 35.2%). There is thinning and hypokinesis of the basal to mid inferior and inferolateral wall, consider prior myocardial infarction or hibernating myocardium. 2. Normal RV size and systolic function (RVEF 56%).3. Severe left atrial dilation.4. See extra-cardiac findings.


Instruction: Generate impression based on medical findings.

Input: Reason: Soft tissue mass fifth digit left foot History: left foot pain Severely limited examination secondary to extensive patient motion artifact. The examination was terminated early due to the patient's inability to further tolerate the examination per the technologist note. A skin marker was placed over the dorsal aspect of the proximal phalanx of the fifth digit of the left foot. Note is made of multiple foci of decreased signal abnormality along the dorsal and lateral aspect of the proximal phalanx of the fifth digit of the left foot which correspond to the foci of calcification seen on recent radiographs. There is also diffuse bone marrow signal abnormality within the proximal phalanx of the fifth digit and head of the fifth metatarsal which is nonspecific. There is fluid within the fifth MTP joint indicating a mild synovitis. No definite erosions are identified. There is a small amount of fluid within the first MTP joint. There is deformity of the proximal phalanx of the fourth toe likely reflecting prior remote trauma.

Output: Limited examination demonstrating nonspecific bone marrow signal abnormality within the fifth metatarsal head and proximal phalanx of the fifth digit with foci of calcification in the overlying soft tissues. These findings are incompletely characterized and nonspecific but may represent the sequela of gouty arthropathy, avascular necrosis, prior trauma, or infection/osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Reason: L knee pain, swelling, giving out x 8-9 months History: L knee pain, swelling, giving out x 8-9 months Please note that the high-resolution coil was unable to be used secondary to patient body habitus. An alternative coil was used, however, image quality is suboptimal.MENISCI: There is globular high signal intensity in the body of the medial meniscus extending into the posterior horn without a clear linear component. The lateral meniscus appears intact. ARTICULAR CARTILAGE AND BONE: There is marked thinning with full-thickness signal abnormalities of the articular cartilage of the patella, particularly along its medial facet. There is also pronounced thinning of the condylar surface of the medial compartment. Patchy red marrow signal is seen within the distal femur and proximal tibia. The bones are otherwise unremarkable.LIGAMENTS: Edema-type signal intensity surrounding the medial collateral ligament and iliotibial band suggest a low grade sprain. There are no full thickness defects identified. The cruciate ligaments are intact.EXTENSOR MECHANISM: There is edema throughout the subcutaneous tissues of the knee, particularly within the fat anterior to the patella and proximal tibia. The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Degeneration of the medial meniscus without a definite tear.2. Sprain of the medial collateral ligament and iliotibial band.3. Degeneration of the articular cartilage of the patella and medial tibiofemoral compartment.


Instruction: Generate impression based on medical findings.

Input: Worsening headaches with vision changes. Neck pain and weakness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate focus of high T2 signal in the subcortical white matter of the right inferior frontal gyrus. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a low signal nodule in the right parietal scalp, which may represent an inclusion cyst. There is a small retention cyst in the right maxillary sinus. Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small posterior disc-osteophyte complex at C5-6, but no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Nonspecific punctate focus of high T2 signal in the subcortical white matter of the right inferior frontal gyrus. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of spinal cord lesions or significant spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Evaluate for stress fracture TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Bone infarction in the distal tibia. No evidence of stress fracture


Instruction: Generate impression based on medical findings.

Input: Severe left arm pain and weakness, evaluate for radiculopathy. Hx of SLE Examination is limited by motion artifact. There is straightening of the cervical lordosis which may be positional. The vertebral bodies are aligned and the vertebral body heights are maintained. Multilevel anterior osteophyte formation is demonstrated, most prominent at C5 level. No worrisome focal marrow signal is identified. The intervertebral disc spaces are grossly maintained. There is developmental narrowing of the cervical spinal canal. The spinal cord is suboptimally evaluated secondary to motion artifact.C2-C3: There is hypertrophy of the ligamentum flavum, however otherwise no significant abnormality is appreciated.C3-C4: There is hypertrophy of the ligamentum flavum with small posterior disc osteophyte complex formation causing moderate central spinal and bilateral neuroforaminal stenosis.C4-C5: There is a small posterior disc osteophyte complex with hypertrophy of the ligamentum flavum and uncovertebral joints resulting in mild to moderate spinal canal and moderate bilateral neuroforaminal stenosis.C5-C6: Posterior disc osteophyte formation and hypertrophy of the ligamentum flavum result in moderate to severe left and moderate right neuroforaminal stenosis as well as mild to moderate central spinal stenosis.C6-C7: There is a posterior disc osteophyte complex with hypertrophy ligamentum flavum causing mild spinal canal stenosis without significant neuroforaminal stenosis.C7-T1: No significant disc herniation or neuroforaminal stenosis is noted at this level.

Output: Limited examination secondary to artifact demonstrates multilevel spondylosis of the cervical spine with multilevel at least moderate grade central spinal stenosis predominantly on the basis of developmental narrowing.


Instruction: Generate impression based on medical findings.

Input: Ms. Villa is a 67 year-old female with left breast ILC/LCIS status post lumpectomy with positive margins. MRI demonstrated abnormal enhancement separate from the lumpectomy bed. Patient subsequently underwent left breast simple mastectomy and hormonal therapy. No family history of breast cancer. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. Stable well circumscribed oval isodense masses within the right upper outer quadrant, with imaging features suggestive of benign intramammary lymph nodes on prior MRI study of 12/22/2015.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Reason: S/P UFE, uterine fibroids, menorrhagia, dysmenorrhea History: uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus measures 7.9 x 7.9 x 11.2 cm (series 7 image 18, series 5 image 21), previously 7.9 x 8.4 x 12.2 cm. Multiple subserosal, intramural, and submucosal T2 hypointense lesions are again seen throughout the uterus compatible with fibroids. Previously measured largest submucosal fibroid in the right lower uterine segment measures 1.2 x 2.2 x 1.3 cm (series 7 image 19, series 5 image 18)., previously 3.6 x 4.0 x 3.4 cm. An additional reference submucosal fibroid measures 1.7 x 2.7 x 3.3 cm (series 7 image 20, series 5 image 26), previously 1.7 x 3.2 x 3.4 cm. The fibroids predominantly have decreased in degree of enhancement with exception of this reference submucosal fibroid that demonstrates some mild enhancement. Multiple nabothian cysts again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter focus of fatty process in the subcutaneous right gluteal soft tissues is again noted.OTHER: No significant abnormality noted.

Output: Interval decrease in size and degree of enhancement of uterine fibroids compatible with some treatment response.


Instruction: Generate impression based on medical findings.

Input: Compression of brain. Other specified postprocedural states. Other specified diseases of spinal cord Compression of brain. Assess Chiari decompression There have been interval surgical changes related to Chiari decompression. There appears to be decreased mass effect upon the brainstem anterior to the tonsils. CSF flow is demonstrated anteriorly and posteriorly, at the level of the cerebellar tonsils and through the foramen magnum.The cervical vertebral bodies are appropriate in overall alignment and height. The C1 vertebral body appears to be fused to the skull base. The posterior arch of C1 is not readily identified laminectomy changes from C2 through C6 are demonstrated. The previously identified T2 signal involving the upper cervical spinal cord is unchanged.At C2-3 there is no significant compromise to the spinal canal. There is a disc bulge present at level associated with some uncovertebral osteophytes and narrowing of the neural foraminal encroachment of left-sided exiting nerve roots..At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present this level associated with uncovertebral osteophytes and narrowing of the neural foramina bilaterally and encroachment of the exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level. There are some right-sided uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with uncovertebral osteophytes bilaterally worse on the right side. There is encroachment of the right exiting nerve roots within the neural foramen.At C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Chiari I malformation status post decompression.2.There is biphasic CSF flow present at the level of the cerebellar tonsils.3.Stable T2 signal abnormality involving the upper cervical spinal cord.4.Multilevel degenerative changes similar to prior examination.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o tendon / muscle / ligament tear History: pain, swelling TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: Degenerative changes affect the first MTP joint. Metallic susceptibility artifact is identified within the first metatarsal head indicating postsurgical change. Otherwise no bone marrow signal abnormality is identified. ADDITIONAL

Output: Nonspecific subcutaneous edema along the anterior and lateral aspect of the ankle. No evidence of ligamentous injury. Osteoarthritis and surgical changes of the first MTP joint.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old, with CCM3 mutation, known acoustic neuroma, yearly follow-up examination. Innumerable susceptibility inducing lesions are redemonstrated scattered throughout both cerebral hemispheres, the brainstem and cerebellum. Since the prior examination, at least three new foci are identified, two in the left centrum semiovale and one in the left aspect of the pons. There may also be several additional new punctate foci but accurate comparison is limited by the small size of these lesions.Of those lesions identifiable on T1-weighted imaging, none shows any evidence of increasing T1 hyperintensity to suggest interval bleeding. In addition, none of these lesions induces any significant local mass effect.An extra-axial enhancing lesion based along the left aspect of the anterior interhemispheric falx is unchanged over multiple prior exams. No new enhancing lesions are appreciated. No significant generalized mass effect is seen. No abnormal extra-axial collections are detected. The ventricles remain normal in size and morphology.On thin section T2-weighted imaging of the IACs, a small nodule of soft tissue thickening is redemonstrated within the right IAC. This lesion no longer enhances as it did and may even be somewhat smaller when compared to earlier examinations. No new IAC or CP angle lesions are identified. The visualized cisternal cranial nerves are otherwise unremarkable.

Output: 1.Innumerable lesions are redemonstrated compatible with multiple cavernous malformations. Although there is evidence for at least three new lesions, the bulk of the disease is unchanged and there are no findings to suggest significant interval bleeding.2.A presumed parafalcine meningioma shows no evidence of interval growth.3.A presumed right vestibular schwannoma shows no evidence of interval growth.


Instruction: Generate impression based on medical findings.

Input: Female 27 years old Reason: evaluate for possible pleural infection/empyema History: sob, malabsorption of csf in pleural space LUNGS AND PLEURA: There is right basal atelectasis and a small right pleural effusion with minimal loculation. The lung parenchyma is suboptimally evaluated on MRI. MEDIASTINUM AND HILA: Left sided central venous catheter with tip in the distal SVC.CHEST WALL: A ventriculopleural shunt tracks within the right anterior chest wall subcutaneous tissues, and traverses the right pleura terminating in the right lower pleural space.UPPER ABDOMEN: Incidental note is made of a small splenule.

Output: A ventriculopleural shunt tracks within the right anterior chest wall subcutaneous tissues and terminates in the right lower pleural space within small adjacent atelectasis/minimally loculated right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 17 year old male with a history of Tetralogy of Fallot with Pulmonary atresia, status post RV to PA conduit containing a bioprosthetic pulmonary valve, and conduit replacement in 2005. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function, and global hypokinesis. There is diastolic flattening of the interventricular septum. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 179 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. There is an RV to PA conduit anastomosis in the distal anterior wall. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 97ml/m2 (normal range 82+/-16), the RVEDV is 176 (normal range 142+/-31), the RV end systolic volume index is 49ml/m2 (normal range 31+/-9), and the RVESV is 88ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlargedMitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Coronary ArteriesBoth the right and left main coronary arteries originate from a single orifice in the right sinus of Valsalva. The left main courses anterior to the aortic valve and bifurcates to the left anterior descending and circumflex. Distal coronary arteries and posterior descending could not be visualized.Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild aortic regurgitation. The angle of the LVOT and aortic valve is distorted due to the presence of the RV to PA conduit on the right side of the ascending aorta. Aortic valve annulus = 30 x 30 mmAortaThere is a left aortic arch. The aortic root and ascending aorta are moderate-severely dilated and deviated leftward due to the RV to PA conduit.Aortic Sinuses = 42 x 42 x 42 mm (Z-score +4)S-T Junction = 40 x 41 mm (Z-score +4)Ascending Aorta = 42 x 43 mm (Z-score +4)Transverse Arch = 31 x 32mmDescending aorta = 17 x 19 mmTricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitationPulmonic ValveThere is a right ventricle to pulmonary artery conduit in place, containing a bioprosthetic pulmonary valve. The conduit courses from the anterior RV wall, passing to the right of the ascending aorta to the PA anastomosis. There is an elevated trans prosthetic velocity of 2.9 m/s. No other stenosis within the conduit. Moderate pulmonary regurgitation, regurgitant fraction 23%.Pulmonary ArteryRV to PA conduit = 30 x 32 mmRPA = 10 x 13 mmLPA = 9 x 15 mmRPA receives 51% of forward flow, LPA 49%.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function and diastolic flattening of the interventricular septum(LVEF 50%). 2. Normal right ventricular size, with mildly reduced systolic function (RVEF 49%)3. Elevated peak velocity of the valved conduit prothesis, and moderate regurgitation.4. Low-normal branch pulmonary artery dimensions with equal flow.5. Severe aortic root and ascending aorta dilation (see measurements above).6. Mild aortic insufficiency.7. Moderate TR8. Anomalous origin of the left main coronary artery, arising from the right sinus of Valsalva and coursing anterior to the aortic valve.


Instruction: Generate impression based on medical findings.

Input: 32-year-old female dancer with pain and intermittent effusions as well as a proximal tibial shaft stress fracture. Please evaluate. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified to suggest a stress fracture.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is a subcentimeter focus of fluid signal intensity within the distal fibers of the anterior cruciate ligament which may represent ganglion formation versus mucoid degeneration.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Normal appearing MRI of the knee. Specifically, there is no evidence of a proximal tibial stress fracture to correspond to the findings seen on recent radiographs.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with branch duct type IPMN, follow-up. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense foci are too small to characterize but stable compared to the prior exam and likely benign. Tiny stones within the gallbladder fundus. Stable vascular malformation of the left hepatic lobe (axial series 10013 image 350). SPLEEN: No significant abnormality noted.PANCREAS: Stable 0.9 x 0.9 cm cystic lesion of the pancreatic head (axial series 5 image 15, coronal series 9 image 50), which again likely represents a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable simple cyst of the left upper renal pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable sidebranch IPMN of the pancreatic head.2.Stable vascular malformation of the left hepatic lobe.


Instruction: Generate impression based on medical findings.

Input: Hodgkin's lymphoma, preoperative evaluation. MRI brain: Please note, sequences of the brain are limited for presurgical planning and includes 3-D T2 and post gadolinium 3-D T1 sequences. Again seen is persistent diffusely enhancing tumor centered in the right lateral skull base region with soft tissue extension into the right upper deep neck spaces, right cerebellomedullary cistern, right jugular foramen, hypoglossal canal, right Meckel's cave extending to the posterior right cavernous sinus as seen on prior MRI. There is persistent diffuse enhancement of the bone marrow involving the right lateral and central skull base as seen on the prior exam. There is persistent right tympanomastoid opacification.There is redemonstration of bilateral optic disc protrusion and prominence of the optic sheaths compatible with intracranial hypertension.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.MRV brain: There is tumor involving the right jugular foramen with occlusion of the upper right internal jugular vein. Tumor appears to extend intracranially at the level of the right sigmoid sinus and resulting in partial occlusion of the right sigmoid sinus. More proximally, there is diminished flow/partial thrombosis involving the right transverse sinus. The right jugular vein more distally is patent as seen on recent CT neck study from 3/31/2016.There is heterogeneous signal involving the posterior aspect of the superior sagittal sinus suspected to represent partial thrombosis with preserved flow more anteriorly and posteriorly in the superior sagittal sinus. Nondominant/hypoplastic left transverse and sigmoid sinuses are are patent as is the left internal jugular vein.The straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent.

Output: 1. Limited sequences of MRI brain for presurgical planning redemonstrates right lateral skull base tumor with enhancing soft tissue extension into the upper deep neck spaces and intracranial extension along the right jugular foramen, hypoglossal canal, right Meckel's cave, and posterior inferior aspect of the right cavernous sinus compatible with known lymphoma.2. Occlusion of the upper right internal jugular vein at the level of the tumor which involves the jugular foramen. The right internal jugular vein more inferiorly is patent as demonstrated on CT neck from 3/31/2016. There is partial thrombosis and slow flow involving the right sigmoid sinus and right transverse sinus. There is also irregularity involving the posterior aspect of superior sagittal sinus suspicious for partial thrombosis. The superior sagittal sinus more anteriorly and posteriorly however remain patent. The nondominant/hypoplastic left transverse sinus, sigmoid sinus, and jugular vein remain patent.3. Persistent right tympanomastoid effusion.4. Papilledema and prominence of the optic nerve sheath are compatible with elevated intracranial pressure.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for ischemia. Signs and symptoms: Right facial droop of right leg weakness. Nonenhanced brain MRI:Examination demonstrates small focus of restricted diffusion in the right lateral aspect of medulla measuring at 11.7 times 7-mm. No evidence of hemorrhagic changes or any appreciable mass effect.Examination in addition demonstrate extensive chronic strokes in the vertebral vascular system and including total PCA territory chronic stroke as well as multiple small bilateral cerebellar ischemic strokes and several chronic nonhemorrhagic pontine lacunar infarct.Images through supratentorial space in addition demonstrate findings of mild to moderate small vessel ischemic strokes in the subcortical and periventricular white matter of cerebral hemispheres.Midline is maintained and the cortical sulci appear normal for patient stated age.Signal void the major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells as well as calvarium and soft tissues of the scalp.

Output: 1.Focus of restricted diffusion in the right lateral medulla measuring at 7 times 11.7-mm.2.several chronic bilateral cerebellar ischemic stroke as well as large chronic nonhemorrhagic ischemic stroke involving the entire left PCA territory.3.Findings consistent with mild to moderate chronic nonhemorrhagic small vessel ischemic strokes.


Instruction: Generate impression based on medical findings.

Input: 81 year old woman. Evaluate for ICH/CVA. There is no evidence of intracranial hemorrhage, mass or edema. There are extensive periventricular and subcortical regions of hypoattenuation consistent with small vessel ischemic disease. These findings are age-indeterminate. If acute stroke remains a clinical concern, recommend evaluation with MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Extensive, age-indeterminate findings of small vessel ischemic disease. 2. No CT findings of acute cortical stroke or hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Reason: left ankle sprain History: STF rupture/PTT tear -> tendinosis -? injury x > 5 years. TENDONS: No significant abnormality noted.LIGAMENTS: The anterior talofibular ligament is not well visualized and likely chronically torn. The remainder of the ligaments appear intact. ARTICULAR SURFACES AND BONE: Small amount of edema within the talus and anterior calcaneus, likely stress reaction. Large talar osteophyte. Small amount of abnormal signal within the posterior tibiotalar joint likely representing synovitis. ADDITIONAL

Output: 1.Probable chronic ATFL tear.2.Edema within the talus and anterior calcaneus, likely stress reaction. 3.Posterior tibiotalar joint synovitis.4.Intact PTT as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Post craniotomy with aneurysm clipping. New symptoms and worsening headaches Non-infused head CT:Minimal area of low attenuation in the inferior aspect of right frontal lobe near the surgical site of clipped aneurysm may represent edema or encephalomalacia. This finding remains stable since prior exam. Expected postoperative changes of right-sided frontal craniotomy with interval improvement since prior study. Patchy nonspecific foci of subcortical low attenuation could represent small was ischemic disease. This appears a slightly more pronounced on the current exam than prior study. Recommend follow-up with an MRI. There is no evidence of cortical low attenuation to suggest ischemic cortical stroke.Widened subarachnoid space along the inner table of the skull in the right posterior frontal and parietal is highly suspected only small subdural collection. This is also a new finding since prior exam. There is very subtle effacement of cortical sulci secondary to finding.

Output: 1.Findings I do suspect that of small vessel disease of indeterminate age with interval worsening since prior study. Recommend follow-up with an MRI to exclude new subcortical ischemic strokes.2.A small CSF density subdural in the right posterior frontal -- parietal with minimal effacement of adjacent cortical sulci is a new finding since prior exam3.there is no evidence of any acute cortical stroke, hemorrhage, hydrocephalus or midline shift.


Instruction: Generate impression based on medical findings.

Input: 78 year old male with metastatic colon cancer in lung and liver. Staging. CHEST: LUNGS AND PLEURA: Scarlike opacities and postsurgical changes are seen in both lungs. In the left upper lobe, there is a 1.5 x 1.4 cm nodule consistent with metastatic disease. A smaller and more irregularly shaped nodule in the right lower lobe measures 1.1 x 1.4 cm, consistent with a metastasis. Small right pleural effusion has resolved. MEDIASTINUM AND HILA: Atherosclerotic calcifications in the thoracic aorta and coronary arteries. Normal heart size. No pericardial effusion. Borderline enlarged right hilar lymph node. Small mediastinal lymph nodes.CHEST WALL: Right chest wall Port-A-Cath with the tip in the superior vena cava. There is possibly partial collapse of the L1 vertebral body which is incompletely visualized on this study. Right-sided venous access device is in expected position.ABDOMEN:LIVER, BILIARY TRACT: Intra- and extra-hepatic biliary ductal dilatation to the level of the ampulla. No obstructing mass is identified.Large mass noted in the right lobe of the liver without enhancement. This mass has an exophytic component. It measures 4.7 x 7.7 cm (image 82, series #3). A second, smaller lesion with similar characteristics is noted inferior to the dominant mass that also is compatible with a metastasis. Additional, subcentimeter lesions are scattered throughout the liver with typical features of benign cysts on the MRI exam. Cholelithiasis noted.SPLEEN: No significant abnormality noted. Calcified splenic granulomata. PANCREAS: Prominent pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression deformity at the superior endplate of L1.OTHER: IVC filter is in the expected position. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid diverticulosis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Benign calcifications in the left groin and left spermatic cord.

Output: 1. Minimal intra- and extra-hepatic biliary ductal dilatation to the level of the ampulla. No obstructing mass is identified; however, cannot rule out obstructing ampullary stricture.2. Hepatic metastases are stable since the prior MRI exam.


Instruction: Generate impression based on medical findings.

Input: Exam is limited by motion artifact and suboptimal field of view.Brain: No diffusion weighted abnormality. No evidence of intracranial hemorrhage. The gray-white matter differentiation is preserved. The signal intensity and morphology of the cerebral, cerebellum and pons are within normal limits. No evidence of mass, mass effect, or hydrocephalus. There is no abnormal intracranial enhancement. No extra-axial fluid collections. Tonsils are at the level of the foramen magnum, stable from prior study. Mucosal thickening of the left maxillary sinus, bilateral sphenoid sinuses, and opacification of left ethmoid air cells, new from prior study. Trace opacification of bilateral mastoid air cells. The orbits are unremarkable. Flow voids are present within the major vessels indicating patency. Pituitary: Exam is limited by motion artifact and suboptimal field of view. Pituitary gland is small, similar to the prior study, which can be normal for patient's age. The size and signal intensity of the pituitary stalk is well demarcated and enhanced. The optic chiasm and hypothalamus demonstrate normal signal intensity and morphology.

Output: 1.Exam is limited by motion artifact and suboptimal field of view. Within this limitation, there are no gross abnormalities of the brain or pituitary gland.2.Paranasal sinus opacification as above.


Instruction: Generate impression based on medical findings.

Input: The lumbar spine displays a normal lordotic curvature. The lumbar vertebral body and disk heights are preserved. There is heterogeneous marrow signal throughout the lumbar vertebrae, which is unchanged and likely related to fatty marrow infiltration. There is a small disc bulge at T11-T12 without significant spinal canal or neural foramen stenosis. There are no significant disc bulges or herniations in the lumbar spine. However, there is mild facet hypertrophy and ligamentum flavum thickening at multiple levels of the lumbar spine bilaterally. There is a subcentimeter right sacral perineural cyst. The spinal cord displays normal signal and morphology. There is diffuse atrophy of the paravertebral muscles.

Output: 1. Small disc bulge at T11-T12 without significant spinal canal or neural foramen stenosis. 2. Mild degenerative facet degenerative changes and ligamentum flavum thickening at multiple levels of the lumbar spine without significant central canal stenosis or neural foraminal narrowing.3. Small right sacral perineural cyst.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: 10-day-old male lateral assessment of imperforate anusVIEW: Abdomen AP (one view) 01/16/15 Previously identified perineal soft tissue mass is again noted and better evaluated on the prior MRI examination. Nonobstructive bowel gas pattern. No free intraperitoneal air. The osseous structures are normal.

Output: Perineal soft tissue mass.


Instruction: Generate impression based on medical findings.

Input: Reason: Elevated PSA, evalaute for Prostate cancer History: see aboveBiopsy 6/17/2014: Right mid small focus of atypical glands, target lesion negative.Biopsy 3/4/2013: Left posterior apex Gleason 6, 1.5 mm.PSA: 2.01 PELVIS:PROSTATE:Prostate Size: 5.0 x 2.5 x 3.6 cmPeripheral Zone: There is a small focus (804/244) of linear low ADC signal and enhancement in the left posterior apex seen previously which is suspected to represent a vessel. In the surrounding left apex peripheral zone, there is a 1.5 x 1.2 cm (1401/1210) region of early enhancement without associated abnormal T2/ADC signal.Central Gland: BPH nodules and urethral thickening.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: Focus of early enhancement in the left apex peripheral zone without associated abnormal ADC/T2 signal is indeterminate.


Instruction: Generate impression based on medical findings.

Input: 16-week-old male with left septic hip arthritis and abscesses status post incision and drainage. Evaluate for osteomyelitis/septic hip/soft tissue abscess. The left femoral metaphysis is displaced anteriorly and laterally to the femoral epiphysis and acetabulum similar to prior. Moderate-sized intermediate T1 and intermediate T2 signal intensity joint effusion with synovial enhancement decreased in size from prior exam. New small T2 hyperintense/T1 hypointense joint effusion in the right hip with associated synovial enhancement.Focal increased T2 signal in the distal left femoral metaphysis is unchanged from prior study with no associated enhancement or bone destruction. Mild subperiosteal T2 hyperintensity and enhancement along the femoral metaphyses, left greater than right, appear more prominent and well-defined compared to prior exam. The precontrast sequences of this area demonstrate normal marrow T1 signal with no bone destruction. Again seen is moderate T2/STIR signal within the left gluteal and left thigh musculature with associated enhancement. The previously referenced collections/abscesses in the gluteal and proximal thigh musculature are no longer visualized. There are new two linear T2 hyperintensity/T1 hypointense nonenhancing tracts coursing through the left anterior and lateral soft tissues to the hip joint most compatible with tracks related to recent incision and drainage procedure. A drain enters the lateral tract and terminates adjacent to the proximal femur. Also present in the soft tissues/musculature about the right hip and thigh however to a lesser degree compared to the left is T2/STIR hyperintense induration without appreciable enhancement. Similar signal intensity pattern is also present along the fascial planes.

Output: 1. Extensive edema and inflammation in the left gluteal and thigh soft tissue/musculature with interval resolution of the previously identified abscesses. New moderate edema and inflammatory changes in the right gluteal and thigh soft tissues/musculature.2. Decreasing size of moderate left hip joint effusion with associated synovitis and displacement of the left femoral metaphysis. New small right hip joint effusion with associated synovitis. 3. Bilateral subperiosteal edema and enhancement along the femoral metaphyses, left greater than right, with no evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: History of primary sclerosing cholangitis status post liver transplant 2013 evaluate for worsening strictures and hepatic vasculature. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant and hepaticojejunostomy. Minimal irregular dilatation of the left intrahepatic biliary tree is not significantly changed from the prior study. The right intrahepatic and the extrahepatic biliary tree appear unremarkable. No new dominant stricture or focal lesion. The hepatic vasculature appears patent.SPLEEN: Mild splenomegaly measuring 13.3 cm in length, decreased from prior. Splenic collateral vessels. Probable old splenic infarct from interval embolization of previously seen splenic artery aneurysms.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Esophageal varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Very mild dilatation and irregularity of the left intrahepatic biliary tree is unchanged without a new dominant stricture or focal mass.2.Postoperative changes related to orthotopic liver transplant and hepaticojejunostomy.3.Interval splenic artery aneurysm embolization with chronic splenic infarct.


Instruction: Generate impression based on medical findings.

Input: Metastatic head and neck cancer. Neck CT:The visualized brain demonstrates an enhancing nodule in the right occipital lobe. Post-surgical changes in the right frontal lobe and additional metastatic lesions in the brain are better seen on prior MRI brain dated 7/19/2011.Postsurgical changes of previous laryngectomy is again noted. There is soft tissue thickening at the oropharynx and hypopharynx which is unchanged and presumably represents post treatment granulation.Degenerative changes of the cervical spine is again noted

Output: 1. Postsurgical changes of previous laryngectomy. No evidence of interval change.2. Metastatic brain lesions. Please refer to MRI brain for further details.


Instruction: Generate impression based on medical findings.

Input: 86 years Female (DOB:3/10/1930)Reason: Look for cause of dizziness History: vertigoPROVIDER/ATTENDING NAME: ADAM S CIFU IRSK JASON ANDERSON The CSF spaces are appropriate for the patient's stated age with no midline shift. There is vague T2 and FLAIR signal hyperintensity associated with T1 hypointensity present in the midbrain centrally at the expected location of the oculomotor nuclei, medial longitudinal fasciculus and periaqueductal gray which extends to the superior cerebellar peduncles suggesting that there is involvement of rubrocerebellar or cerebellothalamic tracts.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are likely of little clinical significance.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus and mucosal thickening in the right maxillary sinus with the partial opacification of the ethmoid air cells and frontal sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The eyeball lenses are thin.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is no evidence for intracranial mass lesion3.There is subtle signal change present in the midbrain and superior cerebellar peduncles as detailed above which is nonspecific. It is felt not to be artifactual. This could represent a neurodegenerative process, metabolic process or even paraneoplastic process. It is nonspecific.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female status post Whipple's procedure in 2014 for IPMN now with recent elevation of LFTs, nausea, and vomiting. ABDOMEN:LIVER, BILIARY TRACT: 2.1 x 1.3 cm segment 6 mildly T2 hyperintense lesion with mild peripheral enhancement which slightly increases on delayed phase images, most likely an atypical hemangioma (series 13/57). No suspicious hepatic lesions are evident on this nondedicated study.Gallbladder surgically absent. Marked intra and extrahepatic biliary ductal dilation with the common bile duct measuring up to 1.4 cm (series 5/1) with abrupt transition at the biliary enteric anastomosis, most suspicious for stricture. Small amount of dependent low T2, high T1 signal within the distal common bile duct, most likely due to biliary sludge.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from Whipple's procedure. Remaining pancreas is atrophied with main pancreatic ductal dilation measuring up to 10 mm (series 5/1) and multiple dilated side branches visualized. There is an abrupt transition at the pancreatic enteric anastomosis, for which stricture cannot be excluded.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: Pancreaticobiliary tree dilation status post Whipple's procedure. Stricture at the biliary enteric anastomosis is suspected. Stricture at the pancreatic enteric anastomosis is also a possibility, though clinical correlation for such would be needed, comparison to prior imaging if available may be helpful.


Instruction: Generate impression based on medical findings.

Input: Dizziness, hyperreflexia, and previous C4-C5 disc herniation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, and scalp soft tissues are grossly unremarkable. However, there is fluid signal in the bilateral mastoid air cells, right more than left. There is a small secretion within the left posterior ethmoid sinus.Cervical Spine: There is a small posterior disc-osteophyte at C4-5 that mildly indents the spinal cord. There is a larger posterior disc-osteophyte complex at C5-6 that indents the spinal cord. There is no significant spinal canal stenosis at the other cervical levels and the spinal cord displays normal signal. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Posterior disc-osteophyte complexes at C4-5 and C5-6 with mild indentation upon the spinal cord.


Instruction: Generate impression based on medical findings.

Input: Non-small cell lung cancer with brain metastasis. Nausea and left more than right with weakness. Since the prior examination, there has been slight overall increase in the size of the multiple supratentorial and infratentorial contrast-enhancing brain metastatic lesions. For example, the largest lesion involving the right left cerebellum now measures 2.9 cm x 2.4 cm compared to 2.6 cm x 2.1 cm previously. The perilesional edema has also increased with increased involvement of the left brainstem and right cerebellar hemisphere. The associated compression of the fourth ventricle and midline shift in the posterior fossa are also increased as well as the downward herniation of the left cerebellar tonsil. The second largest lesion involves the posterior paracentral lobule and measures 2.8 cm x 2.6 cm, compared to 2.4 cm x 2.1 cm previously. There is a punctate focus of diffusion restriction adjacent to the metastatic lesion in the left frontal lobe. Otherwise, the diffuse background of T2-hyperintensity involving the cerebral white-matter has not significantly changed. Punctate foci of susceptibility effect remain unchanged. There are subcentimeter chronic lacunar infarcts in the bilateral thalami. Although the mass-effect on the fourth ventricle has increased, dilatation of the lateral and third ventricles remains unchanged. The skull and orbits appear to be unchanged.

Output: 1.Increase in the size of the multiple brain metastasis since the fairly recent examination of May 27, 2016. Progression of the largest lesion and the associated edema in the left cerebellar hemisphere result in increased compression of the fourth ventricle and left cerebellar tonsillar herniation. 2.Punctate focus of diffusion restriction in the left frontal lobe adjacent to the second largest metastatic lesion may represent a tiny recent infarct or may relate to the metastasis itself, such as a tumor embolus, or small vessel ischemic 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: Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: L1 vertebral bone biopsy under CT guidance. A total of 11 samples were delivered to pathology for analysis.


Instruction: Generate impression based on medical findings.

Input: There is slight straightening of the upper cervical spine which is likely positional. 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: UnremarkableC3/4: UnremarkableC4/5: Mild bilateral uncinate hypertrophy without stenosis.C5/6: Mild posterior osteophyte disc complex without stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: Negative noncontrast cervical spine MRI. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: 71 years, Female, Reason: liver mets? History: ovarian mass along with liver abnormalities on CT. ABDOMEN:LUNG BASES: Small right and trace left pleural effusions are increased from the prior exam.LIVER, BILIARY TRACT: There is a 4.1 x 3.3 cm ill-defined lesion involving the gallbladder fundus and adjacent right hepatic lobe. There is soft tissue components along the gallbladder fundus with adjacent areas of peripheral enhancement within the liver parenchyma. The majority of the hepatic component is hypointense on T1-weighted images with heterogeneous T2 signal. No additional hepatic lesions are present. No intrahepatic or extra hepatic biliary ductal dilatation. Large stone within the gallbladder.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: Lesion within the hepatic hilum with peripheral enhancement likely represents an enlarged portacaval lymph node and measures 2.9 x 2.4 cm (1005/285). Additional large para-aortic nodes.BOWEL, MESENTERY: No evidence of obstruction. No peritoneal implants are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large pelvic mass is partially visualized and coronal sequences. Small amount of ascites. Fat containing peri-umbilical hernia.

Output: 1.Lesion involving the gallbladder fundus and adjacent liver. Neoplasm is suspected, although this would be an unusual appearance for a metastatic lesion. The appearance is more consistent with a primary gallbladder adenocarcinoma with liver invasion. Biopsy may be considered.2.Retroperitoneal lymphadenopathy.3.Large pelvic mass is partially visualized.4.Increased small right and trace left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0] / Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: 3T Scanner, Please screen for cerebral AVMs, HHT History: HHT Brain MRIThere is a prominent vascular structure likely represent a cortical vein at the post-central sulcus draining toward superior sagittal sinus across the right superior parietal lobule. The lesion is also connected to a prominent medullary vein which drains toward ependymal surface of the right lateral ventricle.There is no evidence of adjacent brain parenchymal enhancement or evidence of enlarged arterial structure on this scan.Constellation of these findings may suggest cortical located micro AVM most likely fistulous type thus those enlarged vascular structures are superficial and deep drainages or could represent normal cortical vein and medullary vein. However, it would be unusual to see the connection of a medullary vein and cortical vein without vascular pathology.There is no evidence of acute ischemic or hemorrhage lesion.There is no abnormal enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic leison.2. Prominent cortical vein and medullary vein located at the post-central sulcus as described above. There is no evidence of abnormal brain parenchymal staining. This may indicate micro AVM. 3. Normal brain MRA.


Instruction: Generate impression based on medical findings.

Input: Images are slightly limited by patient motion.PHARYNX/LARYNX: There is redemonstration of minimal posttreatment changes, with no significant asymmetry in soft tissues. The nasopharynx, oropharynx, and hypopharynx are unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable.ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: There is a large mucosal retention cyst in the left maxillary sinus with a smaller one on the right. There is mild scattered mucosal thickening in the remainder of the paranasal sinuses. There is prominent lower leftward nasal septal deviation with a prominent bony spur.

Output: No MR evidence of local regional tumor recurrence or cervical adenopathy, with mild motion limitation.


Instruction: Generate impression based on medical findings.

Input: 44 years Female (DOB: 3/10/1972)Reason: Multiple Sclerosis History: follow up progressionPROVIDER NAME: BARRY G. ARNASON BARRY G. ARNASON MRI brain:There are periventricular white matter lesions present some which are perpendicularly oriented to the lateral ventricles. There is some involvement of the corpus callosum. Additional lesions are present along the right posterior lateral aspect of the midbrain and right cerebral peduncle as well as the right middle cerebellar peduncle and the cervical medullary junction.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is T2 hyperintense lesions present throughout much of the cervical spinal cord. One extends from C1 to down to C2-3 and is centered anteriorly. Another from extends from C3 vertebral level down to C4 and is centered along the right hemicord. Another one extends from the C4-5 disc space level to the C6 vertebral body level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a T2 hyperintense lesion present along the anterior aspect of the thoracic spinal cord at the T11-T12 level which is centered in the left anterolateral aspect of the spinal cord.

Output: 1.There are multiple white matter lesions present in the brain as well as the cervical and thoracic spinal cord which are suspicious for demyelinating disorder. None of these enhance following gadolinium administration suggesting that they're more likely in the chronic phase. There are no comparison studies available.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old, with left sixth nerve palsy. A focus of subcortical T2 hyperintensity is present within the right superior frontal gyrus. No associated mass effect is seen. A few additional scattered small foci of white matter T2 hyperintensity are demonstrated elsewhere in the brain.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. On postcontrast images, there is no evidence of any pathologic parenchymal or extra-axial enhancement.No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles demonstrate normal size and morphology.The globes are symmetric and round. The extraocular muscles demonstrate normal morphology and enhancement. The optic nerves, chiasm and visualized optic tracts are within normal limits. No abnormalities of the cavernous sinus are seen.The cranial nerves are within normal limits. In particular the sixth cranial nerves are visualized as they traverse the prepontine cistern and are normal.

Output: 1.A focus of T2 hyperintensity within the right superior frontal gyrus is nonspecific but could reflect the sequela of prior trauma or perhaps a chronic ischemic lesion.2.No acute intracranial abnormalities are seen.3.The orbits, cavernous sinuses and visualized cranial nerves are within normal limits.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old, with left lower extremity radiculopathy. Alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are heterogeneous but no concerning areas of marrow replacement or marrow edema are detected. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.Facet arthropathy develops at lower lumbar levels, most notably at L4-5 and L5-S1. At L4-5, severe disc degeneration is seen with loss of disc height and chronic fatty endplate signal change. An inferiorly directed disc protrusion is also evident on the left at this level where it effaces the lateral recess likely impinging upon the transiting left L5 nerve root. The spinal canal is generally mildly narrowed. The neural foramina are moderately narrowed.At L5-S1, there is minimal disc bulging but no significant spinal canal or foraminal stenosis.

Output: Severe disc degeneration is seen at L4-5 with loss of disc height and a disc herniation projecting into the left lateral recess likely impinging the transiting left L5 nerve root.


Instruction: Generate impression based on medical findings.

Input: Check for AVN. Patient on chronic steroids for lupus. Pain specifically for glenohumeral rotational movement ROTATOR CUFF: No significant abnormality noted. Rotator cuff is well visualized and intact throughoutSUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No marrow changes are abnormalities within the humeral head to suggest AVN. The labrum is grossly intact given nonaugmented exam technique. Please also note that the anterior superior aspect of the labrum is not well visualized and likely secondary to a Buford's normal variant.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal shoulder without specific findings to support or suggest AVN


Instruction: Generate impression based on medical findings.

Input: 53-year-old female patient with left hand hypothenar eminence swelling and pain. A marker is placed along the palm of the hand along the hypothenar eminence. We see no signal abnormality or enhancement deep to the marker to suggest an etiology of the patient's pain. The muscles of the hand are within normal limits as are the tendons. Bone marrow signal intensity is within normal limits. Please note the large field-of-view used to evaluate the hand limits evaluation of small ligamentous structures.

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


Instruction: Generate impression based on medical findings.

Input: Diagnosis: LumbagoClinical question: disc degenerationSigns and Symptoms: pain began after epidural for childbirth 4 y prior Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a central disk protrusion which is slightly eccentric towards the left at this level which minimally affects the nerve roots at the lateral recesses. There is a clear fat plane between the nerve root sleeves and the ligamentum flavum. There is disk dessication present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a central disk protrusion at L5-S1 which is slightly eccentric towards the left.2.No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on medical findings.

Input: Right lower extremity weakness. For the purposes of numbering, there are 5 lumbar type vertebral bodies. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact. 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. Bilateral facet arthropathy.L2-L3: The spinal canal has been surgically decompressed with evidence of left-sided laminotomy. Mild disc bulge with minimal effacement of the thecal sac. No significant neural foraminal stenosis. Bilateral facet arthropathy.L3-L4: There is mild spinal canal narrowing, on a predominantly congenital basis. There is minimal prominence of epidural fat and mild right-sided neuroforaminal stenosis. Bilateral facet arthropathy.L4-5: Postsurgical changes of left-sided laminectomy and prior discectomy are noted. There is residual disc protrusion which may represent residual/recurrent disc herniation with associated mild to moderate degree of effacement of the thecal sac. There is no significant compromise to the neural foramina. Bilateral facet arthropathy.L5-S1: There is minimal disc bulge. Bilateral facet arthropathy. There is minimal bilateral neural foraminal stenosis. No significant spinal canal stenosis.There is a partially imaged right hip prosthesis noted.

Output: Postsurgical changes of spinal canal decompression at L2-3 and L4-5 in addition to discectomy at L4-5. There is evidence of residual/recurrent disc herniation at L4-5 with mild to moderate effacement of the thecal sac at this level. There is no high-grade spinal canal or high-grade neuroforaminal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: 60-year-old man with history of known IPMN. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology with overall decreased signal. No focal hepatic lesion identified.SPLEEN: No significant abnormality noted.PANCREAS: There is a 59 x 40 mm well-defined T2 hyperintense lesion within the head of the pancreas, not clearly communicating with the pancreatic duct. The common bile duct is displaced by this cystic lesion and the pancreatic duct is nondilated. This lesion contains 2 small septations, but there is no enhancement. 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: Subsegmental atelectasis noted in the left lung base.

Output: Cystic lesion in the head of the pancreas increasing in size over multiple exams, most likely a macrocystic serous cystadenoma or IPMN (although communication with the pancreatic duct is not seen).


Instruction: Generate impression based on medical findings.

Input: 66 years Male (DOB:5/5/1950)Reason: Stroke work up History: R side sensory deficitPROVIDER/ATTENDING NAME: KATIE TATARIS KOUROSH A REZANIA MRI of the brainThere is a small focus of diffusion restriction present along the inferior and posterior lateral aspect of the left thalamus. This associated with vague T2 and FLAIR signal hyperintensityThere are punctate foci of T2 and FLAIR signal hyperintensity located in the basal ganglia, thalami and brainstem.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.MRA brain:There is 90% stenosis at the origin of the right posterior cerebral artery.There is 50% stenosis of the right pericallosal artery at the proximal A4 segment.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very very small.. The right vertebral artery is smaller than the left vertebral artery.There is extracranial and extradural origin of the right posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. There is a 75% stenosis at the origin of the right vertebral artery.The right vertebral artery is smaller than the left vertebral artery.

Output: 1.Findings are compatible with acute lacunar infarct located in left thalamus.2.There is a 75% stenosis at the origin of the right vertebral artery.3.There is 90% stenosis at the origin of the right posterior cerebral artery4.Punctate lesions in the basal ganglia, thalami and brainstem are most likely related to prior lacunar infarcts5.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: History of HCV and alcohol cirrhosis. 2.9 cm right liver lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology. Small volume perihepatic ascites. No intra or extrahepatic biliary ductal dilatation. The vessels are patent. Cholelithiasis without cholecystitis. Segment 6/7 lesion measuring 3.2 x 2.8 cm demonstrating intrinsic T1 weighted hyperintensity (series 801/57) with regions of T2-weighted hypointensity posteriorly and T2-weighted hyperintensity anteriorly and mild restricted diffusion. There is arterial-enhancement on subtraction images (series 902/272). The intrinsic T1 weighted hyperintensity limits evaluation for washout on delayed images although it is suspected given the subtraction images.Recanalized periumbilical vein. The vessels are patent.SPLEEN: The spleen measures 10.7 cm in craniocaudal dimension. Minimal perisplenic fluid.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: Partially imaged incisional hernia containing fluid better seen on prior CT.OTHER: Body wall collateral vessels.

Output: The segment 6/7 3.2 cm lesion demonstrates intrinsic T1 weighted hyperintensity and arterial enhancement. Intrinsic T1 weighted hyperintensity limits evaluation for washout on delayed images although it is suspected given the subtraction images. The findings are suspicious for hepatocellular carcinoma.Cirrhosis with trace ascites.


Instruction: Generate impression based on medical findings.

Input: Evidence of again seen of left temporal craniotomy with resolution of the swelling along the scalp and in the left periorbital tissue. The resection cavity appears smaller with some clearance of the blood products. Hemosiderin staining around the cavity remains. The hemosiderin appears more conspicuous than in the previous study, likely due to imaging at 3T.There is normal gray-white matter differentiation with normal ventricular size. No midline shift. Basal cisterns are patent. No evidence of infarction. No evidence of new hemorrhage. Mastoid air cells and paranasal sinuses are clear.

Output: Status post recent resection of a left temporal lobe cavernous malformation with residual blood products along the periphery of the resection cavity, not significantly changed from the previous study.


Instruction: Generate impression based on medical findings.

Input: Evaluate parotid gland enlargement. Possible sarcoidosis. None in views CT of soft tissues of neck:Limited value exam due to lack of intravenous contrast. This study was performed without the benefit of contrast as it was requested by clinical service.Images through the skull base, paranasal sinuses and bilateral petrous bones are unremarkable.Examination demonstrates normal low attenuation of parotid glands bilaterally. The left parotid gland appears a slightly larger than the right however with similar normal appearing density. Very small nodes within the left parotid measuring approximately 5 mm in size are identified. These findings were observed on prior MRI examination and show no change. The fascial planes surrounding the parotid glands remain within normal limits.Images through the rest of the neck demonstrate no evidence of a mass or any pathologic adenopathy.

Output: Essentially unremarkable CT of soft tissues of neck and without enhancement. Minimally larger left parotid gland however the normal density and morphology. Very small sub-centimeter lymph node in the left parotid is noted.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old, with GBM, status post two cycles immunotherapy. Postoperative changes are again seen in left occipital lobe. A small area of encephalomalacia is unchanged. Enhancing nodules are redemonstrated, including two small nodules and a dominant nodule with associated rim-enhancing cyst. The smaller nodules are stable or at most minimally increased in size. The dominant nodule, however, has mildly increased in size, now measuring up to 20 mm in axial short axis, previously 17 mm. As before, enhancement from this lesion spreads to the ependyma of the left atrium. Susceptibility artifact somewhat limits evaluation on perfusion sequences, but there is clear elevated rCBV correlating to the dominant nodule and at least one of the smaller nodules.T2 hyperintensity surrounding this lesion has progressed with further extension of this signal abnormality anteriorly into the temporal lobe. The left splenium of the corpus callosum is involved, but no definite contralateral spread is seen. The left lateral ventricle is partially effaced similar to prior. The remaining ventricles are unremarkable.

Output: Multiple nodular enhancing lesions are redemonstrated within the left parieto-occipital junction. The dominant lesion demonstrates a mild interval increase in size. Extensive T2 hyperintensity surrounding these lesions has also progressed. Given that subtle progressive findings were suspected on the prior examination, the possibility that this represents slowly growing tumor is raised.


Instruction: Generate impression based on medical findings.

Input: 64 year old male with history of atypical mycobacterial infection within the right wrist. Abnormal signal intensity and enhancement within the distal ulna is compatible with the stated history of osteomyelitis. On large field-of-view images, this signal abnormality and enhancement appears to extend from the distal end of the ulna into the diaphysis over a length of at least 8 cm. Signal abnormality and enhancement is most prominent within the distal aspect of the ulna, where it is associated with several cortical defects / sinus tracts.There is a heterogeneously enhancing soft tissue mass surrounding the distal ulna, perhaps containing tiny pockets of fluid, but with no large drainable collection is identified. Overall, the circumferential mass measures approximately 4 cm in greatest diameter and presumably represents extension of infection into the soft tissues. There is also enhancement of the distal radioulnar joint indicating inflammation/infection, with a small cortically-based erosion along the medial aspect of the distal radius.Enhancement appears to extend through a defect in the triangular fibrocartilage into the radiocarpal joint, and there is abnormal signal and enhancement within the medial aspect of the triquetrum that may represent early osteomyelitis. This inflammation extends further distally along the dorsal aspect of the wrist and into the dorsal soft tissues of the hand, although the remaining carpal bones are of normal signal. Inflammation within the dorsal soft tissues of the hand is incompletely evaluated on today's MRI, but signal abnormality and enhancement along the length of the third metacarpal and within the distal half of the second metacarpal are also suspicious for osteomyelitis. Additional enhancement is seen in the soft tissues between the second and third metacarpals as well as third and fourth metacarpals. The signal intensity of the first, fourth, and fifth metacarpals appears normal.Diffuse subcutaneous edema involves the wrist and dorsum of the hand. Small foci of signal void in the soft tissues medial to the distal ulna likely represent metallic susceptibility artifact from prior surgery.There is medial subluxation of the extensor carpi ulnaris tendon as it courses through the aforementioned inflammatory mass. Mild generalized tenosynovial enhancement of the extensor tendons of the wrist indicates mild inflammation. There is perhaps minimal tenosynovial enhancement of the flexor tendons but this is of uncertain clinical significance.

Output: 1.Extensive soft tissue inflammation as described above, extending from the distal ulna into the wrist and dorsal soft tissues of the hand. This presumably represents infection with possible tiny foci of fluid along the ulna, although no large drainable fluid collection is seen.2.Signal abnormality within the distal ulna represents osteomyelitis that has likely progressed when compared to radiographs from May 2015. Additional foci of signal abnormality within the triquetrum and second and third metacarpals is also concerning for osteomyelitis.3.Enhancement of the radiocarpal joint and distal radioulnar joint, suggestive of septic arthritis.


Instruction: Generate impression based on medical findings.

Input: 40 year old male with status epilepticus now with ST elevations on the monitor. Mental status changes. The previously seen right frontal hematoma has resolved. The surrounding encephalomalacia demonstrates some evolutionary change. Subtle left occipital low attenuation posteromedial to the left occipital horn indicates an area of previous hemorrhage better seen on prior MRI.There is very subtle loss of gray-white matter differentiation at the left parietal-occipital region which probably corresponds to the cortical signal abnormality reported on prior MRI.There is no evidence of new intracranial hemorrhage. Prominent ventricles; unchanged. There is no extra-axial fluid collection.The visualized osseous structures are unremarkable except for a Burr hole in the right frontal bone. Prominent cerebellar folia indicating volume loss.

Output: 1. Further resolution of the previously identified right frontal hematoma, with associated right frontal encephalomalacia. 2. Left posterior parietal encephalomalacia; unchanged from previous.3. No new hemorrhage is identified.4. Subtle loss of gray-white matter differentiation at the left parietal-occipital region probably corresponds to the cortical signal abnormality reported on prior MRI. Follow-up with MRI should be considered for better evaluation.


Instruction: Generate impression based on medical findings.

Input: Mass within distal forearm Within the superficial ulnar soft tissues of the distal forearm approximately 3 cm from the distal radius/ulna is a well-circumscribed, T1 isointense/T2 hyperintense solid mass which measures approximately 1.3 x 1.2 x 1.4 cm in the greatest transaxial and craniocaudal dimensions. There are some areas of low signal internally on the T2 sequences. The mass enhances relatively homogeneous with scattered areas of low signal on postcontrast sequences as well. The mass is in close proximity to the basilic vein which appears to run through or over the lesion.No additional soft tissue masses are identified. The osseous structures of the forearm are normal.

Output: Superficial soft tissue mass within the volar the cutaneous tissues of the distal forearm further described above. The imaging findings are nonspecific in nature with some differentials including a vascular lesion or peripheral nerve sheath tumor.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Multiple sclerosis. Transient alteration of awarenessClinical question: Assess status of MS, identify possible lesions that may have caused seizures or confusion in generalSigns and Symptoms: History of MS, acute confusional state The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical white matter T2 and FLAIR hyperintense lesions present some of which are perpendicularly oriented to the lateral ventricles. Additional lesions are present in the brainstem and cerebellar hemispheresNo 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.There is a cystic lesion just beneath the floor of the left maxillary sinus which this forms the floor of the left maxillary sinus and is associated with patient's dentition.

Output: 1.There are multiple lesions scattered in both hemispheres of the brain as well as the brainstem and cerebellum which are compatible patient's clinical diagnosis of demyelinating disorder. No enhancing lesions are appreciated to suggest acute demyelination.2.Findings are suggestive of a radicular cyst involving the left maxillary dentition.


Instruction: Generate impression based on medical findings.

Input: There are postoperative findings related to prior right parietal craniotomies. There has been significant progression of enhancing tissue within the right frontal lobe. For example, the dominant anterior enhancing lesion now measures 41 x 59 mm, previously 17 x 19 mm. The more posterior and superior lesion currently measures 19 x 20 mm, previously 8 x 7 mm. The enhancement does however have a somewhat abnormal appearance with the superior portions respecting the gyral morphology, and the inferior margin showing a very ill-defined speckled pattern of enhancement. The more anterior dominant enhancing lesion now infiltrates inferiorly into the genu and body of the corpus callosum. There has also been a significant increase in the surrounding T2 hyperintensity that now crosses to the left side of the corpus callosum. There is a significant increase in mass effect with new 6 mm leftward midline shift and subfalcine herniation. The mass effect is however slightly less than expected given the size of the enhancing lesion. These enhancing masses demonstrate markedly elevated relative cerebral blood volume, at least along their periphery.

Output: Significant progression of right frontal enhancement is seen with corresponding increase in mass effect and new leftward subfalcine herniation. Particularly given the elevated rCBV, these findings are concerning for progressive tumor.However, considering the rapidity of progression compared with the previous slow progression of tumor from 2013, and considering the recent administration of an immune modulating drug and somewhat atypical imaging appearance of the lesion, a component of superimposed inflammation may also be contributing to this appearance.