Instruction: Generate impression based on medical findings.

Input: Female, 84 years old, with history of breast cancer, presenting with confusion and change of motor function. Brain:Patchy periventricular T2 hyperintense lesions are seen in both cerebral hemispheres. Also noted is mild T2 hyperintensity within the right subinsular region.No evidence of restricted diffusion, parenchymal edema or significant parenchymal mass effect is detected. No abnormal extra-axial fluid collection or evidence of intracranial hemorrhage is seen. The ventricles and sulci are diffusely and symmetrically prominent likely indicating underlying parenchymal volume loss.Lumbar spine:Grade 1 anterolisthesis of L3 relative to L4 and L4 relative to L5 is observed. Vertebral body height and morphology are within normal limits. Degenerative endplate irregularity and signal change is seen but no definite worrisome marrow replacement or evidence of marrow edema is detected. Visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed by level below.No worrisome intraspinal enhancement is detected. No significant or concerning marrow space lesions are seen. Patchy degenerative endplate enhancement is noted, along with inflammatory enhancement along the degenerated lower facet joints. In addition, a 10 mm enhancing lesion within the right lateral aspect of the L4 vertebral body is nonspecific.The discs of the lumbar spine demonstrate diffuse loss of T2 signal. In addition, there is substantial loss of disc height at L4-5 and L5-S1. Additional level specific findings are as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disc asymmetric to the right. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate to severe generalized spinal canal stenosis with near complete exclusion of CSF and slight crowding of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing with particular effacement of the right lateral recess. Moderate bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small left paracentral annular fissure. No significant spinal canal narrowing. Moderate bilateral foraminal narrowing.

Output: 1.Within the limitations of a noncontrast examination, no definite evidence of intracranial metastatic disease is seen.2.No definite acute intracranial abnormalities are detected. Scattered white matter lesions are nonspecific but statistically most likely represent chronic microvascular ischemic disease.3.Multilevel degenerative findings in the lumbar spine resulting in fairly significant spinal canal narrowing at L3-4 and L4-5, as well as scattered foraminal narrowing as above.4.No definite evidence of metastatic disease is seen in the lumbar spine. A nonspecific enhancing lesion within the right lateral aspect of the L4 vertebral body is nonspecific. If clinical concern warrants, follow-up imaging can be considered.


Instruction: Generate impression based on medical findings.

Input: Left tinnitus, constant, for the past 8 months. Left asymmetric sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. Small hippocampal sulcus remnant cysts are more pronounced on the right. There is bilateral parotid sialosis and temporomandibular osteoarthrosis. There is an incidental right occipital developmental venous anomaly.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with respiratory failure pre-lumbar puncture evaluation. Provided further history of vascular malformation. There is no evidence of intracranial hemorrhage or edema. Right frontal mass-like lesion overlying right frontal cortex with internal coarse popcorn calcifications measuring approximately 3.4 x 2 .4 cm (series 3 image 21). This lesion exerts a mass effect on underlying right precentral and postcentral gyri with minimal sulcal effacement and an about one to 2 mm of midline shift to the left. This is unchanged compared to prior MRI. The right ventricle appear slightly asymmetrically thinner than the left likely from minimal mass effect of the extra-axial mass.The basal cisterns, third and fourth ventricles are normal in size and configuration. The calvaria and skull base unremarkable. The orbits are unremarkable. The visualized paranasal sinuses are well pneumatized. There is partial opacification of bilateral mastoid air cells.

Output: 1. No acute intracranial hemorrhage. 2. Right frontal mass like lesion is compatible with vascular malformation seen on an outside MRI. The associated minimal mass-effect and midline shift have been stable. Further evaluation with brain MRA and MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Pt with baseline ataxia with episodic exacerbations, evaluate cerebellum FLAIR images are degraded due to motion artifact. Within this limitation there are scattered foci periventricular white matter FLAIR hyperintensity. The fissures of the cerebellar vermis are prominent suggesting atrophy of the vermis.No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, and cisterns are normal in size without evidence of ventriculomegaly. Gray-white matter differentiation is preserved. Left maxillary mucous retention cyst. Nonspecific mild ethmoid air cell mucosal thickening. Mastoid air cells are clear. The orbits are intact. The osseous structures and scalp soft tissue appear unremarkable.

Output: 1.Findings suggestive of atrophy of the cerebellar vermis. 2.Scattered foci of white matter signal abnormality are nonspecific.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of thyroid nodules, subclinical hyperthyroidism RIGHT LOBE MEASUREMENTS: 5.2 x 2.1 x 2.0 cmLEFT LOBE MEASUREMENTS: 7.0 x 2.1 x 2.4 cmISTHMUS MEASUREMENTS: 1.0 cmRIGHT LOBE: Enlarged thyroid lobe with multiple solid thyroid nodules. A solid, inferior right thyroid lobe nodule without microcalcifications or increased vascularity measures 1.9 x 1.9 x 1.5 cm.LEFT LOBE: Enlarged thyroid lobe with multiple coalescent nodules without discrete measurable nodule.ISTHMUS: Enlarged isthmus with solid, slightly hyperechoic, inferior nodule measuring 2.2 x 2.1 x 1.6 cm. No microcalcifications or increased vascularity is identified.PARATHYROID GLANDS: Not noted.LYMPH NODES: Subcentimeter lymph nodes in bilateral neck. OTHER: No significant abnormality noted.

Output: Enlarged and heterogeneous multinodular thyroid with measurements above. A nuclear medicine thyroid scan may be considered if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old, with severe headaches and family history of aneurysms. Also with neck pain. Assess for disk impingement. Brain:Numerous scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres, largely in a peripheral and subcortical distribution.No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected.No evidence of intracranial hemorrhage or abnormal extra axial fluid collection noted. The ventricles are normal in size and morphology.There is a mucus retention cyst in the right maxillary sinus. Bone marrow signal characteristics are unremarkable.C-spine:There is a slight reversal of the normal cervical lordosis centered at C5-6, unchanged. Alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. Marrow signal characteristics are benign with evidence of mild likely degenerative endplate marrow edema at C5, C6 and C7.Very slight prominence of the central canal of the spinal cord is seen at the C6 and C7 levels measuring no more than 1 mm in diameter and likely within the limits of normal variation. No other areas of cord signal abnormality are seen.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild posterior disk osteophyte with a small superimposed right paracentral extrusion. The extrusion is smaller than on the prior examination. There is minimal flattening of the ventral cord but no cord signal abnormality. No significant generalized canal stenosis is seen. The foramina are patent. C5-6: Loss of disk height. Posterior disk osteophyte formation slightly asymmetric to the left. Mild spinal canal stenosis with slight ventral cord flattening but no cord signal abnormality. Mild bilateral foraminal narrowing. No significant interval changes. C6-7: Loss of disk height. Posterior disk osteophyte formation without cord impingement or significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No significant interval changes. C7-T1: Facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: 1.Numerous scattered small foci of white matter signal abnormality are seen in a predominantly peripheral and subcortical distribution. The differential for this finding is broad and would include chronic sequelae of migraine, vasculitis, or some other inflammatory process.2.No definite evidence of any active or acute intracranial abnormality is seen. Please note that this examination was not tailored for the evaluation of aneurysms. If such assessment is warranted, an MRA or CTA should be considered.3.Level cervical spondylosis is seen most severely affecting the C5-6 and C6-7 levels where there is loss of disk height, posterior disk osteophyte formation and minimal spinal canal narrowing as above. A small disk extrusion seen at C4-5 on the prior examination has become smaller.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male status post fall. Question bleed question fracture. Review of prior studies indicates the patient has metastatic melanoma. Numerous brain masses are present. A prominent high attenuation mass in the high convexity of the right frontal lobe (series 6900 image 30) measures 1.1 x 0.9 cm. This lesion was not visualized on the MRI dated 3/2/2009. A high attenuation lesion in the right parietal lobe (series 6900 image 22) is also not clearly visualized on the previous MRI. Two high attenuation lesions in the right cerebellar hemisphere are faintly visible on post contrast images of the the study dated 3/2/2009. The large lesion seen in the left temporal lobe on the previous MRI is not well visualized on today's study.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. No CT evidence of traumatic hemorrhage or fracture.2. Numerous high attenuation lesions scattered throughout the cerebral hemispheres and cerebellum -- consistent with hemorrhagic metastases from the patient's known melanoma.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with altered mental status and known metastatic melanoma to brain. Evaluate brain mets and edema. There is a punctate focus of restricted diffusion involving the right posterior medial parietal region with corresponding dark ADC suspicious for a punctate microinfarct.Redemonstrated are multiple lesions with FLAIR signal abnormality along the left anterior temporal lobe, left paramedian frontal lobe, right posterior temporal lobe are compatible with metastatic lesions. The lesion in the left anterior temporal lobe again demonstrates extensive surrounding vasogenic edema. There is small amount of vasogenic edema around the left paramedian frontal lobe lesion. Size comparisons are limited given the absence of contrast but these lesions appear similar in size and configuration. There is redemonstration of underlying mild periventricular and subcortical FLAIR signal abnormality which is nonspecific but is likely related to chronic small vessel ischemic disease. There is mild diffuse volume loss.There is no evidence of intracranial hemorrhage. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the right mastoid air cell. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: 1.Findings suspicious for a punctate micro-infarct involving the posterior medial parietal region without mass effect or intracranial hemorrhage.2.Multiple areas of FLAIR signal abnormality corresponding to the enhancing lesions in the previous MRI exam within the left anterior temporal lobe, right posterior temporal lobe and left perimedian frontal lobe. Full comparison is limited in the absence of contrast, however the lesions appear grossly similar.3.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.4.The exam is somewhat limited due to the patient's inability to cooperate. SWI and T1 axial imaging were not performed.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old, with low back pain. Image quality is degraded by motion artifact. Within this limitation, the following observations are made.Spinal alignment is anatomic. Vertebral body heights are preserved. Mild endplate edema is seen anteriorly at L2-3. No other significant or concerning marrow signal abnormality is seen.The visualized spinal cord and conus are unremarkable. Details of the cauda equina will be discussed by level as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Disc bulge asymmetric to the left foraminal and far lateral regions. Mild generalized spinal canal stenosis. Moderate left foraminal narrowing. L3-4: Moderate facet hypertrophy. Ligamentum flavum thickening. Bulging disc with mild to moderate generalized spinal canal stenosis. Moderate left foraminal narrowing. L4-5: Severe facet hypertrophy. Ligamentum flavum thickening. Bulging disc. Severe generalized spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Severe facet hypertrophy. Ligamentum flavum thickening. Mild generalized spinal canal stenosis. Moderate to severe right and mild left foraminal narrowing. Ill-defined STIR hyperintense signal is seen along the left prevertebral and periaortic soft tissues of uncertain significance. This is visualized only on sagittal STIR images and not well seen on the axial sequences.

Output: 1. Multilevel degenerative findings, most severely affecting the L3-4 level where there is a mild to moderate spinal canal stenosis, and at the L4-5 level where there is a severe spinal canal stenosis.2. Ill-defined abnormal signal is seen within the prevertebral and periaortic tissues on the left as visualized on sagittal STIR images. The significance of this finding is uncertain and it could even be technical in nature. If clinical concern warrants, dedicated abdominal imaging can be considered.


Instruction: Generate impression based on medical findings.

Input: Stage III melanoma of the left neck. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered punctate foci of abnormal T2 hyperintensity within the right periventricular and subcortical white matter, which are nonspecific. 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 right maxillary sinus appears hypoplastic or atelectatic. The skull and extracranial soft tissues are unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of the prostate. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.3 x 4.9 cmPeripheral Zone: There is a focus of signal abnormality in the peripheral aspect of the base of the left peripheral zone (series 801, image 15) measuring 5 x 8 mm which demonstrates decreased T2 signal and decreased ADC signal. There is an additional focus of signal abnormality in the base of the right peripheral zone (series 801, image 16) measuring 2 x 3 mm which demonstrates decreased T2 signal and decreased ADC signal. There is an additional focus of signal abnormality in the left mid gland peripheral zone (series 801, image 10) measuring 4 x 4 mm which demonstrates decreased T2 signal and decreased ADC signal. These lesions are suspicious for prostate cancer.Central Gland: There is marked benign prostatic hypertrophy. The median lobe impresses upon the bladder.Seminal Vesicles: No significant abnormalities.Extracapsular Extension: No definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small retroperitoneal lymph nodes are not pathologically enlarged by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Three subcentimeter foci of abnormal signal within the peripheral zone with imaging characteristics (low ADC and T2 hypointense signal) suspicious for prostate carcinoma.


Instruction: Generate impression based on medical findings.

Input: Vague, non-dermatomal lower back pain. There appear to be 6 lumbar type vertebral bodies, in which the first nonrib-bearing vertebral vertebral body will be designated L1. Furthermore, there is partial sacralization of the right L6 vertebra, where there appears to be hypertrophy at the articulation with the sacrum. There is associated slight narrowing of the L5-6 neural foramen. Otherwise, there is no significant neural foraminal or spinal canal stenosis elsewhere in the lumbar 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. The spinal cord displays normal signal and morphology. The tip of the conus is approximately situated at the level of L1-L2. The paravertebral soft tissues are unremarkable. There is a 2.4 cm left ovarian physiologic follicle.

Output: Apparently there are 6 lumbar type vertebral bodies with partial sacralization of the right L6 vertebra, where there appears to be hypertrophy at the articulation with the sacrum and associated slight narrowing of the L5-6 neural foramen. This may represent a form of Bertolotti syndrome. Otherwise, there is no significant neural foraminal or spinal canal stenosis elsewhere in the lumbar spine. 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: Past history of right breast DCIS and pagets disease, status post mastectomy presents for routine surveillance There is scattered fibroglandular tissue in left breast. Patient is status post right mastectomy.Moderate parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast and right chest wall. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Neoplasm of unspecified nature of brain [239.6], Reason for Study: ^Reason: eval tumor rsxn History: postop There is no acute ischemic lesion on the scan.Near total resection of previously shown the right parieto-temporal lobe large cystic mass. Resection area blood products are seen and shows layering which is measured about 19.1mm x 19.1mm sized. On gad enhanced images, there are irregular and multifocal enhancing areas especially lateral and inferior aspect of the original mass, these enhancing lesions may indicate residual mesion but could also be postoperative reactive changes. Follow up MR imaging study can be considered if clinically indicated.Resection margin and overlying dura and craniotomy sites also show blood products indicating postoperative changes.There are minimal amount of subdural fluid collections with pneumocephalus, again related to surgical resection.Midline shift toward left side is minimal. Other intra axial lesions including corpus callosum, left posterior temporal, left lateral ventricle occipital horn ependymal lining and left temporal lobe anterior horn appear to be stable in terms of size and MR characteristics.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Near total resection of the right parieto-temporal lobe intra axial mass with resection cavity blood products as described above.2. Multifocal and irregular enhancing areas of resection cavity are seen which may indicate residual lesion or post resection reactive changes. Follow up MR study can be considered for further evaluation.3. No change of other multifocal intra axial lesions including corpus callosum, left temporal lobe anterior horn, left lateral ventricle occipital horn ependymal lesion and left posterior temporal lobe lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old, with history of multiple sclerosis, presenting with numbness and weakness. Evaluate for MS FLAIR. Brain:Numerous T2 hyperintense lesions are redemonstrated involving the corpus callosum, the periventricular white matter, the juxtacortical white matter and the cerebellum. Most of these T2 lesions are unchanged in size, but there are new T2 lesions within the left parietal operculum and within the right gyrus rectus, both of which enhance. Many of the pre-existing lesions are also demonstrate new enhancement when compared to prior exams.Brain morphology is otherwise unremarkable. No intracranial hemorrhage or abnormal extra-axial fluid is detected. Ventricular size and morphology are unchanged.Cervical spine:Image quality is degraded by motion artifact. Within this limitation, ill-defined areas of cord T2 hyperintensity are redemonstrated in the upper to mid cervical region without significant interval change. More focal appearing cord lesions from C6 through T1 are new or have progressed when compared to the prior examination. These lesions demonstrate corresponding enhancement. Mild left lateral cord enhancement is also seen at the C2 level.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. No significant compromise of the spinal canal or neural foramina is noted.Thoracic spine:Image quality is reduced by motion artifact. A few scattered vague areas of cord T2 signal abnormality are seen in thoracic region without significant interval change from the prior examination. Except at the T1 level as discussed above, no additional areas of pathologic cord enhancement are seen in the thoracic region.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. No significant compromise of the spinal canal or neural foramina is noted.

Output: 1.Findings are seen compatible with a multiple sclerosis FLAIR in the brain. This includes the presence of lesions which are new from the prior exam, and new enhancement within pre-existing lesions.2.New lesions are also evident within the spinal cord, most notably at the cervicothoracic junction.


Instruction: Generate impression based on medical findings.

Input: 64 years, Male, Reason: 64 y/o M with PMH of ADHF presents with concern for liver lesion on previous imaging, please evaluate History: as above. ABDOMEN:LUNG BASES: Small bilateral pleural effusions. LIVER, BILIARY TRACT: Diffuse reticular pattern with dilated hepatic veins, likely representing passive hepatic congestion. Hepatomegaly.There is a lesion in segment 6/7 measuring 1.4 cm (501/22) with a focus of enhancement which persists on delayed phase images. There is an additional adjacent lesion which is mildly hyperintense on T2 with minimal irregular enhancement and delayed phases (1001/22). A few smaller faint T2 hyperintense lesions are also present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Increased T2 signal and enlargement of the left psoas muscle.OTHER: Moderate ascites.

Output: 1.There are two right hepatic lobe lesions enhancing lesions. These do not meet criteria for hemangioma and have a non specific appearance. Differential considerations include metastatic disease, regenerative nodules in the setting of hepatic venous congestion. The stability in their size suggests against metastasis. If needed a biopsy of these lesions can be performed.2.Diffuse reticular pattern within the liver suggests passive congestion.3.Moderate ascites.4.Increased T2 signal and enlargement of left psoas muscle.


Instruction: Generate impression based on medical findings.

Input: 14-year-old male with neurofibromatosis and new hearing loss, evaluate for vestibular schwannomas. Redemonstrated is an enhancing extra-axial mass within the right internal auditory canal extending into the adjacent cerebellar pontine angle measuring 12 x 9 mm in axial dimension (previously 11 x 7 mm). A similar-appearing, yet smaller, lesion is present within the internal auditory canal without extension into the adjacent cerebellopontine angle measuring 8 x 4 mm (previously 7 x 4 mm). As before, there is no associated mass effect upon the brain parenchyma. Redemonstrated is lace-like FLAIR hyperintensity signal in the subcortical white matter of the left middle frontal gyrus which does not enhance, has no mass effect, and appears similar to the prior study. There is also a much smaller similar-appearing focus in the right which is also stable in appearance. These are felt to most likely represent stable appearing prominent perivascular spaces with mild surrounding high T2 signal. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. Expected vascular flow-voids are demonstrated. The orbits, skull, and scalp soft tissues are unremarkable. Previously demonstrated mucosal thickening in the paranasal sinuses has mostly resolved. Mastoid air cells are clear.

Output: 1. The bilateral presumed vestibular schwannomas have slightly increased in size.2. Unchanged prominent perivascular spaces in the bilateral middle frontal gyri, left greater than right. 3. Unchanged mildly low-lying tonsils.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old, with history of parafalcine meningioma status post fractionated radiotherapy. A T2 heterogeneous, T1 isointense tumor nodule is seen along the anterior interhemispheric falx just above the cingulate gyrus. The lesion is bilateral but predominantly right sided. Since the prior examination, there has been perhaps a slight decrease in lesion size as it now measures 17 x 15 mm in the axial plane, previously 19 x 16 mm. The lesion abuts the adjacent frontal lobe parenchyma but causes no edema or mass effect.Patchy periventricular white matter T2 hyperintensity is again seen, a finding which likely reflects chronic microvascular ischemic disease. No evidence of parenchymal edema, mass effect or restricted diffusion is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricles and sulci are prominent compatible with parenchymal volume loss.

Output: The treated anterior parafalcine tumor is perhaps slightly smaller than on the prior examination. No new intracranial lesions are detected.


Instruction: Generate impression based on medical findings.

Input: Craniocervical junction is unremarkable. There is minimal anterolisthesis of C3 on C4. Alignment is otherwise unremarkable. The osseous marrow signal is benign. There is mild disk desiccation at all levels in the cervical spine. The vertebral body heights are preserved. The cord signal is within normal limits.C2-3: No significant disk/endplate degeneration or spinal stenosis.C3-4: Small central disk osteophyte complex. No spinal canal or neural foraminal stenosis.C4-5: Small central disk osteophyte complex with no spinal canal or neural foraminal stenosis.C5-6: Small central disk osteophyte complex with no spinal canal or neural foraminal stenosis.C6-7: No disk/endplate degeneration or spinal stenosis.C7-T1: No disk/endplate degeneration or spinal stenosis.The upper imaged thoracic spine shows no significant disk herniation or spinal canal/neural foraminal stenosis.

Output: Minimal degenerative changes without significant spinal canal or neural foraminal stenosis at any level. No cord signal abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: any evidence of a neurofibroma? History: woman with pain in left triceps who has neurofibromatosis type 1 Note is made of numerous cutaneous and subcutaneous foci of increased signal abnormality on fluid sensitive sequences which likely represent cutaneous neurofibromas. There is a 1.4 x 0.8 cm focus of increased signal intensity along the anterior aspect of the pectoralis major muscle which likely represents a neurofibroma. There is associated decrease signal abnormality centrally within this lesion. More inferiorly, within the medial head of the triceps is a 4.0 x 3.7 x 6.6 (AP x TR x CC) cm mass which demonstrates heterogeneous but predominantly increased signal intensity on fluid sensitive sequences with low signal intensity centrally, also likely representing an neurofibroma, although the possibility of a malignant peripheral nerve sheath tumor cannot be completely excluded. Note is made of prominent axillary lymph nodes which retain the normal fatty hilum. No bone marrow signal abnormality is identified. The imaged musculature of the left arm is otherwise normal in appearance

Output: Findings consistent with the patient's history of neurofibromatosis as described above. There is a 6.6 cm mass within the medial head of the triceps musculature that likely represents a neurofibroma, however, the possibility of a malignant peripheral nerve sheath tumor cannot be completely excluded by this examination.


Instruction: Generate impression based on medical findings.

Input: Recurrent adenoid cystic carcinoma, status post radiation and surgery. There is no evidence of intracranial hemorrhage or infarction. There are scattered hypoattenuating foci in bilateral cerebral white matter, which may represent small vessel ischemic changes.Extensive post-treatment changes are again present involving the left orbit, maxillary region and upper neck. Again noted are enhancing soft tissue lesion involving the left orbit, extending to the orbital apex, superior and inferior orbital fissure. There is extension into the region of the left pterygopalatine fossa and left cavernous sinus. There is lesion involving the left nasopharyx and sphenopalatine foramen, with bony destruction at the floor of the sphenoid sinus and bone destruction of the left basisphenoid. There is soft tissue lesion overlying and lateral to the ramus of the left mandible. The lesion at the left lacrimal fossa measures slightly larger as 21 x 7 mm (image 12, series 3) compared to prior measurement of 19 x 5 mm (image 33, series 10). There is increased erosion of the lateral wall of the left orbit, with soft tissue lesion involving also the left temporalis muscle. The lesion overlying the ramus of the left mandible is also slightly increased.The enhancing lesions involving the anterior pole of the left temporal lobe, and enhancement in the left foramen ovale seen on prior MRI are not as well appreciated on this CT study and may be related to technical difference.There is patchy opacity in the right lung apex, which may represent inflammatory change. Degenerative disease of cervical spine is noted.

Output: 1. Enhancing lesions involving the left maxillary region and left orbit with extension into the left nasopharynx, left masticator space, sphenoid sinus, skull base, and left cavernous sinus as described above. There is subtle interval increase of the lesions as evident at lateral aspect of the left orbit and left masticator space.2. Enhancing lesion in anterior pole of the left temporal lobe seen on prior MRI study is not well-visualized and may be related to technical difference. This could potentially represent post radiation necrosis versus tumor brain parenchymal involvement. This can be further evaluated with MRI brain using skull base protocol.


Instruction: Generate impression based on medical findings.

Input: Unspecified nystagmus [H55.00] / Unsteadiness on feet [R26.81], Reason for Study: ^Reason: Evaluate for brainstem lesion History: Horizontal and vertical nystagmus, episodes of gait instability Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are, however, multifocal high signal intensity lesions on bilateral periventricular white matter, centrum semiovale, bilateral trigone area (right worse than left) and right midbrain. These lesions appear to be a bit perpendicular to the axis of ventricular system suggesting possible demyelinating disease such as multiple sclerosis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. 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.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous major arch vessels without evidence of luminal stenosis. In particular, the right extracranial ICA is located medially and likely to be retropharyngeal course. Bilateral carotid bifurcation appear to be normal without evidence of luminal stenosis.Vertebrobasilar system appears to be normal without showing any evidence of luminal stenosis.

Output: 1. Multifocal scattered high signal intensity lesions on white matter on FLAIR images. Diagnostic possibility includes demyelinating disease such as multiple sclerosis. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.2. Normal brain MRA.3. Tortuous course of craniocervical arterial system without evidence of luminal stenosis or irregularity.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for traumatic injury of cervical spinal cord History: right arm weakness, tingling, neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There are left-sided uncovertebral osteophytes associated with the left-sided facet hypertrophy at this level and encroachment of the left-sided exiting nerve root. There is mild narrowing of the right neural foramen at this level as a result of disk material and uncovertebral osteophytes. This level is unchanged since the prior exam.At C4-5 there is no significant compromise to the spinal canal. There are endplate reactive changes at this level which were also present on the prior exam but has evolved and are now mostly in a chronic stage. There are uncovertebral osteophytes present at this level and some endplate osteophytes as well some posterior ligamentous hypertrophy. There is a uncovertebral osteophyte formation bilaterally right more than left with bilateral encroachment of the exiting nerve roots. Compared to previous exam the degree of exiting nerve root encroachment as mildly progressed.At C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes at this level associated with posterior ligamentous hypertrophy and encroachment of the exiting nerve roots within the neural foramina. These findings were also present on the previous exam and have not progressed substantially.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is some small uncovertebral osteophytes at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Examination is mildly degraded on the axial imaging due to some patient motion

Output: 1.There are multilevel degenerative changes present in the cervical spine which demonstrates little progression and compared to the 2013 exam. Degenerative changes at C4-5 appear to be in a more chronic stage and there is slightly more encroachment of the exiting nerve roots at this level. There continues to be encroachment of exiting nerve roots on the left-sided C3-4 and at C5-6 as detailed above. There is no evidence for spinal stenosis.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with type 2 diabetes mellitus with unspecified complication. Right diabetic foot ulcer. Rule out osteomyelitis. TENDONS: The flexor and extensor tendons appear grossly intact. The peroneal tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the fifth metatarsal remnant on fluid sensitive sequences with decreased signal abnormality on T1-weighted sequences consistent with osteomyelitis. There is cortical distinctness along the lateral aspect of the base of the fifth metatarsal consistent with osteolysis. No focal fluid collection is identified, although evaluation for abscess formation is limited on this noncontrast examination. Note is made of postsurgical changes of prior transmetatarsal amputation.ADDITIONAL

Output: Findings consistent with osteomyelitis of the base of the fifth metatarsal remnant as described above. No focal fluid collection to suggest abscess formation, within the limitations of a noncontrast examination. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 9-year-old female with history of pilocytic astrocytoma resection, yearly follow-up Examination is motion degraded. Redemonstrated are changes from previous left suboccipital craniotomy with left paramedian cerebellar resection tract and left cerebellar volume loss. No new FLAIR signal abnormality or significant enhancement within the resection bed is demonstrated to suggest tumor recurrence. No new parenchymal or meningeal enhancement is seen within the remainder of the brain. No evidence of acute infarct or hemorrhage. No intracranial mass effect. No hydrocephalus. No extra-axial collections. Mild mucosal thickening is seen within the left maxillary sinus. Visualized extracranial soft tissues are otherwise unremarkable.

Output: Examination is mildly motion degraded but demonstrates no appreciable evidence of recurrent tumor.


Instruction: Generate impression based on medical findings.

Input: Again seen are postsurgical changes of a right frontal craniotomy with resection of a right middle frontal gyrus lesion. At the superior margin of the resection cavity, there is again a non-specific enhancing nodule which measures approximately 5 mm in greatest dimension. This has not significantly changed since the prior examinations dating back to 7/5/2016. There are foci of susceptibility artifact again seen within the surgical bed, likely related to hemosiderin deposition. A heterogeneous ring-enhancing lesion is again seen extending into the trigone of the right lateral ventricle, which measures 21 x 15 mm (series 1100, image 90) compared to 21 x 16 mm previously. Portions of the wall of the lesion again demonstrate restricted diffusion and enhancement, similar to the previous examination. Stable FLAIR signal abnormality surrounding the lesion is consistent with vasogenic edema. No new enhancing lesions are identified.Scattered foci of signal hyperintensity on FLAIR and T2-weighted images in the periventricular and subcortical white matter likely reflect chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1.A right periventricular white matter lesion appears stable compared to the prior exam on 11/24/2016. No new enhancing lesions are identified.2.Stable appearance of the right middle frontal gyrus resection cavity.


Instruction: Generate impression based on medical findings.

Input: Dementia with unresolving AMS. There is diffuse cerebral white matter T2 hyperintensity bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions with high T1 and low T2 signal and diffuse mucosal thickening within the right maxillary sinus.

Output: 1. Probable chronic small vessel whiter matter ischemic disease and mild diffuse cerebral volume loss, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Complete opacification of the right maxillary sinus with hyperattenuating components and mild protrusion into the nasal cavity, which may be related to chronic inspissated secretions.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with pain in wrist. LIGAMENTS: The scapholunate ligament appears abnormally thickened which may reflect prior injury but no contrast extends through the ligament to indicate a tear. The lunotriquetral ligament appears intact. There is a small amount of contrast entering the midcarpal joint via what we believe to be communication with the radiocarpal joint along the lateral supporting structures of the wrist; the clinical significance of this is uncertain. TRIANGULAR FIBROCARTILAGE COMPLEX: Contrast extends from the radiocarpal joint into the distal radioulnar joint via a tear of the articular disc of the triangular fibrocartilage complex near its radial attachment.TENDONS: The tendons appear intact.BONES: There is mild cartilage degeneration affecting the wrist, particularly at the capitolunate and lunohamate articulations. Bone marrow signal intensity is otherwise unremarkable.

Output: Tear of the articular disc of the triangular fibrocartilage complex and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old, with unprovoked first time generalized tonic-clonic seizure. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The medial temporal lobe structures are symmetric and free of pathologic signal abnormality.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation with no specific findings to account for the patient's seizure.


Instruction: Generate impression based on medical findings.

Input: Wrist pain Tendons: The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: There is no extravasation of contrast into the radiocarpal space or the distal radioulnar joint. The scapholunate ligament is intact. The lunotriquetral ligament is intact. The triangular fibrocartilage complex is intact.Joints: There is abnormal marrow signal intensity involving the lunate dorsally with a small amount of cystic change. There is no evidence of gross collapse or fragmentation although there is some irregularity along the dorsal margin best appreciated on series 601 image 14. The remaining marrow signal of the carpal bones as well as the distal radius and ulna are normal. There is no dislocation or subluxation. There is no significant arthrosis.Muscles: There is no muscle tear or atrophy of the flexor or extensor compartments.Nerves: The median nerve in the carpal tunnel is unremarkable. The ulnar nerve in Guyon’s canal is unremarkable.

Output: 1. Abnormal marrow signal intensity and cystic change which is isolated to the lunate. These findings are concerning for developing avascular necrosis. Although this could conceivably be posttraumatic in nature, it is thought to be less likely as the marrow signal intensity of the remaining osseous and surrounding soft tissue structures is normal.2. Intact scapholunate ligament.


Instruction: Generate impression based on medical findings.

Input: MRI CARDIAC W/FLOW W/STRESS WWO, 11/16/2016 8:15 AM First Pass PerfusionDuring hyperemia, no perfusion defects were present. Mild dark rim artifact is present. Viability/ Myocardial ScarThere is mid-myocardial late gadolinium enhancement of the septum from the mid wall to the base which represents an infiltrative process, inflammation, or fibrosis. The finding is not typical for prior myocardial infarction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 161 ml/m2 (normal range: 65+/-11), the LVEDV is 334 ml (normal range 109+/-23), the LV end systolic volume index is 133 ml/m2 (normal range 18+/-5), the LVESV is 277 ml (normal range 31+/-10), the LV mass index is 41 g/m2, and the LV mass is 69 g. There is global hypokinesis with regional variation. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 117 ml/m2 (normal range 69+/-14), the RVEDV is 243 ml (normal range 110+/-24), the RV end systolic volume index is 97 ml/m2 (normal range 22+/-8), and the RVESV is 200 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is mildly dilated. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilatedVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions (right greater than left). 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. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity of any vasodilator stress test is likely reduced in the face of severe LV dilation and dysfunction. 2. The left ventricle is severely dilated with severely reduced systolic function (LVEF 17%). There is evidence of myocardial fibrosis involving the mid-myocardial layer of the basal septum. This finding is not typical for prior myocardial infarction and has been commonly described in non-ischemic/ dilated cardiomyopathy. 4. The right ventricle is severely dilated with severely reduced systolic function (RVEF 17%).5. At least moderate mitral regurgitation.6. Severe biatrial enlargement.7. Mild dilation of main pulmonary artery and aortic root. 8. Small pericardial and pleural effusions. 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: Left hip pain ACETABULAR LABRUM: There is tearing of the labrum superiorly and posteriorly which is best appreciated on series 11 images 8-11 of 22. The anterior labrum appears relatively spared. There are numerous associated paralabral cysts (series 9 image 19/40) which also involve the superior acetabulum.ARTICULAR CARTILAGE AND BONE: There is prominence of the femoral head neck junctions suggesting the the presence of a CAM type deformity. Multiple presumed paralytic labral cysts are noted within the superior acetabulum.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Tearing of the superior and posterior labrum with multiple associated paralabral cysts which appear to also involve the superior acetabulum.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o bleed History: s/p fall None infused head CT:There is no intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Bilateral extra-axial CSF density collections in frontal and anterior parietal regions are concerning for old subdural hematomas. Recommend follow-up with an MRI examination. The collection on the left at the level of frontal horn of lateral ventricle measures approximately 9 mm in size and results in very minimal flattening of the cortex. The smaller right-sided subdural measures approximately 6.4 mm. Minimal patchy foci of periventricular white matter is concerning for mild small vessel disease of indeterminate age.

Output: 1.No evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.2.Small bilateral frontal CSF density subdural collections (left greater than right) with very subtle mass effect on the brain parenchyma.3.Mild small vessel disease of indeterminate age.


Instruction: Generate impression based on medical findings.

Input: Acute hypoxic event at birth. Evaluate brain structures. There is no evidence of intracranial hemorrhage, mass or edema. There is diffuse low attenuation in the subcortical tissues consistent with unmyelinated brain tissue, an expected finding given the patient's age. There are no CT findings of hypoxic injury -- if clinical concern remains recommend noncontrast 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: Unremarkable brain CT. If clinical concern remains for hypoxic injury, recommend noncontrast MRI.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female status post Chiari decompression experiencing headache, subjective balance issues, as well as pressure in head Redemonstrated are changes from previous suboccipital craniectomy for treatment of Chiari malformation. A previously demonstrated extradural fluid collection has resolved, resulting in resolution of mass effect upon the adjacent dura, with commensurate increase in the CSF space at the distal aspect of the tonsils. As before, there is biphasic CSF flow at the level of the cerebellar tonsils. Redemonstrated is straightening cervical spinal may be 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: Unremarkable and unchangedC3/4: Unremarkable and unchangedC4/5: Unremarkable and unchangedC5/6: Unremarkable and unchangedC6/7: Mild disc bulge and bilateral uncinate hypertrophy. There is mild bilateral neural foraminal stenosis. These findings are unchanged.C7/T1: Unremarkable and unchanged

Output: 1.Redemonstrated are changes from previous suboccipital craniectomy for treatment of Chiari malformation. A previously demonstrated extradural fluid collection has resolved, resulting in resolution of mass effect upon the adjacent dura, with commensurate increase in the CSF space at the distal aspect of the tonsils. As before, there is biphasic CSF flow at the level of the cerebellar tonsils.2. C6/7: Mild bilateral neural foraminal stenosis, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p injury to hand, evaluate index MCP joint, pain with extension History: pain Limited study as the patient refused to complete the examination per the technologist memo. Several sequences are also limited due to patient motion artifact. A marker was placed along the dorsal aspect of the second MCP joint. Given the aforementioned limitations, the underlying extensor tendon appears intact. We see no underlying bone or soft tissue injury affecting the MCP joint. There is a small sesamoid bone volar to the second metacarpal head. There is a small focus of signal abnormality within the lateral aspect of the second metacarpal head which may represent a small cyst. We see no frank synovitis. The remainder of the second metacarpal appears normal. The proximal and middle phalanges of the index finger appear normal. There is a fracture through the tuft of the distal phalanx as seen on recent radiographs.

Output: Limited study due to patient motion artifact and refusal to complete the examination which shows no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Left knee pain The knee appears normal without specific findings to account for the patient's pain.

Output: Normal-appearing knee without findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient with persistent non-traumatic left ankle pain. Please identify potential causes (fracture, injury to ligaments). History: Left ankle pain. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. There is a lobulated fluid signal intensity within the tendon sheath of the peroneus longus tendon indicating a tenosynovitis. The Achilles tendon is normal in appearance.LIGAMENTS: The distal tibiofibular syndesmotic complex appears intact. There is disruption of the ATFL. The PTFL and calcaneofibular ligaments appear intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is subchondral cyst formation within the second cuneiform likely degenerative in etiology. There is bone marrow signal abnormality within the lateral aspect of the talar dome.ADDITIONAL

Output: 1. Disruption of the ATFL.2. Bone marrow signal abnormality in the lateral aspect of the talar dome likely representing degenerative changes/subchondral cyst formation, although this could represent a chronic osteochondral defect. Other findings as described.3. Tenosynovitis of the peroneus longus tendon.


Instruction: Generate impression based on medical findings.

Input: 50 year old female patient with history of left breast cancer s/p chemotherapy and RT presents for 6 month follow up for non-mass enhancement in the right breast at 2 o'clock position s/p biopsy that demonstrated PASH. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Clip artifact is identified in the noted along the anterior aspect of the previously seen non-mass enhancement in the right upper inner breast at posterior depth at 2 o'clock position that measures approximately 0.3 x 0.3 cm, previously 1.2 x 0.7 x 1.2 cm (AP x LM x CC). Postsurgical changes in central medial left breast lumpectomy including skin thickening and seroma that measures 6.7 x 1.5 cm is noted that demonstrates homogenous rim enhancement.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Postsurgical changes in the left breast. Clip from prior stereotactic biopsy within a tiny residual focus in the right breast 2 o'clock position, which is much smaller in size from prior MRI examination. No further 6 month follow up is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluation for stress fracture History: Right hip and groin pain x 5 months in runner ACETABULAR LABRUM: A small focus of increased signal intensity along the undersurface of the anterior labrum, between the 3 and 4 o'clock positions, is suspected to represent cartilaginous undercutting, or perhaps a small normal variant recess, rather than a tear. The remainder of the labrum is unremarkable.ARTICULAR CARTILAGE AND BONE: Note is made of a supraacetabular fossa, a normal variant. Otherwise, the articular cartilage appears normal. The bone marrow signal intensity is within normal limits. We see no stress fracture or CAM deformity.SOFT TISSUES: There is minimal peri-trochanteric edema on the right, which appears slightly more prominent than the left, but this is of questionable clinical significance. The remainder of the soft tissues are unremarkable. ADDITIONAL

Output: Minimal right peri-trochanteric edema of questionable clinical significance. We see no stress fracture or other specific findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with acute mental status changes evaluate for metastases. Again seen are multiple areas of hypoattenuation in the bilateral cerebellar hemispheres, basal ganglia, and the bilateral parietal lobes consistent with metastatic disease. No new definite metastatic lesions are seen. If there is clinical concern for a new metastatic lesion, contrast enhanced CT or MRI recommended.There are multiple areas of periventricular and subcortical hypoattenuation consistent with small vessel ischemic disease of indeterminate age. There is redemonstration of the low density focus in the brainstem which likely represents a chronic infarction.Hyperdense material in the left globe is evident, compatible with patient's known intra-ocular metastasis with possible hemorrhage.There is no evidence of intra-or extra axial hemorrhage, mass effect, or midline shift. The size of the ventricles remains stable. The visualized mastoid air cells and paranasal sinuses are clear.

Output: 1.No significant interval change in multiple intracranial metastatic lesions. If there is clinical concern for a new metastatic lesion, contrast enhanced CT or MRI is recommended.2. Stable hyperdense material in left globe, compatible with patient's known intra-ocular metastasis with possible hemorrhage.


Instruction: Generate impression based on medical findings.

Input: 61 year-old female. Recurrent urothelial cancer, pelvic pain, evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Expected mild hydronephrosis with diversion into a right lower quadrant ileal conduit.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical findings in the small bowel and colon from partial resection. Anterior mesenteric soft tissue nodule, likely a metastasis (series 11, image 30).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical findings of total vaginectomy. BLADDER: Postsurgical findings of cystectomy and right lower quadrant ileal conduit.LYMPH NODES: Left inguinal lymphadenopathy and soft tissue nodules in the left lower abdominal wall, likely metastaticBOWEL, MESENTERY: Postsurgical findings in the small bowel and colon from partial resection.BONES, SOFT TISSUES: 5 x 4.8 cm soft tissue mass in the central lower pelvis within the operative bed invading into the right labia consistent with residual tumor. Multiple soft tissue nodules inside the pelvis, studding a small bowel loop and sigmoid colon consistent with local metastasis. Additional multiple soft tissue nodule metastases are seen in the medial proximal pelvic musculature (obturator internus, obturator externus, pectineus) and in the perineum, including one on the left that is 2 x 2.1 cm. Comparison to prior is difficult given presence of extensive background post-surgical changes. Post-surgical findings of bilateral superior pubic rami resection and edema in the pelvic muscles.OTHER: No significant abnormality noted.

Output: Significant residual tumor in the operative bed in the central lower pelvis with multiple soft tissue metastatic nodules in the perineum and medial pelvic musculature.


Instruction: Generate impression based on medical findings.

Input: 11 year old male with history of Tuberous Sclerosis. Evaluate for renal angiomyolipoma. ABDOMEN:LUNG BASES: There is bibasilar dependent atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous tiny (3 mm or less) low attenuation lesions are present in both kidneys, with the largest measuring up to 6 mm (series 3, image 57) located in the midportion of the right kidney. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fundoplication clips are noted. Otherwise no significant abnormality noted.BONES, SOFT TISSUES: The height of the vertebral bodies is diminished most likely due to lack of upright weight bearing. OTHER: Gastrostomy tube tip in the stomach.

Output: Numerous tiny bilateral renal low attenuation lesions with one small lesion located in the right kidney. These are likely a combination of cyst and angiomyolipoma.


Instruction: Generate impression based on medical findings.

Input: 22 years Male (DOB:9/1/1993)Reason: evaluate for etiology of decreased vision, headache History: lymphoma, sigmoid sinus thrombosisPROVIDER/ATTENDING NAME: GREG TOMCZYK CHADI NABHAN MRI brain:There is redemonstration of a marrow replacing lesion which involves the clivus and right petrous bone surrounding the carotid canal and extending to the right jugular bulb with a soft tissue component which extends towards the right carotid space and jugular vein and a small component of the right lateral aspect of the right prevertebral space at the level of the occipital condyle.. This has been present on the prior exam and does not appear to have significantly changed since 5/13/2016 exam.There is redemonstration of enhancement along the sphenoid wings and mandibular heads bilaterally. This does not appear to have changed substantially since the prior exam. There is additional patchy involvement of the masticator spaces which relatively stable.There is enhancement of the trigeminal nerves present extending to the root entry zones. This has progressed since the previous exam. There is some contrast enhancement present along the cranial nerves VII and VIII. There is subtle enhancement along the third cranial nerves bilaterally.Small enhancing focus is present at the right hypoglossal canal and extending into the right cerebellar medullary angle cistern. It appears to abut the right cerebellar hemisphere at that location. This appears to have slightly progressed compared to the prior exam. It currently measures approximately 11 x 6 mm in axial dimensions and previously measured 3 x 11 mm axial dimensions. There are some subtle enhancement along the surface of the medulla and cerebellum at the left cerebellar medullary angle cistern.A ventriculostomy tube courses of the right frontal lobe into the right lateral ventricle with tip in the region of foramen of Monro. The lateral ventricles are stable in size.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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 demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Findings suggest some enhancement along the dural sleeves of the optic nerves bilaterally. This appears to be new since the prior exam.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.MRV brain:There is redemonstration of intraluminal filling defect within the right jugular bulb and right sigmoid sinus.The rest of the dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.Since the prior exam there appears to be some dural involvement involving the dural sleeves of the optic nerves bilaterally. 2.Since the prior examination patient developed new cranial nerve enhancement involving the fifth cranial nerves bilaterally but also the cranial nerves VII and VIII and possibly the third cranial nerves. Suggesting leptomeningeal or direct cranial nerve involvement/reaction.3.There is redemonstration of a skull based tumor involving clivus and right petrous bone with associated extension into the right carotid space and right prevertebral space. This appears to be relatively stable in extent when compared to the previous exam. Some extension into the right cerebellar medullary angle cistern appears to be slightly progressed compared to the prior exam. There is additional marrow involvement which includes the sphenoid wings and sphenoid bone and mandibular heads as well as portions of the masticator space which are stable.4.There is a intraluminal filling defect within the visualized portions of the proximal jugular vein and distal sigmoid sinus which could represent thrombus and/or tumor.


Instruction: Generate impression based on medical findings.

Input: 66 year old male with history of rheumatic heart disease, diabetes, hypertension who presents for cardiac MRI to further evaluate aortic valve regurgitation, aortic valve stenosis, and ascending aorta. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 92 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 131 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is late gadolinium enhancement in the basal inferolateral wall which spares the endocardium and is in a pattern atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as old myocarditis/ vasculitis/ etc.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly increased.Aortic ValveThere is a bioprosthetic valve is the aortic position. There is mild aortic regurgitation. There is thickening and likely calcification of the aortic valve; however, aortic valve morphology is limited by artifact caused by the prosthetic valve. There is evidence of flow acceleration through the aortic valve and aliasing at a velocity of 3m/s. These findings suggest that there is at least moderate aortic valve stenosis, with a peak velocity >3m/s.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; however, the ascending aorta is mildly dilated (43mm) measured approximately 5cm from the aortic valve plane.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are 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. Normal LV size and systolic function (LVEF 58%) with evidence of late gadolinium enhancement involving the basal inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The finding most likely represents prior myocarditis.2. Normal RV size and systolic function (RVEF 60%).3. Severe left atrial dilation.4. There is a bioprosthetic valve is the aortic position. There is thickening of the aortic valve with at least moderate aortic valve stenosis and mild aortic regurgitation.5. Mild dilation of the ascending aorta.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis. Evaluate for progression. There is minimal retrolisthesis of C4 on C5 and C5 on C6. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal morphology. There are scattered foci of T2 hyperintense signal within the cervical spinal cord at multiple levels as follows: at the C2 level, in the slight right paramidline posterior aspect; at the C3-4 level, in the right lateral aspect; at the C5 level, in the posterior midline; at the C6-7 level, in the left lateral aspect; at the C7-T1 level, in the right lateral aspect. There is minimal degenerative spondylosis in the lower cervical spine without significant spinal canal or neural foramen stenosis. There is a subcentimeter left adenoid retention cyst. The paravertebral soft tissues are unremarkable.

Output: Multiple lesions within the cervical cord may represent a demyelinating process. No prior cervical spine MRI is available to evaluate for progression.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: Known sarcoidosis with possible biliary mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is of normal in morphology and size measuring 15 cm in craniocaudal dimension. There is mild intrahepatic biliary ductal dilatation. The common bile duct measures approximately 7 mm, within normal limits. Cholelithiasis within a normally distended gallbladder without wall thickening or pericholecystic fluid. At the gallbladder neck there is a 2.8 x 2.6 cm (series 4/19) focus which is very low signal intensity on all imaging sequences (as are the smaller gallstones) without postcontrast enhancement likely representing a large gallstone. Thrombosed residua of the pseudoaneurysm identified on the CT dated 9/6/2014 is considered unlikely. No hepatic artery pseudoaneurysm is identified compatible with the findings of the 1/12/2015 angiogram.There is a left sided percutaneous biliary drain extending through the left hepatic lobe and common bile duct into the duodenum.At the junction of segment 4A and 4B just anterior to the left sided biliary drain there is a focal masslike region of T1 hypointensity measuring approximately 3.4 x 3.2 cm (series 11/57) on the precontrast imaging which demonstrates gradual postcontrast enhancement measuring up to 2.4 x 2.3 cm (series 13/56). There may be a corresponding hypoattenuating focus in a similar region on the CT dated 9/6/2014 (series 3 image 19). This is associated with subtle T2-weighted hyperintensity and restricted diffusion (series 5/52 and series 10/12).The hepatic veins, portal vein and visualized portion of the hepatic artery are patent.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate renal cysts. No hydronephrosis. Symmetric mild perinephric fluid.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Persistent right basilar segmental consolidation/atelectasis. Cardiomegaly.

Output: 1. At the junction of segment 4A/4B there is a focal masslike region demonstrating gradual post contrast enhancement along the anterior margin of the left-sided biliary drain. Given the history of sarcoidosis and possible presence on the 2014 examination this may be secondary to hepatic sarcoidosis. However this can't be distinguished on imaging from cholangiocarcinoma which remains in the differential.2. Previously described lesion at the gallbladder neck likely represents a large gallstone. No evidence of an enhancing pseudoaneurysm.3. Persistent right basilar segmental consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: There is a large cystic intra-axial mass centered in the right medial frontal lobe in the right superior/middle frontal gyri with no significant enhancement and numerous foci of susceptibility representing calcification as seen on outside CT imaging documented on patient's electronic medical record. There is infiltrative masslike appearance involving the right superior frontal and cingulate gyri.The overall mass measures 79 x 50 mm on axial image series 501 image 26, and up to 51 mm AP on series 1002 image 93. There is no associated restricted diffusion within the cystic component or rim enhancement. There is moderate surrounding nonenhancing T2 hyperintense signal abnormality without extension across the corpus callosum. There is mass effect with midline shift to the left of 14 mm, with mass effect on the bilateral frontal horns, right greater than left and downward mass effect on the anterior corpus callosum.There is no acute infarct or separate focus of abnormal intracranial enhancement. There is mild entrapment of the left lateral ventricle. There is no transtentorial, uncal or cerebellar tonsillar herniation. There are bilateral maxillary sinus mucus retention cysts.

Output: Intra-axial nonenhancing right frontal lobe mass with masslike infiltration involving the right superior frontal gyrus and cingulate gyrus and surrounding edema. There are foci of calcifications and a cystic component laterally. Mass is most favored to represent a primary brain neoplasm such as oligodendroglioma or oligoastrocytoma. 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: Known perirectal abscess status post seton, persistent rectal pain and leukocytosis (WBC=17.9) despite antibiotics PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Heterogeneously T2 hyperintense, peripherally enhancing tract / collection arising from the right lateral wall of the rectum at the 9 o'clock position does not communicate with the skin (series 4, image 42). A seton is present within the tract.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Suprasphincteric perirectal fistula as described above with associated abscess.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old. History of blue finger and thumb intermittently. TENDONS: There is a small amount of fluid within the extensor tendon sheaths, likely physiologic. BONES: There is no abnormal enhancement or bone marrow edema. No focal osseous lesions.ANGIOGRAM: The ulnar artery and the takeoff of the superficial palmar arch is well-opacified and normal in caliber. The common palmar digital arteries are patent proximally, however there is gradual tapering and the proper digital arteries are not well opacified distal to the bifurcation. The digital artery supplying the radial aspect of the fifth finger is well opacified distally, however the artery arising from the superficial palmar arch supplying the ulnar side of the fifth finger is communicated and poorly opacified.The radial artery gives rise to the deep palmar arch. The radial artery and deep palmar arch are patent but are diminutive in caliber. The princeps pollicis artery and the radial artery of the index finger arise from the deep palmar arch and are also diminutive, as are the metacarpal arteries through the ulnar aspect of the deep palmar arch.ADDITIONAL

Output: Diminutive caliber of the radial artery, deep palmar arch, and metacarpal arteries, most severely involving the thumb and index finger. This can be related to vasospasm as can be seen with Raynaud's disease, less likely vasculitis or upstream chronic embolization. If more detailed evaluation is needed, further evaluation with conventional catheter angiography could be performed.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old, history of GBM. Findings are redemonstrated related to left parietal craniotomy for tumor resection. A small epidural collection subjacent to the craniotomy is not significantly changed in thickness. A small surgical cavity within the posterior lateral left temporal lobe is stable in size and morphology. T2 hyperintensity surrounding this cavity, and extending superiorly into the parietal lobe, is also unchanged.On postcontrast images, irregular enhancement along the periphery of the resection cavity is unchanged. Two or three nodules of enhancement anterior to the resection cavity are also stable in size and morphology. More superiorly, a thick band of enhancement within the left parietal lobe is also stable. This tissue, and some areas surrounding the resection cavity, demonstrate elevated rCBV, while the discontiguous nodular foci anterior to the resection cavity are not well assessed due to proximity to bone.A nonenhancing round focus of T2 hyperintensity within the right thalamus is stable. Also stable is mild asymmetric T2 hyperintensity within the left posterior thalamus and the left insula.No new pathologic intracranial enhancement is seen. No new fluid collections are detected. The ventricular system is stable and normal in size.

Output: Stable examination with no convincing evidence of progressive tumor.


Instruction: Generate impression based on medical findings.

Input: Pain. Suspect medial meniscus injury. MENISCI: There is a small undersurface tear at the posterior horn of the medial meniscus. The lateral meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: There is mild chondral softening at the medial facet of the patella, without full-thickness defect or underlying bone marrow reactive changes. There is a full thickness defect with underlying bone marrow reactive changes at the deep flexion portion of the medial femoral condyle. The remainder of the cartilage and bone marrow is unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact and unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small undersurface tear of the posterior horn of the medial meniscus.2. Focal areas of chondromalacia, as above.


Instruction: Generate impression based on medical findings.

Input: 72Yrs male with history of ulcerative colitis s/p colectomy and ileostomy (1970), cholecystectomy (1970), splenectomy (1974), PSC s/p liver transplant (1989), HCV s/p Harvoni (2015), CKD, chronic pancreatitis, presents for evaluation of pancreatitis. Evaluation limited by lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes related to liver transplant. Susceptibility artifact at the hepatic hilum mildly limits evaluation of surrounding structures. No significant biliary ductal dilatation. The hepatic parenchyma demonstrates normal signal intensity without focal lesions. No significant biliary ductal dilatation. Trace perihepatic ascites.SPLEEN: Status post splenectomy.PANCREAS: There is irregular dilation of the pancreatic duct in the body and tail measuring up to 13 mm, increased from the 12/6/2013 examination. The pancreatic duct abruptly narrows in the proximal body and is nondilated in the neck and head. Filling defects are noted within the dilated portions of the pancreatic duct compatible with pancreatic duct stones. The pancreas is atrophic. There are subcentimeter cystic structures in the uncinate process which could represent side branch IPMNs. Postsecretin imaging demonstrates that the aforementioned pancreatic duct stenosis remains fixed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left greater than right renal parenchymal atrophy. Numerous simple and complex cysts are again noted in the kidneys. Several cystic lesions are new or more prominent than on the 12/6/2013 examination, demonstrate intrinsically increased T1 signal, and may reflect proteinaceous and/or hemorrhagic cysts but are incompletely characterized without intravenous contrast.RETROPERITONEUM, LYMPH NODES: Mild lymphadenopathy is again noted with a reference aorto-caval node measuring 1.2 cm in short axis, not significantly changed.BOWEL, MESENTERY: Postsurgical changes related to colectomy and ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Examination limited by lack of intravenous contrast.2.Findings compatible with chronic pancreatitis. 3.Pancreatic duct stenosis with increased pancreatic ductal dilation in the body. Associated pancreatolithiasis. Further evaluation with ERCP may be considered as clinically warranted.4.Numerous renal cystic lesions, some of which are more prominent than on the prior examination. Though these may simply represent proteinaceous/hemorrhagic cysts, they are incompletely characterized without intravenous contrast.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with metastatic lung cancer and known metastasis, please do violate for progression. No evidence of acute intracranial hemorrhage. There is a 5-mm focus of high attenuation in the peripheral cortex of the right frontal lobe (image 22/30, series 2) which may correlate with a previously seen metastatic lesion at this site on the previous brain MRI. Other metastasis there were previously demonstrated and not well seen given the lack of intravenous contrast on this examination.There are a few foci of subtle low attenuation in a periventricular distribution compatible with small vessel ischemic disease of indeterminate age.The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection.The calvaria and skull base are radiographically normal. The left frontal sinuses are completely opacified. There is partial opacification of the ethmoid air cells and sphenoid sinuses. There is slight erosion of bone of the posterior right lamina papyracea near the orbital apex. The soft tissue density previously seen in the ethmoid air cells in this region has partially resolved. Please see recent MRI for further detail. The mastoid air cells are appropriately pneumatized. The maxillary antra are not visualized on the current exam.

Output: 1. Stable noncontrast CT of the head without new acute abnormality. Please note that the lack of intravenous contrast limits the sensitivity of this examination for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: New onset seizure with left temporoparietal localization. Given gross patient motion throughout the examination and inability to cooperate, the examination protocol was changed and the seizure localization specific sequences were not performed. There is no mass-effect or brain herniation. Accounting for patient motion, there is no gross intracranial hemorrhage or gross acute infarct. Mild-to-moderate periventricular frontoparietal confluent T2-hyperintensity probably reflect microvascular ischemia. There is also dilatation of the ventricular system and the other CSF-containing spaces, reflective of underlying moderate brain volume loss. The major intracranial vascular flow voids are preserved.The orbits are notable for bilateral lens replacement. The lobulated right facial mass is markedly T2-hyperintense and T1-hypointense in its posterior larger component but is more solid in its anterior component. It probably arises from the right first gland but is incompletely imaged. There is no associated skull lesion.

Output: 1.Limited, incomplete examination, because of patient's gross motion and inability to cooperate.2.There are cerebral white-matter changes of chronic microvascular ischemia and global brain volume loss. There is no gross signs of acute ischemia/infarct or intracranial hemorrhage.3.Large right facial mass probably arises from the right parietal gland and shows findings suggestive of being partly cystic and partly solid. However, the mass is not completely assessed.


Instruction: Generate impression based on medical findings.

Input: Female; 81 years old. Reason: radiation planning for treatment of cervical cancer History: cervical cancer PELVIS:UTERUS, ADNEXA: Large cervical mass with intermediate T2 signal, restricted diffusion, and contrast enhancement measuring up to 3.4 x 5.3 x 4.6 cm (AP by transverse by craniocaudal, series 1403/468 and series 701/27), compatible with cervical cancer. The mass is predominantly confined within the uterine serosa. However, there is focal area of loss of fat plane between the mass and the rectum, suspicious for mild rectal invasion (series 601/36). There is also mild extension of the tumor beyond the serosa toward the left pelvic sidewall seen inferiorly (series 601/37). Lastly, there appears to be mild inferior extension to involve the left lateral aspect of the upper vagina, where mild increased vaginal wall thickening and enhancement is seen (series 1403/398).Low T2 signal material below the mass in the endocervical and vaginal canals with intervening high T1 signal, most compatible with packing material and blood products. Uterine fibroid at the fundus measuring up to 4.3 x 4.2 cm (series 1403/513). Additional smaller myometrial fibroids are seen in the uterine body bilaterally.BLADDER: Foley catheter tip in bladder.LYMPH NODES: Bilateral pelvic sidewall lymphadenopathy, compatible with metastatic disease. For future reference, the largest lymph node measures 1.7 x 2.6 cm in the right pelvic sidewall (series 1403/478). A smaller, rounded left pelvic sidewall lymph node is seen on series 1403, image 498.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: Large left renal cyst extending into the superior pelvis, partially visualized.

Output: 1. Cervical cancer as detailed above with probable left pelvic sidewall and left upper vaginal involvement. Additionally, there is loss of the fat plane between the rectum, and underlying extension is not excluded, although not overtly seen.2. Bilateral pelvic sidewall metastatic lymphadenopathy, worse on the right.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old, with history of lung cancer metastases to the brain status post radiosurgery. A lesion in the left inferior frontal lobe demonstrating minimal peripheral enhancement shows no significant interval change in size when compared to the prior examination. Likewise, a mildly rim-enhancing lesion in the left cerebellum shows no significant interval change in size.A punctate enhancing focus within the left intraparietal sulcus is less conspicuous than on the prior examination. Previously described punctate enhancing lesions within the right superior parietal lobule and along the right occipital cortex are no longer distinctly visualized.None of the above mentioned lesions cause any significant edema. No new lesions are identified. No generalized mass effect is detected. The ventricles remain normal in size and morphology.

Output: Lesions in the left inferior frontal lobe and left cerebellum show no significant interval change. A punctate lesion within the left intraparietal sulcus is less conspicuous than on the prior examination. Two other previously described punctate lesions are no longer distinctly visualized. No new lesions are seen.


Instruction: Generate impression based on medical findings.

Input: history of Chiari decompression in 1995Signs and Symptoms: neck and arm pain paresthesia The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.The patient status post suboccipital craniectomy for Chiari 1 decompression.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is loss of disc space height as well as a mild disc bulge and mild uncovertebral osteophytes bilaterally. There is mild narrowing of neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal. There is loss of disc space height, disc bulge and endplate and uncovertebral osteophytes is also mild posterior ligamentous hypertrophy at this level. There is a encroachment of the left-sided exiting nerve roots more than the right exiting nerve roots related to combination of disc material and osteophytes.At C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation and a disc bulge at this level. There is narrowing of the neural foramina bilaterally at this level with mild encroachment of exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation and a disc bulge at this level. There is narrowing of the neural foramina bilaterally at this level with mild encroachment of exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Incidental note is made of partial empty sella.

Output: There are multilevel degenerative changes present in the cervical spine with associated narrowing of the neural foramina at multiple levels and some mild encroachment of exiting nerve roots at multiple levels as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old, with worsening altered mental status, word finding difficulty, dyskinesia and tremor in the severely immunosuppressed patient. No restricted diffusion is seen. No evidence of significant parenchymal edema or mass effect is detected. There are a few scattered small nonspecific foci of T2 hyperintensity in the brain. Numerous foci of susceptibility are, however, detected throughout the brain ranging in size from punctate to several millimeters. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.

Output: 1.No findings are seen to suggest infection, edema or any other definite acute process.2.Note is made of numerous scattered foci of susceptibility in the brain. These could represent sites of chronic microhemorrhage, amyloid angiopathy, or even sequelae of remote trauma. Correlation with clinical history and cerebrovascular risk factors may be helpful.


Instruction: Generate impression based on medical findings.

Input: 31 years Female (DOB:8/14/1985)Reason: evaluate for 2/2 cause of memory loss, frontal lobe deficits History: short term memory lossPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. There are T2 and FLAIR hyperintense curvilinear bands present along the medial aspects of the cerebellar hemispheres and vermis as well as medial aspects of the occipital lobes. These are not seen on the T1 images nor on the B0 images. They're suspected represent artifact.History: Is made of a developmental venous anomaly in the left cerebellar hemisphere inferiorly.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.T2 signal noted projecting over the cerebellar hemispheres and medial occipital lobes suspected to represent artifact related the patient's hair or hair extensions.2.No abnormal lesions are appreciated within the brain parenchyma that would explain the patient's memory loss.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male. Patient with pain, swelling, febrile, changes on XR, gram positive cocci bacteremia. Evaluate for osteomyelitis. Exam is motion degraded, limiting evaluation. Bone marrow signal intensity is within normal limits without evidence for osteomyelitis. Diffuse subcutaneous edema. No focal fluid collection is evident within limits of noncontrast exam. Severe osteoarthritis of the talonavicular joint. Small degenerative cysts are seen in the midfoot.

Output: Limited study due to motion artifact and lack of IV contrast. No evidence of osteomyelitis. Diffuse subcutaneous edema.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of endometrium. There are numerous supratentorial and infratentorial peripherally enhancing lesions predominate at the gray-white matter interface suspicious for metastatic disease. Several of these lesions demonstrate intrinsic T1 shortening angriness susceptibility likely related to hemorrhage. The largest lesion is located in the right cerebellum measuring up to 3.4 cm. There is significant surrounding vasogenic edema and mass effect compressing the fourth ventricle and brainstem anteriorly with associated cerebellar herniation. The largest supratentorial lesion is located in the right posterior temporal lobe. This lesion creates significant surrounding Visigenic edema and mass effect. There is associated 5 mm left of midline shift and mild right uncal herniation. There is deformity of the right lateral ventricle with mild prominence of the temporal horn of the left lateral ventricle. There is an empty sella.

Output: 1. There are numerous hemorrhagic supratentorial and infratentorial metastases with significant mass effect/edema and associated cerebellar tonsillar herniation, right uncal herniation, and mild subfalcine herniation.2. There is compression of the fourth ventricle with mild prominence of the temporal horn of the left lateral ventricle.