Instruction: Generate impression based on medical findings.

Input: Evaluate intracranial hemorrhage. Found down, unresponsive. MRI brain: There is stable to slight interval increase in size of a right frontal lobe intraparenchymal hematoma measuring 3.2 x 2.7 cm (AP x TR), previously 3.1 x 2.4 cm, with surrounding edema and mild mass effect. There is a homogeneously enhancing lesion measuring 1.2 x 1.5 x 2.5 cm (AP x TR x CC) at the paramedian right frontal lobe along the cortical surface with questionable associated mineralization hyperostosis on recent CT. This lesion is favored to be extra-axial but possibility of intra-axial location along the cortical surface not entirely excluded. There are foci of susceptibility which may be related to hemorrhage or mineralization.There is restriction diffusion in the right thalamus and the right posterior medial cerebellar hemisphere with corresponding FLAIR hyperintensity.There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. No hydrocephalus. There are multiple foci of susceptibility effect within the supratentorial compartment predominantly in a lobar distribution, consistent with hemosiderin deposition from chronic microhemorrhage. Few foci within the left thalamus and bilateral basal ganglia are also noted which may be related to chronic hypertension. There is trace fluid in the right maxillary sinus and nasopharynx. An endotracheal and oroenteric tube are partially imaged. Partial bilateral mastoid air cell opacification also noted.MRA brain: The intracranial internal carotid arteries are normal in course and caliber. No significant stenosis is seen involving the anterior or middle cerebral arteries. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRV brain: MRV images are limited by motion degradation. In combination with the postgadolinium sequences there is no convincing evidence of venous sinus thrombosis. The left transverse sinus appears hypoplastic. Cervical spine: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. There is moderate loss of disc height and disc desiccation throughout the cervical spine. No worrisome focal marrow signal abnormality is appreciated. No definite cord signal abnormality is appreciated. Degenerative changes are seen as described below:C2-C3: Mild posterior disc osteophyte complex. No significant spinal canal or foraminal stenosis.C3-C4: Posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal stenosis and moderate left and mild right foraminal stenosis.C4-C5: Posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal stenosis and moderate left greater than right foraminal stenosis.C5-C6: Posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild to moderate spinal canal stenosis and moderate to severe right and moderate left foraminal stenosis.C6-C7: Posterior disc osteophyte complex with superimposed central disc extrusion with cranial migration of 10 mm, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal stenosis and mild left worse than right bilateral foraminal stenosis. There is mass effect on the cord.C7-T1: No significant disc bulge, spinal canal or foraminal stenosis. Disc extrusion is also seen at the T1-T2 level on the sagittal sequences with effacement of the ventral thecal sac.

Output: 1. There is stable to slight interval increase in size of a right frontal lobe hematoma measuring up to 3.2 cm with surrounding edema and mild local mass effect. No associated enhancement is definitively appreciated.2. There is a 2.5 cm homogeneously enhancing lesion along the paramedian right frontal lobe which may represent an extra-axial enhancing lesion such as meningioma. However, the possibility that this is a enhancing intra-axial lesion at the cortical surface cannot be entirely excluded. There is associated susceptibility effect which may be related to mineralization versus chronic blood products. Motion degraded postcontrast sequences do not demonstrate additional enhancing masses within the brain. If clinically warranted, the postgadolinium sequences may be repeated with perhaps inclusion of a 3-D T2 sequence to better delineate if this mass is extra-axial or intra-axial in location.3.Multiple foci of susceptibility effect consistent with chronic microhemorrhages involving the bilateral cerebral hemisphere. These are predominantly in the lobar distribution favoring amyloid angiopathy. This may be the etiology of the right frontal lobe hemorrhage. 4. Restriction diffusion in the right thalamus as well as the right posterior medial right cerebellar hemisphere with corresponding FLAIR hyperintensity favored to represent acute to subacute infarcts. There is also evidence of moderate chronic small vessel ischemic disease.5. No evidence of intracranial aneurysm or flow-limiting limiting stenosis. No definite evidence of venous sinus thrombosis.6. Advanced degenerative changes of the cervical spine with moderate spinal canal stenosis and mild cord deformity at C3-4, C4-C5, and C6-C7. No definite cord signal abnormality is appreciated.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male 24 years old Reason: Crohn's disease with phlegmon evaluate for response to therapy History: Abdominal pain 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: Stable mild focal prominence of the upper collecting system of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Persistent mural thickening and hyper enhancement of the terminal ileum (segment measuring 4.8 cm on series 4, image 4) and ascending colon (segment measuring 4.5 cm on series 5, image 18) immediately distal to the ileocecal valve and to the level of the hepatic flexure. The appearance is suggestive of acute on chronic inflammation with interval improvement in the active inflammation compared to prior MRI study, as evidenced by decreased abnormal diffusion. These areas demonstrate luminal narrowing suggestive of stricturing with associated prestenotic dilatation of the cecum and distal ileum. There is a small residual focus of phlegmon measuring 1.6 x 1.2 cm (series 11, image 4), reduced from recent CT abdomen and pelvis where it measured 2.8 x 2.2 cm. There is no high-grade bowel obstruction. There are residual inflammatory changes within the surrounding mesentery. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Acute on chronic inflammation of the terminal ileum and ascending colon, reduced compared to prior study with associated stricturing. 2.Interval decrease in the adjacent previously described phlegmon.


Instruction: Generate impression based on medical findings.

Input: Personal history of right breast cancer. The patient has had a right mastectomy and prophylactic left mastectomy. The patient is status post bilateral mastectomies with implant placements. No abnormal enhancement is seen in the chest wall. Enhancement with the nipples is within normal limits. No abnormal lymph nodes are identified in either axillary region.High T2 hepatic lesion compatible with a cyst again noted.

Output: No MRI evidence for malignancy. Given that the patient has had bilateral mastectomies, clinical follow up is recommended. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Urinary retention and weakness with a sensory level. Assess for transverse myelitis/ADEM. Additional clinical history from electronic medical records: 32Yrs male with no past medical history who was sent to ER from urgent care for workup of myositis vs myelopathy vs GBS. Exam shows limited upgaze and rapid eye movement 2/2 pain w/o tenderness or inflammation and brisk reflexes. Subjective T10 paresthesia level but no sensory loss. Unlikely GBS given brisk reflexes and no weakness, less likely myositis w/ normal CK, but exam concerning for myelopathy given brisk reflexes, level, and constipation. BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a small right frontal developmental venous anomaly, which is a common incidental finding. 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. Of note, the left posterior cerebral artery is fetal in origin, which is a common variant. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are left maxillary retention cysts. There are small mucosal retention cysts in the nasopharynx.SPINE:Alignment is anatomic. Vertebral bodies are preserved in height. Intervertebral discs are also preserved in height. Marrow is diffusely less fatty than expected without discrete focal lesion or osseous destruction. This is likely benign and related to hematopoietic marrow. Small fat-containing lesions are present in the T1 vertebral body and left L5 pedicle and are most compatible with hemangiomas. There is a small eccentric to the right L5-S1 disc bulge which abuts but does not displace the right traversing S1 and exiting L5 nerve roots. There is no significant degenerative disease at the other levels of the spinal canal is preserved as well as the neural foramina. The spinal cord has normal precontrast signal. The tip of the conus medullaris lies at L1 level. There is faint central contrast enhancement in the lower thoracic spinal cord extending from T8-T9 to mid T11 level. There is also suggestion of faint contrast enhancement along the cauda equina roots. Small T1-hypointense, T2-hyperintense, non-contrast-enhancing kidney lesions may represent cysts but are not completely assessed.

Output: 1.Brain: No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Spine: Faint T8-T11 level spinal cord and cauda equina root enhancement is of unknown significance. While this may represent an imaging artifact, the possibility of an underlying inflammatory process is also reduced.


Instruction: Generate impression based on medical findings.

Input: History of bladder cancer status post cystectomy nephrectomy and chemoradiation. PELVIS:UTERUS, ADNEXA: The uterus is atrophic. The endometrium is normal in thickness. No focal abnormality.BLADDER: Status post cystectomy with right lower quadrant ileal conduit. Multiple bowel loops have descended into the surgical bed. No specific evidence of recurrence in the cystectomy bed.LYMPH NODES: No enlarged pelvic lymph nodes. In the proximal right external iliac chain there is a 1.6 cm cystic structure which may represent a postsurgical seroma. Similar finding along the left internal iliac chain.Aortic bifurcation lymph node measures 15 x 14 mm (series 1504/569). Additional prominent mesenteric lymph nodes.BOWEL, MESENTERY: Thin-walled loculated perirectal fluid collection measuring 6.9 x 4.0 cm, unchanged from previous day CT and 2/19/2015 CT.Distended fluid-filled small bowel is partially imaged. Fluid distended proximal ascending colon is partially seen. The distal rectosigmoid is decompressed. There is abrupt transition point in the pelvis where there is abnormal thickening, enhancement and restricted diffusion of the matted loops of bowel (series 1504, image 514; series 1302/408) with mass likely thickening and stellate soft tissue appearance measuring up to 4.1 x 3.3 cm suspicious for tumor. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from the prior day's CT study, including small bowel obstruction with transition point in the pelvis where there is stellate mass-like soft tissue thickening which is suspicious for tumor. Adhesive disease is also a consideration but felt to be less likely. Stable bland-appearing loculated fluid collection in the pelvis. Aortic bifurcation and mesenteric lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: stiffness of the L.arm, H/O L.elbow fracture History: contracture of the L. Elbow LIGAMENTS: The ulnar collateral and radial collateral ligaments appear intact. The lateral ulnar collateral ligament appears intact.TENDONS: The common flexor tendon appears intact. There is minimal intermediate signal intensity within the common extensor tendon indicating mild tendinosis. The common extensor tendon appears intact. The biceps and brachialis tendon appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: There is deformity of the medial aspect of the radial head with near full-thickness to full thickness articular cartilage degeneration and underlying subchondral signal abnormality best seen on the axial T2 fat saturated sequence (series 6; image 16 and series 14; image 12). This appears most consistent with the sequela of a prior radial head fracture although the possibility of an osteochondral defect cannot be completely excluded. There is also irregularity of the capitellum with full-thickness articular cartilage degeneration also likely related to prior trauma. There is osteophyte formation indicating mild osteoarthritis. No definite loose body is identified.SURROUNDING STRUCTURES: The remainder of the imaged musculature and soft tissues are unremarkable.ADDITIONAL

Output: 1. Deformity of the medial aspect of the radial head with radiocapitellar articular cartilage degeneration that appears most consistent with the sequela of prior remote trauma. However, an osteochondral defect cannot be completely excluded. There is also irregularity of the capitellum with full-thickness articular cartilage degeneration which may also likely related to prior trauma. 2. Osteoarthritis of the elbow. Other findings as described.


Instruction: Generate impression based on medical findings.

Input: Is there transverse myelitis? Back pain in setting of disseminated zoster. The spinal cord displays normal signal and morphology. The cauda equina nerve roots are intact. There is no evidence of abnormal enhancement. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is facet arthropathy at L4-5 and L5-S1 bilaterally, which results in slight neural foraminal narrowing at these levels. However, there is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There are bilateral pulmonary consolidations.

Output: 1. No evidence of transverse myelitis.2. Facet arthropathy at L4-5 and L5-S1 bilaterally, which results in slight neural foraminal narrowing at these levels. 3. Bilateral pulmonary consolidations, likely related to pneumonia.


Instruction: Generate impression based on medical findings.

Input: Evaluate for left medial meniscal tear in a patient with left knee pain. MENISCI: The posterior horn of the medial meniscus appears blunted and there is a complex meniscal undersurface tear with both a vertical and horizontal component.ARTICULAR CARTILAGE AND BONE: Marked abnormality of the medial facet of the patella with fissuring, irregularity, and severe loss of cartilage of the whole medial facet. There is minimal bone marrow edema of the medial proximal tibia. There is marked loss of cartilage of the medial femoral condyle.LIGAMENTS: The ACL and PCL appear intact. The MCL and the ostial complex also appear intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the undersurface of the posterior horn of the medial meniscus.2. Marked osteoarthritis of the patellofemoral joint and marked loss of cartilage of the medial femoral condyle.


Instruction: Generate impression based on medical findings.

Input: The ventricles and sulci are prominent, consistent with moderate-severe age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular white matter, consistent with relatively mild chronic small vessel ischemic changes. There is additional focal and cephalization along the posterior right frontal lobe laterally. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal grade 1 anterolisthesis of C7 on T1 which appears degenerative in nature. The cervical spine is in otherwise normal overall alignment, although with mild reversal of the normal cervical lordosis. The vertebral body heights are well-maintained, while there is mild multilevel disc narrowing, although there is also moderate-severe disc narrowing with prominent endplate degenerative marrow changes at T1-T2. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is diminutive in caliber, with focal T2 hyperintensity along the right lateral aspect of the cord at the upper C6 level as seen on 7/33 suggesting myelomalacia. There is prominent developmental narrowing of the cervical spinal canal due to shortened pedicles.At C2-C3, there is right-sided uncovertebral hypertrophy as well as left facet arthropathy. There is overall mild to moderate central spinal canal stenosis, with moderate left and minimal right foraminal narrowing.At C3-C4, there is a mild posterior osteophyte disc complex superimposed by a shallow central disc protrusion. There is overall moderate central spinal canal stenosis. There is moderate-severe right and moderate left foraminal narrowing and bilateral uncovertebral hypertrophy.At C4-C5, there is mild diffuse posterior osteophyte disk complex with moderate central spinal canal stenosis. Bilateral uncovertebral hypertrophy contributing to moderate bilateral foraminal narrowing. There is also ligamentum flavum thickening.At C5-C6, there is a diffuse posterior osteophyte disk complex with superimposed right paracentral disc protrusion. There is moderate-severe central spinal canal stenosis with bilateral ligamentum flavum thickening. There is resultant severe right greater than left foraminal narrowing.At C6-C7, there is mild diffuse posterior osteophyte disk complex with overall moderate central spinal canal stenosis. There is mild bilateral uncovertebral hypertrophy and prominent ligamentum flavum thickening. There is also mild to moderate bilateral foraminal narrowing.At C7-T1, there is minimal uncovering the disc with superimposed mild disc bulge. There is mild bilateral facet arthropathy and ligamentum flavum thickening, as well as moderate bilateral foraminal narrowing.At T1-T2, sagittal images suggest a diffuse posterior osteophyte disk complex which indents the ventral thecal sac and results in mild bilateral foraminal narrowing.There is trace fluid in bilateral mastoid air cells. Incidental note is made of a prominent lobulated area of fat signal intensity along the anterior aspect of the left parotid gland which may represent a lipoma.

Output: 1. No acute abnormality. Minimal chronic small vessel ischemic changes with small area of peripheral right frontal lobe encephalomalacia.2. Developmentally slender cervical spinal canal with superimposed moderate spondylosis, resulting in up to moderate-severe central spinal canal stenosis at C5-C6 with complete effacement of CSF within the thecal sac, as well as severe bilateral foraminal narrowing at this level.3. Focal area of myelomalacia along the right cord at the upper C6 level. Overall, the cord appears thinned in caliber, likely a chronic finding.3. Trace degenerative grade 1 anterolisthesis of C7 on T1.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Unqualified visual loss, right eye, normal vision left eyeClinical question: vision loss both eyesSigns and Symptoms: optic nerve pallor, bilateral MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 demonstrate some mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. 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 .Some minor thickening of the superior aspect of the infundibulum of the pituitary gland is nonspecific, however, it extends into the center of the optic high as in.

Output: 1.There is minimal thickening of the superior aspect of the infundibulum of the pituitary gland extending to the optic chiasm. This a nonspecific finding but may represent some minor or early inflammatory effect (such as granulomatous lesion or other infiltrating lesion). Please correlate with clinical history and findings.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Essential (primary) hypertension [I10] / Headache [R51], Reason for Study: ^Reason: concern for possible stroke on CT, further eval needed History: HTN emergency, Headache Multifocal scattered diffusion restriction lesions on the right hemisphere involving right frontal, parietal, temporal and occipital lobes indicating acute ischemic infarct. There is no evidence of acute hemorrhagic lesion.Right side periventricular white matter extended toward the right side basal ganglia showed high signal intensity on FLAIR imaging indicating prior ischemic infarct related lesion. There are multiple scattered FLAIR/T2 high signal intensities on bilateral centrum semiovale and periventricular white matter indicating nonspecific but likely chronic ischemic infarct related lesions.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening and opacification are seen especially on the left maxillary sinus and left anterior ethmoid sinus

Output: Multifocal acute ischemic infarct on the right hemisphere as described above.Underlying brain shows multifocal chronic ischemic changes.There is no evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: 60-year-old with personal history of right breast cancer and now known to have BRCA gene mutation. Patient desires prophylactic mastectomy. There is heterogeneous amount of fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted in the left breast. The patient is status post right mastectomy and reconstruction. No suspicious enhancement in the right chest wall.There is a 6 mm reniform enhancing mass in the left lower outer quadrant anterior depth. This is probably an intramammary lymph node. No other enhancing masses or areas of non-mass enhancement are seen. No abnormal axillary lymph nodes are identified in either axillary region. Postoperative changes are identified in the right axilla.

Output: A 6 mm left breast mass is probably a normal intramammary lymph node, though establishing stability by comparing to prior examinations is recommended. If stability cannot be established, then targeted ultrasound should be performed to ensure that this has the sonographic appearance of a lymph node as well.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.


Instruction: Generate impression based on medical findings.

Input: Reason: 3 t scanner s/p crani for tumor resection History: surveillanceAdditional history EMR: non-small cell lung cancer status post surgery for a cerebellar lesion, SRS and WBRT. She was recently found to have a small right frontal lesion which is biopsied July 2016 with pathology consistent with gliosis. There is extensive susceptibility along the right frontal and left occipital/suboccipital regions. This relates to a previous right pterional craniotomy and multiple surgical/aneurysm clips along the right sphenoid wing, multiple bilateral burr holes and placement of a posterior fossa drainage catheter. Additional postoperative changes are seen from a right parietal craniotomy for a resection of a right precentral gyrus lesion. A small somewhat ill-defined focus of enhancement along the precentral gyrus appears similar to the preoperative examination with associated T2/FLAIR hyperintensity within the white matter.There remains diffuse pachymeningeal enhancement and dural thickening. Loculated subdural collections along the frontal lobes appears similar, measuring just under a centimeter in greatest thickness.The previously demonstrated shunted lesion within the medial left cerebellum shows no significant interval change. There is associated FLAIR hyperintensity with a central area of irregular enhancement which measures up to 13 mm in greatest axial dimension. A nonenhancing area of T2 signal abnormality within the left middle frontal gyrus appear similar. Other scattered nonspecific foci of T2/FLAIR hyperintensity are seen within the cerebral white matter, remaining nonspecific but stable. The ventricles are stable in size, with evidence of global volume loss. Incidental partially empty sella is again noted.

Output: 1.Stable postoperative changes following previous right precentral gyrus lesion biopsy. Minimal irregular enhancement along this site with associated FLAIR hyperintensity appears similar to the preoperative study.2.An irregular enhancing lesion within the left medial cerebellum and a nonenhancing FLAIR hyperintense lesion within the left middle frontal gyrus appears similar. No new intracranial lesions are seen.3.Persistent bilateral somewhat loculated frontal subdural collections are unchanged. Stable diffuse pachymeningeal enhancement and thickening.


Instruction: Generate impression based on medical findings.

Input: 76 year old female with LV dysfunction, LBBB (LVEF 43% on TTE). Referred for cardiac MRI to evaluate etiology. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 60%. The LVEDV is 186 ml (normal range 109+/-23), LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), LVESV is 75 ml (normal range 31+/-10), and LV end systolic volume index is 33 ml/m2 (normal range 18+/-5). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1000 ms suggestive of absence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 65%, the RVEDV is 175 ml (normal range 110+/-24), the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVESV is 61 ml (normal range 35+/-13), and the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Aorta tortuosity noted.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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is moderately dilated with normal systolic function. LVEF 60%.2.The right ventricle is mildly dilated with normal systolic function. RVEF 65%.3.No late gadolinium enhancement.4.Mild aortic regurgitation.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: 32-year-old female patient with tuberous sclerosis and angiomyolipomas. Evaluate response of angiomyolipoma with afinitor. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are enlarged and entirely replaced by fat containing lesions compatible with angiomyolipomas. No native parenchyma is definitively discerned. The kidneys as a whole measure approximately 23 cm on the left and 25 cm on the right in the craniocaudal dimension. They are significantly increased in size from 2006 study. For reference, an inferior component of the right angiomyolipoma measures approximately 12 cm in the craniocaudal dimension, previously 6 cm. There are interspersed T2 hyperintense cystic areas which may represent interspersed renal cysts or T2 bright components of the angiomyolipomas. Differentiation of different lesions within each kidney is difficult.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Marked levoscoliosis.OTHER: There is moderate ascites within the right hemiabdomen. There is an arcuate morphology of the uterus.

Output: 1.Enlarged, entirely replaced kidneys by angiomyolipomas with interspersed cystic components or renal cysts. These are significantly larger compared to 2006.2.Right abdominal ascites. 3.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on medical findings.

Input: 57 year old male with known CAD, found to have chronic total occlusion of OM and diagonal coronary artery, stress being done to evaluate for ischemic tissue and myocardial viabilityMEDICATIONS: amlodipine, aspirin, atorvastatin, isosorbide mononitrate, metoprolol Stress PerfusionDuring dobutamine infusion, no wall motion abnormalities were present. Viability/ Myocardial ScarThere was presence of late gadolinium enhancement in the basal inferolateral wall of the left ventricular myocardium, suggestive of prior myocardial infarction. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and global function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 80 ml (normal range 47+/-19), the LV mass index is 78 g/m2, and the LV mass is 150 g. There are no regional wall motion abnormalities present. . Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is %, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. 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 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 FindingsSmall hepatic and left renal cysts. 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. There are no wall motion abnormalities seen during dobutamine stress. The entire myocardium is viable.2. There is presence of late gadolinium enhancement in the basal inferolateral wall of the left ventricular myocardium, suggestive of prior myocardial infarction. 3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 60%).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: evaluate for cord compression or epidural abscessSigns and Symptoms: back pain, incontinence Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. A small high signal focus on T1-weighted imaging within the L4 vertebral body is present in most likely represents a small hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level associated with a disc bulge and partial effacement of the fat at the lateral recesses bilaterally.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There is a disc bulge present at L5-S1 without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old, with recurrent glioblastoma, eight week follow-up post-trial. Again seen is evidence of left frontal lobe resection for recurrent glioblastoma. The resection cavity contains fluid which is still FLAIR hyperintense but less T1 hyperintense suggesting resolving proteinaceous or hemorrhagic products. The cavity is not significantly changed in size and morphology.The geographic extent of T2 signal abnormality surrounding the resection cavity has increased mildly from the prior examination. However, a thick and somewhat nodular rim of enhancement particularly along the inferior resection cavity margin is redemonstrated appearing thicker and more conspicuous than on the prior examinations. rCBV mapping is equivocal as it shows areas of increased and of decreased blood volume within this enhancing tissue. No entirely new areas of pathologic enhancement or signal abnormality are seen. Bilateral periventricular T2 hyperintensity is unchanged and may be related to prior therapy. No significant generalized mass effect is detected. The ventricular system is stable in size and morphology.

Output: Since the prior examination, enhancing tissue along the inferior margin of the left frontal resection cavity has increased in thickness and conspicuity. The differential would include progressive disease as well as a treatment-related effect. rCBV mapping in this case does not provide any reliable guidance. No other concerning changes are seen elsewhere in the brain.


Instruction: Generate impression based on medical findings.

Input: Again seen are postoperative findings related to right transfrontal laser ablation of tumor centered at the right thalamus and midbrain. Lack of contrast limits comparison however there appears to be minimal increase in size of the tumor, for example measuring approximately 3.1 cm in the transverse dimension on the coronal T2 sequence, previously 2.8 cm, and 3.0 cm in the craniocaudal dimension, previous 2.4 cm. The tumor enlargement is more notable when compared to prior MRI from 4/3/2016 when the lesion measured approximately 2.0 x 1.8 mm cm the transverse and craniocaudal dimensions measured with a similar technique on the coronal T2 sequence. Extent of surrounding vasogenic edema extending to the brainstem and cerebellum as well as the right temporal and parietal lobes is mildly decreased. There is effacement of the third ventricle and leftward displacement measuring approximately 7 mm and similar to prior. No significant midline shift more superiorly. No uncal herniation. Blood products within the tumor are again evident with evolution and slight decrease in conspicuity. No evidence of acute infarct. There is layering debris in the right occipital horn most evident on the diffusion sequence which while nonspecific may represent pus. Foci of susceptibility in the left occipital horn are compatible with blood products. Periventricular FLAIR hyperintensity reflecting transependymal CSF flow is much improved since prior MRI. Ventricular dilatation is similar to prior MRI from 5/21/2016, but note ventricular dilatation on CT from same day was worse since CT from 6/8/2016. Left frontal EVD in place.CSF flow sequence demonstrates biphasic flow anteriorly in the prepontine cistern which extends to the suprasellar cistern but without evidence of flow extension into the third ventricle through the third ventriculostomy. 3-D T2 sequence demonstrates dilated third ventricular recesses. Partially empty sella.

Output: 1. Right thalamic/midbrain metastasis is suboptimally evaluated without contrast but appears minimally larger than 5/21/2016 and more clearly larger compared to 4/3/2016. Surrounding vasogenic edema is improved. Ventricle size is similar to same-day CT but larger since CT dated 6/8/2016. Left transfrontal EVD in place. Third ventriculostomy does not appear to be patent.2. Lack of contrast limits evaluation for intracranial infection. There is layering debris with restricted diffusion in the right occipital horn, which is nonspecific in the setting of intraventricular blood products, but may represent pus and can be correlated with CSF analysis. No evidence of intracranial abscess or empyema.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of Crohn's disease status post total colectomy with ongoing neurological manifestations without bone formation with question of mesenteric vasculitis. ABDOMEN:MRA: The celiac and SMA arteries are widely patent without significant steno-occlusive disease. No evidence of vasculitis. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post proctocolectomy end ileostomy in the right lower quadrant. A parastomal hernia is again noted without evidence of obstruction. Interval resolution of peristomal edema and increased enhancement. Incomplete distention of proximal small bowel. There are loops of dilated ileum in the right abdomen that subsequently collapse on later sequences favoring peristalsis (series 18, image 20; series 22, 23). No abnormal areas of enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Probable nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small volume pelvic ascites.

Output: 1.Interval resolution of inflammatory changes involving end ileostomy. No abnormal areas of bowel enhancement. Persistent parastomal hernia.2.No evidence of mesenteric artery stenosis or vasculitis.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with lupus status post CVA x 2, hypotensive and unresponsive with distended abdomen. Concern for intracranial process and acute abdomen. There is no evidence of intracranial hemorrhage, mass or edema. No evidence of acute cortical stroke, however, if there is clinical concern for acute stroke an MRI may be considered. Increased density within the left globe may be due to hemorrhage.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute cortical stroke, however, if there is clinical concern for acute stroke an MRI may be considered.2. Increased density within the left globe may be due to hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Infant born at 37 1/7 weeks with respiratory distress. Please evaluate corpus callosum: possible agenesis of corpus callosum on ultrasound. Dysmorphic features (redundant skin folds, edema, micrognathia with recessed jaw). There are several subcentimeter foci of restricted diffusion in the left frontal lobe periventricular white matter. There is a lesion in the left caudothalamic groove with cerebrospinal fluid signal characteristics that measures up to 5 mm. There is diffuse paucity of cerebral white matter with apparent deficiency of myelination in the bilateral corticospinal tracks. There is no evidence of intracranial hemorrhage or mass. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Subcentimeter acute infarcts in the left frontal lobe periventricular white matter, persistent ventriculomegaly that appears to be associated with diffuse cerebral white matter deficiency with severe thinning of the corpus callosum diffusely, as well as apparent delayed myelination, a subcentimeter lesion in the left caudothalamic groove, which may represent a germinolytic cyst, and cerebellar vermis hypoplasia may represent stigmata of an underlying disorder of metabolism or other congenital anomaly. Follow up with MR spectroscopy of the brain may provide additional insights.Discussed with Dr. Singh at 12 PM on 9/23/15.


Instruction: Generate impression based on medical findings.

Input: 36-year-old female with medial right knee pain. MENISCI: The menisci are normal.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the articular cartilage of the patella centrally suggesting early degeneration with superficial fraying of the cartilage along the medial facet of the patella. The remainder of the articular cartilage appears normal.LIGAMENTS: The cruciate and lateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Mild degeneration of the articular cartilage of the patella, but no meniscal tear or other findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: There are several punctate foci of T2 hyperintensity primarily involving the subcortical white matter located within the frontal lobes. These are not associated with mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing lesions within the posterior fossa structures.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Incidental note is made of a small left occipital developmental venous anomaly without MRI evidence of associated cavernous malformation. Otherwise flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of two, 1 cm-sized, foci within the subcutaneous scalp tissues overlying the right paramedian parietal bone as well as left parietal bone, with MRI features consistent with sebaceous cyst.

Output: There are nonspecific punctate foci of T2 hyperintensity primarily involving the subcortical white matter located within the frontal lobes which are not associated with mass effect, restricted diffusion, susceptibility abnormality, or enhancement. For a patient of stated age 53 years, this is most likely secondary to chronic small vessel disease. The differential diagnosis would also include changes from migraine headaches or sequelae of remote head injury. Given lesional appearance and locations, demyelination is felt to be unlikely.


Instruction: Generate impression based on medical findings.

Input: New focal left upper extremity weakness and hyperesthesia; started cyclosporin yesterday for severe ulcerative colitis, also on high dose steroids, but no recorded hypertension episodes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are apparent faint areas of heterogeneity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Apparent faint areas of heterogeneity in the cerebral white matter may be artifactual or less likely represents early toxic encephalopathy. Otherwise, no evidence of intracranial hemorrhage, or posterior reversible encephalopathy syndrome.


Instruction: Generate impression based on medical findings.

Input: Knee pain MENISCI: There is a a globular appearance with increased signal of the posterior horn of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is partial visualization of presumed bone infarctions in the distal femur. Mild thinning of the articular cartilage of both the medial and lateral compartments is seen without full-thickness defectLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Degenerative signal within the posterior horn of the medial meniscus with no evidence of meniscal tear within the medial or lateral meniscus.2. Mild cartilaginous thinning particularly of the medial compartment.


Instruction: Generate impression based on medical findings.

Input: Left sided neck mass below mandible along SCM. US showed solid heterogenous mass. There is diffuse swelling and patchy T2 hyperintensity and enhancement of the left sternocleidomastoid muscle. There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable.

Output: Findings suggestive of left fibromatosis colli.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch) Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch)Clinical question: assess size of pituitarySigns and Symptoms: assess size of prolactinoma There is no indication on the scans that contrast entered the patient's vascular system.There is opacification of the sphenoid sinus with mixed high signal T1 material and intermediate signal material. Anteriorly there is some high signal material on T1-weighted imaging which does not suppress on the fat suppressed images that measures approximately 12 x 16 mm axial dimensions and is suspected represent inspissated secretions. Just behind that within the sphenoid sinus there is soft tissue signal intensity which is heterogeneous on T1 and intermediate signal on T1 this measures approximately 13 x 10 mm axial dimensions and is eccentric towards the right side and appears to be contiguous with the pituitary gland. Measures 19 x 12 mm on sagittal imaging. There is a lesion present in the right half of the pituitary fossa and gland measures approximately 9 x 10 mm coronal dimensions. It is contiguous with a lesion in the sphenoid sinus and involves the clivus. Overall the lesion measures 23x17mm coronal dimensions and 19mmx19mm sagittal dimensions. The lesion bulges into the right cavernous sinus and abuts the right ICA. It enhances heterogenously. It has heterogeneous but predominantly low signal on T2-weighted imaging. It does not appear to have changed substantially since the March exam. The infundibulum of the pituitary gland is slightly tilted towards the left.The infundibulum of the pituitary gland is tilted to the left. No suprasellar mass is identified. There are opacities present within the maxillary sinuses bilaterally most likely representing mucous retention cysts.

Output: 1.There is a mass present which involves the pituitary fossa and the clivus and bulges into the right cavernous sinus. Most likely this is a pituitary adenoma with some inspissated secretions in the sphenoid sinus. However, given its involvement of the clivus and the unusual signal characteristics and involvement of the sphenoid sinus other considerations such as intrasellar chordoma mimicking a pituitary adenoma are also possible. Please correlate with the patient's endocrinological exam.2.Please note that contrast did not reach the tissues. The patient will be asked to return to complete the exam.


Instruction: Generate impression based on medical findings.

Input: Stage IV thyroid cancer status post treatment. There are postoperative findings related to total thyroidectomy with vitamin E capsules positioned over the site of the surgical scar. There is ill-defined patchy enhancement within the thyroidectomy bed, but otherwise no evidence of discrete measurable mass lesions or significant lymphadenopathy in the neck. The upper aerodigestive tract and salivary glands are unremarkable. The osseous structures appear to be intact. The orbits are grossly unremarkable. There is a subcentimeter nodular focus of enhancement in the right paraspinal muscles at the level of C6 that appear continuous with the adjacent veins, which likely represent a prominent segment of vein. There is an enhancing nodule that measures up to 16 mm in the left cerebellar hemisphere with surrounding vasogenic edema.

Output: 1. Post-treatment findings without convincing evidence of recurrent tumor in the neck.2. A lesion in the left cerebellar hemisphere likely represents metastatic disease. A dedicated brain MRI would be useful for further evaluation of intracranial metastases.Discussed with Dr. Cohen at 4:25 PM on 7/24/15.


Instruction: Generate impression based on medical findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Vantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Vantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize right anterior mid gland lesion in the prostate at the site of the T2 hypointense enhancing lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the right side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the right anterior mid gland prostate gland peripheral zone lesion.


Instruction: Generate impression based on medical findings.

Input: Evaluate for cause of acute on chronic weakness and pain in the left arm and shoulder. 47-year-old female with lymphoma status post chemotherapy. Worsening pain and weakness in left arm and shoulder. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with T1 hyperintense focus at T2 compatible with hemangioma.The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancement.Minimal degenerative changes are seen throughout the cervical spine with minimal disc bulges at all levels from C2-C3 to C6-C7 with partial effacement of the ventral thecal sac, relatively worse at C5-C6 and C6-C7. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. No abnormal enhancement.

Output: 1. Minimal degenerative changes in the cervical spine without significant spinal canal or neural foraminal stenosis at any level. 2. No abnormal cord signal. No abnormal enhancement or mass involving the spinal canal.


Instruction: Generate impression based on medical findings.

Input: Reason: labral tear; MR arthrogram History: pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: There is a type IV acromion process, which may result in narrowing of the supraspinatus outlet.GLENOHUMERAL JOINT AND GLENOID LABRUM: A singular cyst is noted in the posterior superior portion of the humeral head. There is no Hill-Sachs or Bankart lesion identified. There is no labral tear identified. The glenohumeral joint is otherwise unremarkable.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: No evidence of labral tear or specific findings to explain the patient's pain.


Instruction: Generate impression based on medical findings.

Input: A 35 year old male with hypertension, systolic aortic murmur, alcohol abuse. Noted to have irregular hear beats, frequent PVC's on holter, a recent echocardiography showed left ventricular ejection fraction of 35-40%. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 242 ml (normal range 142+/-34), the LV end systolic volume index is 72 ml/m2 (normal range 25+/-9), the LVESV is 152 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 116 g (normal range 164+/-36). There is global hypokinesis with regional variation. Considerable breathing artifact on short axis views reducing the diagnostic accuracy of these views, however there is no evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process on long axis views or on post contrast short axis T1 views. T2-weighted images showed no signs of active inflammation. Normal native T1-times. No intracavitary thrombus.Left AtriumThe left atrium is normal in size (79ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 171 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).No evidence of myocardial fatty infiltration. No regional wall motion abnormalities or aneurysms in the RV free wall. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely, is trileaflet and there is no significant aortic regurgitation or flow acceleration.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with moderately reduced systolic function, the LVEF is 36%. There is global hypokinesis with regional variation. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process based on long axis views and post contrast short axis T1 views.3. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. No evidence of myocardial fatty infiltration. No regional wall motion abnormalities or aneurysms. 4. The aortic valve opens widely, is trileaflet and there is no significant aortic regurgitation or flow acceleration.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: 53 year old with history of right lumpectomy for breast cancer, and history of left breast benign biopsy at two sites presents for screening MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast is deformed from prior lumpectomy at lateral aspect with multiple metallic artifacts in the right axillary region.There are two metallic artifacts n the left breast, at retroareolar region and 9:00 position, corresponding to the marker clips from prior benign biopsy.Multiple enhancing masses and foci are present in the left breast; the largest mass measures 8 mm at the central part of the breast, likely fibroadenoma. None of them shows suspicious type of kinetic pattern.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Multiple benign masses in the left breast. Annual breast MRI is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old, vertigo, right hand tingling and retinal migraines. Brain:Several scattered small T2 hyperintense white matter lesions are seen involving the subcortical white matter of the frontal lobes, and the left middle cerebellar peduncle. These are stable to smaller when compared to the prior examination. One small T2 hyperintense lesion is also evident within the splenium of the corpus callosum, smaller than on the prior exam. No new lesions are evident. No additional corpus callosum or periventricular lesions are seen.No evidence of significant parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.C-spine:Mild reversal of the cervical lordosis is seen. Vertebral body height is preserved. Degenerative endplate irregularity is noted at C6-7, but elsewhere vertebral body morphology and signal characteristics are within normal limits.The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are suspected. No epidural abnormality is seen.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Right greater than left uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac but no significant generalized canal stenosis. Mild right foraminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Scattered small white matter lesions are redemonstrated within the supratentorial and infratentorial brain. None of these lesions has progressed from prior, and some are smaller. No new lesions are detected. The lesions are nonspecific in morphology and distribution, and could reflect the sequelae of demyelinating disease, vasculitis, migraine headache, or some other inflammatory process.2.No convincing evidence of any cervical spinal cord lesions are seen. Relatively mild disc degeneration is seen in the cervical spine but with no areas of high-grade spinal canal or foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Bilateral skin/nipple sparing mastectomy in 2009 for right breast ADH/ALH. Status post immediate reconstruction with implants. Left breast thickness/density at 12:00 position, please assess on MRI Status post bilateral mastectomy with bilateral subpectoral silicone/gel implants which appear intact. No evidence of intra or extracapsular rupture.Bandlike area of enhancement is identified between the implant and the skin in the right chest wall at 5 to 6:00 position (close to the inframammary fold), that is dark on T2-weighted sequence measuring 2.5 x 1.1 x 0.5 cm (APX ML x CC ).Similar morphology band like area of enhancement is also identified between the implant and skin surface measuring 1.3 x 0.7 x 0.6 cm (APX ML x CC ) at the 12:00 to 1:00 position of the right chest wall. These areas of enhancement appear to be related to Alloderm configuration used at the time of reconstruction surgery. No abnormal enhancement is seen in either chest wall. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy especially in patient's area of concern (area of thickness/density in left breast at 12:00 position). Band like areas of enhancement along the inframammary fold and 12 to 1:00 position of the right chest wall are most likely related to alloderm usage at the time of reconstructive surgery or fat necrosis. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Wrist mass and pain. Rule out dorsal wrist mass, cartilage lesion versus bony. A marker was placed along the wrist dorsal to the bases of the second and third metacarpals. Just lateral and deep to this marker is a 6 mm focus of low signal intensity adherent to the dorsal aspect of the base of the second metacarpal and the dorsal aspect of the trapezoid, spanning the second carpometacarpal joint. I cannot tell if this represents a prominent bridging osteophyte or thickened fibrotic capsule, but I suspect this represents the palpable mass. I see no other findings to suggest to indicate a mass. There may be mild tendinosis of the extensor carpi ulnaris as it courses adjacent to the ulnar styloid, but the tendons of the wrist are otherwise unremarkable. A small amount of increased signal intensity within the distal radioulnar joint may represent fluid and/or synovitis. There is also fluid signal intensity concentrated within the pisotriquetral recesses. Cysts and edema within the proximal and medial aspect of the lunate may reflect ulnolunate impaction. Additional rounded foci of signal abnormality within multiple carpal bones may represent cysts or chronic erosions. Mild deformity of the ulnar styloid may reflect old trauma. The scapholunate ligament appears intact. Mild increased signal intensity centrally within the lunotriquetral ligament suggests mild degeneration. There is also increased signal intensity within the articular disc of the triangular fibrocartilage suggesting degeneration. Tiny foci of fluid signal intensity volar to the scaphoid may represent small synovial cysts or tiny ganglia.

Output: Subcentimeter low signal intensity focus along the dorsal aspect of the second carpometacarpal joint may either represent a bridging osteophyte or focal thickening/fibrosis of the joint capsule. This can be further evaluated with computed tomography, if clinically warranted. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female patient with HCV cirrhosis. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour. No suspicious arterially enhancing hepatic lesion is identified. SPLEEN: There is an accessory splenule.PANCREAS: Decreased T1 signal and atrophy of the pancreas is suggestive of prior pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are subcentimeter bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The patient is status post right mastectomy.OTHER: No significant abnormality noted.

Output: Cirrhotic morphology of the liver without suspicious lesion to suggest HCC.


Instruction: Generate impression based on medical findings.

Input: 13-year-old with history of Chiari malformation status post decompression as well as pituitary microadenoma status post transsphenoidal resection. Follow-up exam. Pituitary: Expected postoperative findings from prior transsphenoidal pituitary resection. There is about 4mm sized non enhancing foci on the right anterior aspect of the pituitary fossa on dynamic pituitary imaging (series 1401, image 22/40). Since the scan parameter especially slice thickness of the delayed coronal and sagittal scan was different (3mm) from that of dynamic scan (2.5mm), it was difficult to determine the nature of the lesion. In particular, it is not clear if the lesion shows no enhancement or enhancement on delayed scan. Especially on delayed post contrast sagittal scan, the lesion appears to be located on the anterior aspect of pituitary fossa which could raise possibility of partial volume artifacts with sphenoid sinus wall. Comparing to prior scan on Jan 8 2015 dynamic MRI scan, the lesion has not been changed in term of MR characteristics and size (series 1401, image 21/40). Constellation of these findings indicate the lesion could suggest partial volume artifacts of sphenoid sinus wall, postoperative scar or changes or less likely residual pituitary lesion. Clinical and laboratory correlation would help the differential diagnosis.There is no focal enhancement or discrete underlying mass lesion to suggest recurrent microadenoma. The infundibulum is intact and not significantly deviated. There is no mass effect on the adjacent structures. The cavernous sinus is intact.Brain: Postoperative findings related to prior suboccipital decompression. There is a stable appearance of the cerebellar tonsils. No evidence of intracranial hemorrhage, mass, or acute infarct. There is stable asymmetry of the lateral ventricles with the right slightly larger than the left. The major cerebral flow voids are intact. CSF flow imaging at the level of the foramen magnum shows robust bidirectional flow along the ventral aspect of the cord. No significant flow is appreciated along the dorsal aspect of the cord, however this may be technical as this region appears widely patent.

Output: 1. Postoperative changes from transsphenoidal pituitary resection without evidence of recurrent pituitary mass.2. Non enhancing lesion on the dynamic pituitary imaging on the anterior and slightly right lateral aspect of the pituitary fossa was seen, unchanged since prior scan. 3. Postoperative changes from suboccipital decompression. CSF flow imaging at the level of the foramen magnum shows robust bidirectional flow along the ventral aspect of the cord. No significant flow is appreciated along the dorsal aspect of the cord, however this may be technical as this region appears widely patent.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: 38 years, Female, constant headache for 3 weeks. There is evidence of dissection involving the distal right cervical internal carotid artery with presence of dissection flap and narrowing of the lumen. There is T1 hyperintensity related to the mural thrombus. Flow-void of the right cervical internal carotid artery is narrowed related to the dissection. The flow-void of the cavernous and supraclinoid internal carotid artery is normal in caliber. Brain parenchyma appears unremarkable. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. There is dissection involving the visualized portion of the distal right cervical internal carotid artery. There is narrowing of the adjacent right ICA flow-void without occlusion. CTA or MRA head and neck can better assess the full extent of the dissection although cranially appears to extend to the level of the petrous ICA segment.2. Brain MRI is otherwise unremarkable. No evidence of infarct or intracranial mass. Dr. Ali discussed findings with Dr. Vela at 1025 hours on 6/1/2016


Instruction: Generate impression based on medical findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. Loss of C5 and C6 marrow signal is consistent with sclerosis identified on prior CT. 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.The right submandibular gland is absent and the left submandibular gland is enlarged, although normal in density most likely representing hypertrophy.Soft tissue and osseous changes are again noted from previous laminoplasty. There are no postoperative fluid collections.C2/3: Mild degenerative changes without resulting stenosis, unchanged.C3/4: Postsurgical laminoplasty, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy (right greater left). There is no significant central stenosis. Moderate to severe left and moderate right neural foraminal stenosis is stable. C4/5: Postsurgical laminoplasty, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is mild central central and moderate bilateral neural foraminal stenosis, stable. C5/6: Postsurgical laminoplasty, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is no significant central stenosis. Moderate left and moderate to severe right neural foraminal stenosis, stable. C6/7: Postsurgical laminoplasty, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is no significant central stenosis. Severe left and moderate to severe right neural foraminal stenosis, stable. C7/T1: Unremarkable and unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Neck pain due to lifting at work. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from straightening which may be in part positional. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc osteophyte complex. Minimal narrowing of the spinal canal. Mild left neural foraminal stenosis. Right neural foramen is patent.C5-6: There is a disc osteophyte complex including a small left paracentral extrusion component. There is mild indentation of the ventral cord, left greater than right. There is overall mild to moderate spinal canal stenosis. There is also moderate right and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex with mild spinal canal stenosis. There is left-sided uncovertebral hypertrophy with moderate left-sided neural foraminal stenosis. There is mild right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine with up to mild-to-moderate spinal canal stenosis at the C5-C6 level particularly involving the left aspect of the spinal canal. 2. There is also mild or mild-to-moderate neural foraminal stenosis at the C4-C5, C5-C6, and C6-C7 levels. Additional details as above.


Instruction: Generate impression based on medical findings.

Input: Urinary retention, lower back pain, new since Saturday No evidence of high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine. No evidence of cord compression. The vertebral bodies are appropriate in the overall alignment and height. No obvious cord signal abnormality.Mild degenerative changes are seen in the cervical spine without evidence of cord compression. Degenerative changes are noted at the L4-L5 and L5-S1 levels including disc height loss and mild to moderate bilateral neural foraminal stenosis, relatively worse at L5-S1. There is facet arthropathy at L4-L5 and L5-S1. There is mild to moderate spinal canal stenosis at the L4-L5 level. These findings can be better assessed with a dedicated lumbar spine MRI study.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression or high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine is identified. Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine.2. Mild to moderate degenerative changes in the lower lumbar spine as described above.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old s/p right partial knee replacement. Hardware components of a right medial unicompartmental knee arthroplasty device are situated in near anatomic alignment without evidence of hardware complication. There is a moderate joint effusion. A left total knee arthroplasty is situated in near-anatomic alignment as seen on the frontal view. Again seen is a calcified lesion in the proximal tibial diaphysis likely representing a large enchondroma.

Output: Right medial unicompartmental knee arthroplasty in near-anatomic alignment and other findings as above.


Instruction: Generate impression based on medical findings.

Input: 45 year old female with a history of ovarian cancer presents for screening breast MRI. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.There is a port-A-cath in the right upper inner chest wall.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female patient with lateral meniscal pain and joint laxity status post twisting injury four weeks ago. Evaluate for left lateral meniscal tear. Due to the patient's large body habitus, the high definition knee coil could not be used. An alternative coil was used instead which results in suboptimal image quality.MENISCI: There is intrasubstance signal within the lateral meniscus indicating degeneration, particularly within the root of the anterior horn which appears thickened. The remainder of the anterior horn appears flattened and there is slight lateral extrusion of the body of the lateral meniscus. There is intrasubstance degeneration of the medial meniscus with fraying/mild degenerative tearing of the inner fibers of the posterior horn, but we see no findings suggesting an unstable tear.ARTICULAR CARTILAGE AND BONE: There is tricompartmental cartilage degeneration with scattered small full-thickness defects. Subjectively, there is narrowing of the lateral tibiofemoral compartment likely due to diffuse cartilage degeneration.LIGAMENTS: There is intermediate signal intensity within the distal fibers of the anterior cruciate ligament which may reflect degeneration or prior sprain. The posterior cruciate ligament is intact. The popliteus muscle/tendon is intact. The collateral ligaments are intact. There is a 1 cm focus of signal void posterior to the proximal attachment of the fibulofemoral ligament likely representing calcium hydroxyapatite deposition of questionable current clinical significance, or less likely a loose body.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Degeneration and mild degenerative tearing of the menisci as described above; we see no unstable tear.2. Tricompartmental cartilage degeneration.3. Mild increased signal intensity in the distal fibers of the anterior cruciate ligament may represent degeneration or mild sprain.4. Focus of calcium hydroxyapatite adjacent to the lateral collateral ligament is of questionable clinical significance.5. Joint effusion, small Baker's cyst, and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old, with left temporal epilepsy, assess for language and motor areas. Sensorimotor cortical activity maps as expected along the pre- and postcentral gyri.The most reliable language related cortical activity was achieved with the sentence completion paradigm. Language is left dominant. Cortical activity related to Broca's area maps as expected along the left inferior frontal gyrus. Cortical activity related to Wernicke's area maps as expected along the left superior temporal sulcus.

Output: Successful functional MRI for surgical planning. Sensorimotor cortical activity maps as expected along the pre- and postcentral gyri. Language is left dominant with Broca's and Wernicke's areas identified as above.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate healing of microfracture areas, trochlea, and medial femoral condyle 2 years ago, with continue pain and swelling. History: left knee pain MENISCI: There is linear and globular fluid signal abnormality within the posterior horn of the medial meniscus which appears to extend to the femoral articular surface indicating a horizontal tear with probable meniscal cyst formation. There is increased globular signal abnormality within the posterior horn of the medial meniscus indicating intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is increased signal abnormality within the articular cartilage along the weightbearing surface of the medial femoral condyle likely representing the site of prior microfracture. There are foci of low signal intensity in this area which likely represent fibrocartilage formation related to prior microfracture. There is bone marrow signal abnormality in the underlying medial femoral condyle. No full-thickness defect is identified.There is subjective thinning of the articular cartilage of the lateral compartment. There is increased signal abnormality within the articular cartilage along the medial facet of the femoral trochlea which may represent a combination of articular cartilage degeneration and postsurgical change from prior microfracture. No full-thickness defect is identified. There is partial-thickness articular cartilage degeneration along the medial facet of the patella.LIGAMENTS: There is partial tearing of the distal fibers of the anterolateral band of the ACL. There is minimal, if any, increased signal abnormality on fluid sensitive sequences suggesting that this is likely chronic in etiology. The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings indicating a tear of the posterior horn of the medial meniscus as well as postsurgical change2. Chronic appearing partial thickness tearing of the ACL.3. Articular cartilage signal abnormality along the medial femoral condyle and patellofemoral articulation which likely represents a combination of degeneration and postsurgical change from prior microfracture. No full-thickness articular cartilage defects are identified.4. Large Baker's cyst.


Instruction: Generate impression based on medical findings.

Input: Evaluation of mass in R parietal lobe found on CT scan of OSH. Seizures, altered mental status. There is an ill-defined infiltrative T2 hyperintense lesion in the inferior right temporal lobe predominantly involving the white matter. However, there are scattered foci of signal abnormality also involving the cortex extending into the insula and to the parieto-temporal junction. A T2 hyperintense lesion is present in the posterior medial right thalamus. The right amygdala and hippocampus appears thickened and mildly T2 hyperintense. There is no obvious postcontrast solid nodular enhancement. However, there is substantial sulcal enhancement both in the vicinity of the mass and rather diffusely in the right cerebral hemisphere. At least some of this enhancement appears to be related to increased vascularity however leptomeningeal enhancement is not entirely excluded. There is effacement of the temporal horn of the right lateral ventricle, otherwise the ventricles appear nondistended. No definite acute intracranial hemorrhage is identified. There is no midline shift.

Output: There is an ill-defined T2 hyperintense process involving the right temporal lobe, insula, parieto-temporal cortex, posterior right thalamus,and questionably the medial temporal structures. Although there is no definite solid nodular enhancement, there is significant sulcal enhancement some of which is at least in part related to increased vascularity in the region. Although the differential considerations are broad and include neoplastic as well as nonneoplastic etiologies, the possibility of a malignancy, including higher grade primary brain tumors, would need to be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old, with high-grade astrocytic neoplasm, follow-up examination. A rim-enhancing mass within the posterior aspect of the right frontal lobe is again seen with evidence of prior biopsy. The overall size of the lesion has increased from the immediate prior examination, now measuring 36 x 35 mm, previously 34 x 30 mm, when measured in the axial plane. The enhancing rim has become thicker. The degree of T2 hyperintensity surrounding this lesion has also increased. More anteriorly, patchy foci of enhancement have become larger within the right operculum, along with associated T2 signal abnormality. Likewise, foci of enhancement within the corpus callosum and the left centrum semiovale white matter have become larger.rCBV mapping shows elevated blood volume correlating with both the dominant right frontal lesion and the scattered additional areas of patchy enhancement.Ill-defined nonenhancing T2 hyperintensity within the bilateral frontal white matter is not significantly changed. Likewise, nonenhancing T2 hyperintense cortical and subcortical thickening involving the anterior right temporal lobe, amygdala and hippocampal head are not significantly changed.No significant generalized mass effect or brain herniation is seen. The ventricles maintain a relatively normal morphology and configuration.

Output: 1.Mild interval increase in the size of a dominant right posterior frontal mass with associated increased edema.2.Scattered additional foci of enhancement within the right opercular tissues, the corpus callosum and the left centrum semiovale white matter have also increased.3.Other areas of nonenhancing signal abnormality remain relatively stable.4.The overall impression, in conjunction with rCBV mapping, is that of slowly progressing disease including within the contralateral hemisphere.


Instruction: Generate impression based on medical findings.

Input: 78-year-old female with right elbow pain. Evaluate for right elbow mass. Evaluation is markedly limited by motion artifact throughout the entire study. Markers were placed in particular attention was placed in this region.A focal somewhat elongated fusiform intramuscular mass is observed in the area of the patient's markers with mild enhancement. Minimally immediately adjacent fat is suggested the lesion is possibly best observed on the sagittal STIR images and is grossly homogeneous (series 8, image 20).The remaining osseous structures are otherwise grossly intact, specifically marrow signal is unremarkable. The remaining muscular compartments and soft tissues are also grossly unremarkable within this limited study, however please note ligaments are not evaluated adequately for comment.

Output: Markedly limited exam with findings suggesting possible nerve sheath abnormality observed immediately lateral to the radial head and neck. Consultation with Dr Haydon in orthopedics is suggested before further evaluation is considered.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: 69-year-old female with endometrial cancer. Rule out parametrial involvement. PELVIS:UTERUS, ADNEXA: Extensive irregular endometrial tumor with deep myometrial invasion. Tumor extends through the cervix and is confined within the vagina. No evidence for bulky parametrial invasion. There is bilateral proximal fallopian tube thickening compatible with tumor extension (axial series 1002 images 218, 230).Simple left adnexal cyst measuring 6.2 x 4 cm (series 401 image 33).BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged right common iliac lymph node partially visualized (series 301 image 57).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Extensive endometrial tumor extending to the cervix and into bilateral proximal fallopian tubes. Deep myometrial invasion is noted. No bulky parametrial invasion.2.Partially visualized right common iliac stent noted. Extensive retroperitoneal lymphadenopathy better visualized on the 10/30/2016 CT abdomen and pelvis exam.


Instruction: Generate impression based on medical findings.

Input: Jaundice, hepatomegaly, evaluate for obstruction Suboptimal study secondary to patient motion artifact. ABDOMEN:LIVER, BILIARY TRACT: Marked T2 hypointensity of the spleen and liver and diffuse signal dropout in liver suggested on inphase imaging when compared to opposed phase imaging, findings may be seen in setting of iron deposition disease. Liver measures 19 cm in craniocaudal dimension. No intrahepatic or extrahepatic biliary duct dilatation. Increasing moderate abdominopelvic ascites. Small fluid and fat stranding seen extending into region of Morison's pouch and around the gallbladder. Gallbladder mildly prominent, measuring up to 3 cm in transaxial plane. No intraluminal signal void seen to suggest underlying cholelithiasis. Mild asymmetric gallbladder wall prominence, measuring up to 3 mm, may be reactive in presence of ascites. Otherwise, no secondary signs of acute cholecystitis. SPLEEN: Splenomegaly, spleen measures 14.5 cm. Marked T2 hypointensity of the spleen and liver, may be seen in setting of hemosiderosis/iron deposition disease. PANCREAS: Mildly decreased intrinsic T1 signal of pancreas in portions of pancreatic head with possible minimal restricted diffusion, mild mesenteric fat haziness. Findings may be seen in setting of mild acute pancreatitis. Previously visualized sidebranch intraductal papillary mucinous neoplasms not as well seen on current study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly thickened small bowel, particularly jejunum, most likely reactive in setting of ascites.BONES, SOFT TISSUES, OTHER: Bilateral increasing moderate sized pleural effusions with underlying atelectasis. Diastases of rectus muscles and small fat containing umbilical hernia. Upper abdominal artifact, likely secondary to enteric tube

Output: 1. Suboptimal exam secondary to patient motion artifact and absence of IV contrast. 2. Hepatosplenomegaly. Marked T2 hypointensity of the spleen and liver, suggestive of iron deposition disease. Correlation with patient's clinical history advised.3. Mildly decreased intrinsic T1 signal of pancreas in portions of pancreatic head with possible minimal restricted diffusion, mild mesenteric fat haziness. Findings may be seen in setting of mild acute pancreatitis, correlation with patient's clinical history/laboratory values recommended. 4. Increasing moderate abdominopelvic ascites and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Clinical question:? Disk herniation. Signs and symptoms: Back pain and sciatica. Nonenhanced lumbar MRI:Lower most visualized thoracic spine and thoracic cord is unremarkable.T12 -- L1 is unremarkableL1 -- L2 demonstrate moderate disk disease and loss of disk height and mild degenerative changes of the posterior elements without central spinal stenosis or neural MR compromiseL2 -- L3 demonstrate mild disk disease and loss of disk height and mild bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromiseL3 -- L4 demonstrate moderate disk disease and loss of disk height, moderate ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in moderate central spinal stenosis and mild right neural foraminal compromise.L4 -- L5 demonstrate advanced disk disease and loss of disk height, mild grade 1 anterolisthesis, moderate bilateral ligamentum flavum hypertrophy (right greater than left), facet disease and with images of widening of the facet spaces demonstrating T2 hyperintensity (facet effusion or inflammatory change). Constellation of changes result in moderate to severe central spinal stenosis and moderate to severe bilateral neural foraminal compromise.L5 -- S1 demonstrate moderate to severe disk degeneration and loss of disk height, moderate symmetrical bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however a mild to moderate bilateral neural foraminal compromise is detected.Limited view of the SI joints demonstrate no abnormalities.Perispinal soft tissues and musculature remains unremarkable.

Output: 1.Extensive degenerative changes at L4 -- L5 and including mild grade 1 anterolisthesis results in significant central spinal stenosis and moderate to severe neural foraminal compromise.2.Degenerative changes at L3 -- L4 results in moderate central spinal stenosis and mild right neural foraminal compromise.3.Degenerative changes at the L5 -- S1 with resultant mild to moderate bilateral neural foraminal compromise and no central spinal stenosis.4.Mild degenerative changes at other levels however without spinal stenosis or significant neuroforaminal compromise. Please see detailed report per level above.


Instruction: Generate impression based on medical findings.

Input: Female; 29 years old. Reason: abdominal pain, bloating. EGD normal. Assess SB for any inflammation History: abdominal pain, bloating. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant bowel wall thickening or enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant colonic wall thickening or enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable examination with no significant colonic or bowel wall thickening or enhancement.


Instruction: Generate impression based on medical findings.

Input: Status post CCM resection: left temporal seizures. There are postoperative findings related to left-sided craniotomy for left temporal lobe cavernous malformation resection. There is a small amount of hemorrhage within the resection cavity. In addition, there is a residual lesion with susceptibility effect and patchy enhancement in the left hippocampus that measures up to approximately 20 mm. There is vasogenic edema in the anterior temporal lobe, inferior left basal ganglia, and left cerebral peduncle, with mild uncal medialization. There is also perhaps mild acute ischemia along the surgical margins. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is diffuse left scalp fluid. The orbits are grossly unremarkable.

Output: Recent postoperative findings related to resection of a left temporal lobe cavernous malformation, with a small amount of hemorrhage in the surgical cavity and what appears to be a residual portion of cavernous malformation in the left hippocampus and surrounding vasogenic edema.


Instruction: Generate impression based on medical findings.

Input: Previous stem cell transplantation, post of 180 days. Disseminated AFB infection, suspicious for Nocardia infection. No evidence of acute ischemic or hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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 mastoid air cells are clear.Extensive mucosal thickening of bilateral maxillary sinuses, ethmoid sinus, frontal sinus and sphenoid sinus

Output: No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.Pansinusitis.