Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for cervical spine and lumbar spine pathology. Signs and symptoms: Neck pain. LBP and numbness Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.The signal intensity of vertebral column demonstrate subtle changes secondary to degenerative disease and unremarkable otherwise.T10-T11 is unremarkable.T11-T12 demonstrate mild disc disease and with small anteriorly projecting hypertrophic spur. No spinal stenosis or neural foraminal compromise.T12-L1 demonstrate mild disc desiccation and is unremarkable otherwise.L1-L2 demonstrate mild disc desiccation and unremarkable otherwise.L2-L3 demonstrate mild degenerative changes and unremarkable otherwise.L3-L4 demonstrate mild degenerative disease and unremarkable otherwiseL4-L5 demonstrate mild facet and ligamentum flavum hypertrophy (left greater than right) and unremarkable otherwise.L5-S1 demonstrate mild disc desiccation and mild bilateral facet and ligamentum flavum hypertrophy. Subtle left facet effusion is detected. There is a shallow left lateral and far lateral disc protrusion (axial T2 series 6 image 22 and sagittal T2 series 3 images 6 through 8). Finding results in moderate left neural foraminal and mild left lateral recess compromise without central spinal stenosis. There is no detectable abnormality of the paraspinal soft tissues.Nonenhanced cervical MRI:The signal intensity of vertebral column is unremarkable.The anatomical alignment of the vertebral column is preserved however there is straightening of cervical lordosis which could be secondary to positioning or pain.The signal intensity and caliber of cervical and upper most visualized thoracic cord is unremarkable.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 demonstrates mild disc desiccation and unremarkable otherwise.C5-C6 demonstrate mild disc disease, small anteriorly projecting hypertrophic spur and no significant facet or ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.C6-C7 demonstrate mild disc desiccation and unremarkable otherwise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord demonstrate no significant degenerative disease and no spinal stenosis or neural foraminal compromise.

Output: 1.MRI of the lumbar spine demonstrate mild degenerative disc disease and hypertrophic changes of facets and ligamentum flavum posteriorly as detailed her level above. There is no spinal stenosis at any level. There is a left lateral and far lateral L5-S1 shallow disc protrusion with resultant moderate left neural foraminal and mild left lateral recess compromise.2.MRI of cervical spine demonstrate mild degenerative disease without spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with acute myeloblastic leukemia, echogenic liver mass seen on prior ultrasound, elevated bilirubin ABDOMEN:LIVER, BILIARY TRACT: Normal liver contour. Multiple ill defined poorly marginated, enhancing, T2 hyperintense lesions are scattered throughout the liver. The largest in segment six measures approximately 2.9 x 1.8 cm (series 901, image 57).The gallbladder is within normal limits. Small ascites.SPLEEN: The spleen is enlarged measuring 15.7 cm in longest dimension. Small ascites.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T2 hyperintense lesion in the T6 vertebral body is incompletely characterized.OTHER: Small bilateral pleural effusions and adjacent atelectasis.

Output: 1.Multiple ill-defined, enhancing lesions scattered throughout the liver as described above. These lesions do not be the criteria of cyst, hemangioma, or primary liver tumor. Differential includes AML involvement of the liver, and less likely infection. Follow-up after chemotherapy treatment is recommended.


Instruction: Generate impression based on medical findings.

Input: 5 month old female patient with spasmus nutans. Question of glioma or brain lesion. BRAIN: The images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There appears to be a normal degree of myelination. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.ORBITS: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Unremarkable examination of the bilateral orbits.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: History of renal cell carcinoma status post partial nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe subcentimeter hemangioma. No suspicious liver lesion or biliary ductal dilatation. Normally distended gallbladder. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Postsurgical changes of a partial right superior/interpolar nephrectomy. No evidence of residual tumor in the surgical bed. No hydronephrosis. No suspicious renal lesion. No regional lymphadenopathy.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia without evidence of complication.OTHER: No significant abnormality noted.

Output: Status post right partial nephrectomy without evidence of residual, recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: 7-year-old female with treatment related ALL, s/p bone marrow transplant. Having fevers as well as apneic/breath holding episodes. Please assess for fungal infection of brain. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is diffusely increased T2 signal within the white matter, sparing the subcortical white matter, which is nonspecific but favored to reflect treatment effect. There is no associated diffusion abnormality. No pathological enhancement is identified. 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. The partially developed frontal, ethmoid, sphenoid, and maxillary sinuses as well as the bilateral mastoid air cells remain partially opacified. There is also persistent partial opacification of the bilateral middle ears. An endotracheal tube is partially visualized.

Output: 1.Increased T2 signal within the periventricular white matter which is nonspecific but favored to reflect treatment effect.2.No evidence of acute ischemic infarction, hemorrhage, or abnormal meningeal enhancement.3.Persistent opacification of the paranasal sinuses, mastoid air cells, and middle ears.


Instruction: Generate impression based on medical findings.

Input: Female, 13 years old, with new neck pain, history of pseudotumor cerebri, with shunt. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or edema is seen. The paraspinal soft tissues and ligamentous structures are unremarkable.The cerebellar tonsils terminate above the level of the foramen magnum. The CSF space at the foramen magnum is widely patent. The visualized spinal cord shows normal signal intensity and morphology. No focal parenchymal lesions are detected. No epidural abnormalities are seen.The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is detected.

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


Instruction: Generate impression based on medical findings.

Input: Reason: biliary obstruction, stent migration, patient with pancreatic cancer History: n/v, abd pain, jaundice ABDOMEN:LIVER, BILIARY TRACT: There is a stent within the common bile duct which appears to be obstructed with increased moderate intrahepatic biliary ductal dilatation.Multiple hepatic metastases are not significantly changed. A right hepatic lobe lesion measures 2.2 x 2.4 cm (13/153), previously 2.2 x 2.6 cm. A Increased enhancement on arterial phase images is likely due to technique.There is increased T1 signal within the lumen of the gallbladder with surrounding hyperenhancement and increased DWI signal. This likely represents tumor with associated hemorrhage, similar to the prior exam.The main portal vein is narrowed (13/265), but remains patent. Tumor extending into the porta hepatis is slightly increased.SPLEEN: No significant abnormality noted.PANCREAS: Enhancing mixed solid and cystic lesion in the pancreatic tail is unchanged in size measuring 5.1 x 4.6 cm (5/27), previously 5.1 x 4.7 cm. There is increased dilatation of the main pancreatic duct with dilated side branches. The main pancreatic duct is cystically dilated up to 1.1 cm in diameter immediately proximal to an ill-defined mass in the pancreatic head. This ill-defined mass in the pancreatic head is not significantly changed in size measuring 4.3 x 3.3 cm (15/47), previously 4.2 x 3.2 cm on remeasurement.There is fatty atrophy within the majority of the body and neck of the pancreas. There is ill-defined tissue at the pancreatic head surrounding the common bile duct which demonstrates enhancement diffusion restrictionADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node is unchanged measuring 2.6 x 1.6 cm (15/58), previously 2.5 x 1.7 cm. Enlarged periaortic lymph nodes are unchanged.BOWEL, MESENTERY: 8 x 6 mm peritoneal nodule is stable (13/255).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal perihepatic and perisplenic ascites is slightly increased. Small right pleural effusion with thickened adjacent pleura is unchanged.

Output: 1.Common bile duct stent is likely obstructed with increased moderate intrahepatic biliary ductal dilatation.2.Increased dilatation of the main pancreatic duct, likely due to obstruction from pancreatic head mass.3.Soft tissue in the porta hepatis is slightly increased. Hepatic metastases are unchanged.4.Pancreatic head mass is unchanged.5.Peritoneal nodularity is unchanged.6.Small right pleural effusion with thickened pleura suggestive of an empyema is unchanged.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer. Abnormal bone scan findings. The images and the official report of the whole body bone scan performed at outside hospital are not available. The clinical note indicates bone scan shows questionable abnormalities in the lower spine and also a pelvic node measuring 2cm in size.The study quality is mildly degraded by motion.CERVICAL SPINE:Alignment is anatomic accounting for straightening. Vertebral bodies are preserved in height. Marrow signal is notable for mild degenerative change subjacent to the endplates, most pronounced at C5-C6 through C7-T1 which is also associated with mild-to-moderate disc height loss. There is also edema like marrow signal involving the left sided articulating pillars at L2-L3 which is probably related to facet arthropathy. There is no suspicious marrow lesion. The cervical spinal cord shows normal signal and only very minimal ventral flattening by the C4-C5 degenerative disc-osteophyte complex. There is hyperostosis/enthesopathy at the occipital attachment of the ligamentum nuchae.C2-C3: Minimal disc-osteophyte complex and moderate left and mild right facet arthropathy, causing minimal left neuroforaminal stenosis. Left facet arthropathy is associated with marrow edema in the corresponding left articulating pillars. No significant spinal canal or right foraminal stenosis.C3-C4: Minimal disc-osteophyte complex and mild uncovertebral and facet arthropathy. No significant spinal canal or foraminal stenosis.C4-C5: Disc-osteophyte complexes associated with a narrow based central disc protrusion/spurring minimally indenting the ventral aspect of the spinal cord without abnormal cord signal. Mild facet arthropathy with no significant foraminal stenosis.C5-C6 and C6-C7: Disc-osteophyte complex is eccentric to the right but no significant spinal canal stenosis. Mild-to-moderate facet and uncovertebral arthropathy contribute to mild bilateral foraminal stenosis.T7-T1: No significant spinal canal or foraminal stenosis.THORACIC SPINE:Alignment is anatomic. Vertebral bodies are preserved in height and there is no suspicious marrow abnormality. Areas mild disc height loss in the mid thoracic spine associated with a small disc-osteophyte complexes as described below. The spinal canal is otherwise fairly preserved. The thoracic spinal cord shows normal signal and shape. Focal T2-hyperintensity and contrast enhancement just adjacent to the left spinolaminar junction at T3-T4 level on sagittal imaging (image #18) is related to a vessel. A 9 mm well-circumscribed, T2-hyperintense, mildly T1-hyperintense lesion within the skin and T8-T9 level to the left of midline is most likely a sebaceous cyst.T1-T2: Minimal disc-osteophyte but no spinal canal or foraminal stenosis.T2-T3: No spinal canal or foraminal stenosis.T3-T4 and T4-T5: Minimal disc-osteophyte but no spinal canal or foraminal stenosis.T5-T6: Broad-based left paracentral disc protrusion but no significant spinal canal or foraminal stenosis.T6-T7: No spinal canal or foraminal stenosis.T7-T8: Narrow based central disc protrusion mildly narrows the spinal canal. No foraminal stenosis.T8-T9, T9-T10, T10-T11 and T11-T12: No significant disc herniation. No spinal canal or foraminal stenosis.LUMBAR SPINE:Alignment is notable for 7 mm of anterior subluxation of L5 relative to S1 associated with bilateral chronic appearing pars interarticularis defects. There is also lumbar straightening which may relate to patient positioning. The vertebral bodies are preserved in height. Marrow signal shows no suspicious focality. Mild degenerative marrow change is present subjacent to the L2-L3 and, to a lesser extent, L1-L2 endplates anteriorly. There is also edema like signal involving the marrow of the left L4 articulating pillar, which is probably reactive to facet arthropathy. Small Schmorl node is present along the inferior endplate of L2 also with minimal associated subjacent marrow change. Moderate size anterior osteophytes are present at L2-L3. The tip of the conus medullaris is at the upper most L2 level. The conus medullaris and included coronal part of the spinal cord show normal signal and shape.T12-L1: No disc herniation. Mild facet arthropathy. No spinal canal or foraminal stenosis.L1-L2 and L2-L3: Minimal disc bulge but no spinal canal or foraminal stenosis.L3-L4: Disc bulge flattens the ventral aspect of the thecal sac. Moderate facet arthropathy and mild ligamenta flava thickening. There is mild narrowing of the subarticular recesses but no nerve displacement and no central spinal canal stenosis. No significant foraminal stenosis.L4-L5: Disc bulge and severe bilateral facet arthropathy (with a small synovial cyst arising from the dorsal aspect of the left facet) cause no significant spinal canal stenosis but mild-to-moderate left and mild right foraminal stenoses. Edema like signal involving the marrow of the left articulating pillar is probably reactive to facet arthropathy. L5-S1: Spondylolisthesis and anterior subluxation are associated with anteroposterior elongation of the spinal canal. Severe facet arthropathy, associated with minimal effusion, results in moderate transverse spinal canal stenosis and moderate biforaminal stenosis. In addition to disc and covering by the subluxation, there is a tiny right paracentral disc protrusion with coronal migration which abuts the traversing right S1 nerve root.

Output: 1.The study is mildly motion degraded.2.There is no definite, destructive spinal osseous metastasis. Foci of edema-like marrow signal abnormality subjacent to the endplates, as described above, are most likely degenerative in nature. Also, similar signal abnormality involving the left L4 as well as the left C2-C3 articulating pillars is probably reactive to facet arthropathy.3.L5-S1 spondylosis and anterior subluxation along with severe facet arthropathy are associated with moderate transverse spinal canal and biforaminal stenoses. Tiny right paracentral L5-S1 disc protrusion abuts the right S1 nerve root. Please correlate with right S1 radiculopathy.4.There is no spinal cord signal abnormality.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Rule out cause of headache. Signs and symptoms: Migraines, epistaxis. Nonenhanced brain MRI:Negative diffusion weighted series.There is normal anatomical morphology and development of brain and with normal signal intensity on all MRI sequences.Unremarkable CT cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses appear normal on this nonenhanced exam.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Follow-up acoustic neuroma status post resection 4/28. Signs and symptoms: None surveillance study. Pre and post enhanced MRI of the IACs:The examination redemonstrates stable irregular T2 hypointense enhancing lesion within the left IAC fairly similar to prior exam. Additionally there is a thin linear dural based enhancement along the dorsal aspect of the left petrous bone at the surgical site. None of the lesions is highly suggestive of tumor and likely representing postsurgical scarring and less likely possibility of residual tumor cannot be entirely excluded. Further follow-up is recommended.There is widening of left cerebellopontine angle cistern secondary to prior surgery and long standing mass effect secondary to previously removed large tumor at this site.Focus of T2 and FLAIR hyperintensity involving the left brachium pontis reaching the left lateral aspect of the pons and without enhancement similar to prior exam and representing gliosis.Pre and post enhanced brain MRI:No diffusion-weighted abnormality.Examination demonstrates punctate size foci of nonspecific FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally within the left basal ganglia, left thalamus and pons without hemorrhagic changes or abnormal enhancement. Considering patient's stated age of 72 findings are likely representing chronic microvascular ischemic changes of mild degree.Focus of FLAIR hyperintensity in the left brachium pontis with evidence parenchymal volume loss consistent with a focus of encephalomalacia and gliosis as detailed on MRI of IACs. Unremarkable post enhanced brain MRI otherwiseExpected chronic postoperative changes of left suboccipital craniectomy for removal of tumor. Unremarkable calvarium, orbits and paranasal sinuses. There is however evidence of opacification of a single left posterior ethmoid air cell similar to prior exams.

Output: 1.Pre- and post enhanced MRI of IACs demonstrate persistent irregular enhancement within the left internal auditory canal and with a thin dural based enhancement in the left cerebellopontine angle suggestive of post surgical changes/scarring. Less likely possibility of residual tumor within the left IAC cannot be entirely excluded and further follow-up is needed.2.Pre- and post enhanced brain MRI demonstrate no evidence of acute intracranial process. Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes and expected postoperative changes of left suboccipital small craniectomy defect.


Instruction: Generate impression based on medical findings.

Input: Female, 14 years old, with complex seizures, evaluate for focal change providing potential explanation. Image quality is degraded on several sequences by motion artifact. Within this limitation, the following observations are made.An ill-defined focus of T2 hyperintensity is seen within the right frontal white matter just superior to the level of the insula (best seen on image 10 series 501, and image 21 series 801). A thin strand of T2 hyperintensity extending peripherally from this lesion to the brain surface, seen on coronal imaging, is favored to represent a sulcus or perhaps a vessel.No other discrete parenchymal lesions are seen. No restricted diffusion, edema or mass effect is detected. There are no findings to suggest acute or chronic intracranial hemorrhage. No abnormal extra-axial collections are seen. The ventricles are normal in size and morphology. The medial temporal lobe structures are symmetric and morphology and signal.

Output: A nonspecific, ill-defined focus of T2 hyperintensity is seen within the right frontal white matter just superior to the level of the insula. The significance of this finding relative to the patient's seizures is uncertain, though some forms of cortical dysplasia or mild migrational anomaly could represent similarly. Follow-up imaging is suggested.


Instruction: Generate impression based on medical findings.

Input: Female, 10 years old, with right leg spasticity and weakness, syrinx. Brain:Small areas of subcortical T2 hyperintensity are seen within the left superior frontal, left middle frontal gyrus, and the anterior left temporal lobe. These lesions produce no mass effect and the overlying cortex shows normal signal intensity.No additional areas of focal signal abnormality, restricted diffusion or susceptibility effect are seen. Cerebral and cerebellar morphology is otherwise within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. Ventricular size and morphology are within normal limits.The left sphenoid sinus is completely opacified along with scattered ethmoid air cells. There is trace fluid signal in the mastoid air cells.Spine:Expansion of the central canal of the spinal cord is seen beginning at T10-11 and continuing down to T12-L1. The maximum caliber of the central canal measures 3 x 3 mm. Above the T10-11 level, there is minimal prominence of the central canal which can be normal.The spinal cord is otherwise normal in morphology and signal characteristics. The conus tip terminates at L1-2. No evidence of fatty filum terminale or other intrathecal fatty lesion is seen. On prone imaging, there is clear anterior shifting of the conus and cauda equina.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. There is a normal complement of intact vertebral bodies. The intervertebral discs are preserved with no areas of significant spinal canal or foraminal stenosis.

Output: 1.Scattered small areas of signal abnormally are seen in the subcortical white matter of the left frontal lobe and the anterior left temporal lobe. These lesions are nonspecific but could potentially represent areas of gliosis related to prior traumatic injury, or prior inflammation/infection. No acute intracranial abnormalities are detected.2.Syringohydromyelia of the lower spinal cord is seen with a maximum caliber of 3 x 3 mm. The spinal cord is otherwise unremarkable, and there are no findings to suggest tethered cord. The osseous spine is within normal limits.


Instruction: Generate impression based on medical findings.

Input: 60 year old man with known coronary artery disease referred to evaluate viability. Left VentricleThe left ventricle is normal in size and systolic function. There is akinesis of the mid to apical anterior wall and dyskinesis of the apical cap. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 201 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 80 g/m2 (normal range 85+/-15), and the LV mass is 182 g (normal range 164+/-36). There are two distinct regions of late gadolinium enhancement. The larger is a transmural myocardial infarction involving the mid to apical anterior wall and the apical septum. These segments are not likely to be viable. There is an atypical pattern or late gadolinium enhancement (non-myocardial infarction pattern) involving the basal inferolateral and anterolateral walls. The pattern is not consistent with prior myocardial infarction and suggests the presence of a secondary underlying fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is free of late gadolinium enhancement and is viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 73%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 51 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no 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. Normal LV size with normal systolic function (LVEF 55%). There is akinesis of the mid to apical anterior wall and dyskinesis of the apical cap. 2. There are two distinct regions of late gadolinium enhancement. The larger is a transmural myocardial infarction involving the mid to apical anterior wall and the apical septum. These segments are not likely to be viable. There is an atypical pattern or late gadolinium enhancement (non-myocardial infarction pattern) involving the basal inferolateral and anterolateral walls. The pattern is not consistent with prior myocardial infarction and suggests the presence of a secondary underlying fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is free of late gadolinium enhancement and is viable. 3. Normal RV size and systolic function (RVEF 73%).


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old, with history of metastatic nasopharyngeal cancer and concern for new brain metastasis on CT. A somewhat heterogeneously enhancing lesion is evident centered on the anteromedial left inferior temporal gyrus measuring 19 x 15 x 14 mm. On axial images, the lesion demonstrates a gyriform or stellate morphology and is ill-defined on T2-weighted images. The lesion induces moderate edema in the surrounding anterior temporal parenchyma.The lesion sits immediately above the foramen ovale. However, no clear abnormality of the V3 nerve is demonstrated. The lesion abuts the dural margin of the left Meckel's cave, but no abnormalities are seen within Meckel's cave. No lesions are detected along the cisternal segment of the left trigeminal nerve.No additional intracranial enhancing lesions are seen. There is a punctate focus of diffusion restriction within the left superior frontal gyrus. However, this occurs in the context of numerous scattered small foci of FLAIR hyperintensity within the bilateral cerebral hemispheres. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology. Fatty marrow replacement is evident in the clivus and upper cervical spine compatible with prior radiotherapy.

Output: An enhancing lesion is evident centered on the anterior medial aspect of the left inferior temporal gyrus. The differential diagnosis for this lesion would certainly include metastatic disease, potentially via perineural spread given its location relative to the foramen ovale. However, no evidence of tumor involvement of the V3 nerve is seen.Some of the features of the lesion, however, are not completely typical of metastatic disease. Consequently, if a review of the radiation oncology records indicates that the anterior temporal lobes received a sufficient dose of radiation, then radiation necrosis should also be considered in the differential.A punctate focus of diffusion restriction within the left superior frontal gyrus is nonspecific. However, given the context of moderately extensive scattered small foci of signal abnormality, this may simply represent an incidental acute microvascular ischemic lesion.


Instruction: Generate impression based on medical findings.

Input: History of left breast cancer, status post surgery and radiation. Complains of headaches. Rule out metastases. CT of brain without and with infusion:A well demarcated low-density in the left basal ganglia remains stable since prior study. Prior MRI examination from 10 -- 3 -- 2006 is also reviewed which demonstrates the same finding which is believed to represent a lacunar infarct.No evidence of any additional foci of abnormal density of brain parenchyma is detected. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Post infusion images demonstrate no evidence of any abnormal enhancement the brain parenchyma or the leptomeninges and in particular no evidence of metastatic lesion is detected.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are also within normal limits.120 cc of Omnipaque 350 was utilized for the above study.

Output: Normal pre-and post infusion CT examination of brain and calvarium.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate spinal anatomy for possible fusion. Signs and symptoms: Pain and weakness. Non-enhanced CT of lumbar spine:Examination redemonstrates destructive changes of the L1 vertebral body with collapse of more than 50% of one. There is fragmentation of the body of L1 vertebrae with expansion into the spinal canal posteriorly. These findings are similar to what was noted on prior MRI of lumbar spine. There is compromise of the AP diameter of thecal sac secondary to retropulsion of fragments into the canal. There is widening of the articulating facets space between T12 -- L1 and L1 -- L2 levels.There is evidence of minimal lytic changes of the inferior endplate of T12 vertebrae as well. This is result of patient's known diskitis/osteomyelitis. The T12 vertebral body and its pedicles are otherwise unremarkable.Very advanced degenerative disk disease throughout the rest of the lumbar spine with significant loss of disk height and sclerotic changes of the adjacent endplates as well as vacuum phenomenon. The alignment of vertebral column is otherwise unremarkable. There is no evidence of any abnormality of the pedicles of the lumbar spine except for partial involvement of pedicles of L1 with technique changes. Very extensive hypertrophic changes of articulating facets bilaterally are noted throughout the lumbar spine. Multilevel mild neural foramina compromise secondary to degenerative changes are suspected.Nonenhanced CT of thoracic spine:A small leak change along the inferior endplate of T12 is consistent with patient's known osteomyelitis/diskitis noted on multiple prior MRI exams. The density of vertebral column in the thoracic spine is otherwise unremarkable. There is no evidence of sclerotic or lytic changes of the rest of thoracic spine. Could the exception of hypertrophic changes no additional abnormality of the facets or the pedicles are detected.The alignment the vertebral column is within normal limits.Mild-to-moderate degenerative disk disease and hypertrophic changes of posterior elements throughout the thoracic spine is noted.

Output: 1.Lytic/destructive changes of L1 vertebrae with retropulsion of fracture body of L1 into the spinal canal and resultant central spinal stenosis. There is also lytic changes involving the anterior aspect of L1 pedicles bilaterally which is also result the patient's osteomyelitis.2.Extensive degenerative changes of lumbar spine of both disks and posterior elements and with multilevel neural frontal compromise as detailed. There is no evidence of any bony defect in the rest of lumber spine other than L1 level.3.Degenerative changes of disk and posterior elements in thoracic spine. Minimal lytic changes of the inferior endplate of T12 related to patient's known osteomyelitis. Unremarkable CT of thoracic spine otherwise.


Instruction: Generate impression based on medical findings.

Input: 32 years Female (DOB:8/19/1984)Reason: Headaches and confusion spells post head injury History: abovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: Suspected pancreatic mass seen on CT. EGD/US revealed an intramural lesion in ampulla, unclear if inflammatory or neoplastic. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity without focal lesions. There is redemonstration of a percutaneous cholecystostomy tube with tip in the contracted gallbladder. There has been interval decrease in pericholecystic inflammatory changes compared to the 11/4/2015 CT. There is trace intrahepatic biliary ductal dilatation appearing similar to prior. The common bile duct is prominent measuring up to 11 mm which remains dilated up until the ampulla appearing similar to prior.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement without focal lesions identified. There is once again mild fullness of the uncinate process. The pancreatic duct is tortuous and is mildly dilated in the pancreatic neck and body measuring up to 5 mm in diameter appearing similar to prior CT. There is no associated ductal wall thickening or enhancement. The pancreatic duct abruptly and smoothly narrows in the region of the pancreatic head for length of approximately 2 cm proximal to the ampulla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A mildly prominent periportal lymph node appears similar to prior. An IVC filter is present.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Interval improvement of pericholecystic inflammatory changes. Cholecystostomy tube remains in place. 2. Dilation of the common bile duct to the level of the ampulla measuring up to 11 mm appearing similar to prior and which may be related to patient's reported ampullary lesion.3. Mild dilation of the pancreatic duct up to 5 mm with smooth narrowing in the pancreatic head for 2 cm proximal to the ampulla. No discrete pancreatic mass identified, findings suggest a stricture. It is unclear whether or not this is related to patient's reported ampullary lesion. An alternative explanation for the prominent pancreatic duct could be a main duct IPMN, but this is considered less likely given that the pancreatic duct is only dilated up to 5 mm and there is a lack of additional associated findings to suggest IPMN such as ductal wall enhancement. Correlation with patient's ERCP/pathology findings recommended.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Arachnoid cyst, reason for seizures. Signs and symptoms: Headaches, seizures. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a CSF signal intensity extra-axial cyst (arachnoid cyst) in left high convexity posterior frontal region along the inner table of skull. The finding measures maximum 29 x 24 and transaxial dimensions and 41 x 19 on coronal T2-weighted series. There is resultant mass effect and buckling of the adjacent cortex without detectable T2 or FLAIR signal abnormality of parenchymal. The overlying calvarium is unremarkable. The ventricular system remains within normal size and with maintained midline.The anatomical morphology of the brain is otherwise within normal limits and normal signal intensity on all MRI sequences. Cortical sulci, ventricular system and CSF spaces are within normal for patient's stated age. Signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits.Unremarkable calvarium and soft tissues of the scalp.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Left posterior frontal high convexity arachnoid cyst measuring 29 x 14 mm (transaxial) and 41 x 19 mm (coronal T2) with regional mass effect and no detectable signal abnormality of adjacent parenchyma.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on medical findings.

Input: Patient with positive valgus test, check for meniscal pathology. Pain MENISCI: Globular signal is observed throughout the posterior horn of the medial meniscus with a discrete radial tear extending to the posterior aspect. Lateral meniscus is otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: Diffuse cartilaginous thinning with irregularity, most pronounced involving the condylar surface of the medial compartment. Relative sparing of the patellofemoral compartment however a moderate focal signal abnormality is observed in the medial aspect of the trochlear groove (image 23 series 601). Scattered subchondral cysts without additional superimposed acute marrow abnormalityLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial meniscal tear, as described2. Extensive cartilaginous loss and cystic changes, see above


Instruction: Generate impression based on medical findings.

Input: Persistent hyperprolactinemia. Rule out prolactinoma: Galactorrhea. There is an apparent hypoenhancing or nonenhancing focus along the posterior aspect of the adenohypophysis that measures up to 3 mm. The pituitary gland is otherwise neither enlarged or atrophic. The pituitary infundibulum and posterior bright spot are intact. There is no compromise of the cavernous sinuses or

Output: An apparent hypoenhancing or nonenhancing focus along the posterior aspect of the adenohypophysis that measures up to 3 mm may represent a pars intermedia cyst or microadenoma.


Instruction: Generate impression based on medical findings.

Input: 59-year-old woman with history of ulcerative colitis status post total colectomy and ileostomy, now with right-sided pain and fluid collection on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: Spleen appears normal.PANCREAS: Pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a subcentimeter right lower pole renal cyst and the calyces are mildly prominent. Otherwise, the kidneys are normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The patient is status post total colectomy with a right lower quadrant ostomy. There is a ventral hernia containing loops of bowel without evidence of incarceration.In the right lower quadrant adjacent to the ileum (series 18, image 33), there is a 48 x 48 mm multilobulated collection which enhances peripherally and demonstrates restricted diffusion. This collection abuts the right psoas muscle and extends superiorly, abutting the right lobe of the liver. The walls of the adjacent small bowel loops are mildly increased in enhancement suggesting inflammation, however no tract is seen extending to the bowel lumen.Mildly prominent lymph nodes are seen at the root of the mesentery, likely reactive.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right lower quadrant abscess as described above. Finding was discussed with Dr. MIKOLAJCZYK by phone at 13:34 on 10/28/2015.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old, with neurofibromatosis type I, with new nystagmus and worsening gait difficulty. Also problems with writing. Brain:No evidence of restricted diffusion, edema or mass effect is seen. No pathologic intracranial enhancement is observed. Predominantly periatrial white matter volume loss is seen with mild patchy T2 hyperintensity in the surrounding periventricular tissues. This is perhaps minimally progressed from prior. No tumor-like lesions are detected. No evidence of intracranial hemorrhage or any abnormal extra-axial collection is seen. Innumerable cutaneous nodules likely representing neurofibromas are demonstrated.Cervical spine:Deformity, thickening and T2 hyperintensity of the spinal cord at the C2 level are unchanged. This lesion itself does not enhance, nor did it on the prior examination. However, just above the level of this lesion, there is bilateral nodular thickening presumably affecting the exiting nerve roots, similar in size to those seen on the prior examination. These lesions do enhance mildly. Nerve root thickening is also suspected within several cervical foramina, most notably C5-6 and C6-7 bilaterally.Straightening of the cervical lordosis is seen. Sagittal alignment is unremarkable. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous, but there are no areas of definite edema or pathologic marrow replacement. Except as above, the spinal canal demonstrates normal signal characteristics and is free of pathologic enhancement.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild facet arthropathy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes. C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild to moderate left foraminal narrowing. No interval changes. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes. C7-T1: Very small central disc protrusion. No spinal canal stenosis. No foraminal narrowing. An enhancing nodular lesion is seen at the left tracheoesophageal groove at T1. This area was not covered on the prior examination. Innumerable cutaneous neurofibromas are present.

Output: 1.No definite acute intracranial abnormality is seen. No intracranial tumors are detected. There is white matter volume loss predominantly affecting the periatrial regions with mild associated parenchymal signal abnormality. Findings have perhaps minimally progressed from prior.2.An area of spinal cord thickening, deformity and abnormal signal is redemonstrated at the C2 level without significant interval change. This could potentially represent a benign spinal cord tumor related to neurofibromatosis.3.Additional small neurofibromas are suspected intrathecally, above the level of the C2 cord tumor, and within several of the cervical foramina. The findings are nonspecific and unchanged from prior.4.Relatively mild degenerative findings in the cervical spine are unchanged with no areas of high-grade spinal canal stenosis.5.Innumerable cutaneous neurofibromas are seen. In addition, there is a nodule along the left tracheoesophageal groove at the T1 level which is nonspecific but could potentially represent a neurofibroma.


Instruction: Generate impression based on medical findings.

Input: History of gallstone pancreatitis status post cholecystectomy now with rising LFTs. ABDOMEN:LIVER, BILIARY TRACT: Borderline enlarged liver measuring 23 cm in craniocaudal dimension. No intra or extrahepatic biliary ductal dilatation with the common duct measuring up to 6 mm which tapers smoothly to the ampulla. No filling defect to suggest a stone.Status post cholecystectomy with minimal fluid in the surgical bed.Minimal perihepatic fluid, likely postsurgical.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas parenchyma demonstrates mildly decreased T1-weighted signal intensity, however it enhances homogeneously without evidence of necrosis. There is mild peripancreatic inflammatory fluid without a loculated fluid collection. No evidence of arterial pseudoaneurysm or venous thrombosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: Small volume abdominopelvic ascites.BONES, SOFT TISSUES: Postsurgical changes of the right anterolateral abdominal wall.OTHER: Bibasilar atelectasis and small effusions. Note is made of mild cardiomegaly and increased size of the inferior vena cava and hepatic veins.

Output: 1.Interval cholecystectomy. Findings of mild acute interstitial edematous pancreatitis without a significant peripancreatic fluid collection arterial or venous complication. No choledocholithiasis.2.Small effusions and basilar atelectasis.3.Perihepatic ascites.4.Cardiomegaly and findings suggestive of increased right sided heart pressures.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old, with numbness and paresthesia of the left big toe. Mild curvature of the lumbar spine is seen in the coronal plane. There is a grade 1 anterolisthesis of L4 relative to L5.The L2 vertebral body is compressed with approximately 50% loss of vertebral body height centrally. There is no associated marrow edema. The remaining vertebral bodies show preservation of height.Degenerative endplate signal abnormality is seen at L2-3. Elsewhere, marrow signal characteristics are unremarkable. No evidence of marrow edema is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.T12-L1: Mild facet arthropathy and ligamentum flavum thickening. Mild bulging disc. No significant spinal canal or foraminal stenosis.L1-2: Mild facet arthropathy. Loss of disc T2 signal with preserved disc height. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Moderate facet arthropathy with bilateral facet effusions. Ligamentum flavum thickening. Loss of disc height with disc bulging and osteophytic spurring. The lateral recesses are narrowed but no significant generalized spinal canal stenosis is seen. The neural foramina are mildly narrowed. L3-4: Moderate facet arthropathy with bilateral facet effusions. Ligamentum flavum thickening. Loss of disc height and disc bulging. The lateral recesses are narrowed but there is no significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L4-5: Advanced facet arthropathy and ligamentum flavum thickening. Loss of disc height and disc bulging. Effacement of both the dorsal and ventral thecal sac results in a mild to moderate generalized spinal canal narrowing. The descending L5 nerve roots may be somewhat impinged. Mild bilateral foraminal narrowing. L5-S1: Moderate facet arthropathy. Loss of disc height with disc bulging and a right paracentral/subarticular disc protrusion. As a result, the descending right S1 nerve root may be slightly impinged. No significant generalized spinal canal stenosis is seen. The neural foramina are not significantly narrowed.

Output: 1.Multilevel disc degeneration is seen. At L3-4, the lateral recesses are narrowed and there is a moderate right foraminal narrowing. At L4-5, there is a mild to moderate generalized spinal canal stenosis with possible impingement of the descending L5 nerve roots. At L5-S1, there is a right paracentral/subarticular disc protrusion which may impinge upon the descending right S1 nerve root.2.Facet arthropathy is seen at most levels. In addition, there is a compression deformity of the L2 vertebral body which is likely chronic given lack of marrow edema.


Instruction: Generate impression based on medical findings.

Input: History of focal nodular hyperplasia of the liver, 6 month follow-up to evaluate for change in size. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity. There is once again a mass in the right hepatic lobe near the dome (series 901, image 31) measuring 2.7 x 2.8 cm, unchanged. The lesion demonstrates mild T2 hyperintensity with a small central T2 hyperintense component, mild T1 hypointensity with a central T1 hypointense component, homogeneous arterial enhancement, and retention of contrast on the hepatobiliary phase compatible with focal nodular hyperplasia with central scar. There are numerous additional small T2 hyperintense foci throughout the liver without significant enhancement most compatible with benign biliary hamartomas. No biliary ductal dilatation. The gallbladder appears unremarkable.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: Previously seen prominent nonspecific left anterior juxtaphrenic lymph node is not clearly visualized.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right hepatic lobe mass consistent with focal nodular hyperplasia unchanged in size.2.Please note that the pelvis is not included on this examination, and the previously described and subsequently resected pelvic tumor is not assessed.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old, with pain in the right arm. Evaluate for pinched nerve. Alignment is anatomic. Vertebral body heights are preserved. No marrow replacement or edema is seen. No pathologic marrow enhancement is detected.The visualized spinal cord demonstrates normal signal intensity and is free of pathologic enhancement. No epidural abnormalities are suspected.C2-3: No significant spinal canal or foraminal stenosis. C3-4: Mild right uncovertebral hypertrophy. No significant spinal canal stenosis. Mild narrowing of the right neural foramen. C4-5: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation, particularly towards the right. Severe right and moderate left foraminal narrowing. C6-7: No significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis.

Output: 1.A combination of disc osteophyte formation and facet arthropathy results in severe right and moderate left foraminal narrowing at the C5-6 level.2.No other areas of high-grade foraminal or spinal canal compromise are seen.


Instruction: Generate impression based on medical findings.

Input: 52 year old patient with thyroid cancer. Metastatic brain lesion. History of tumor resection and radiation. Tumor recurred and current trauma patient complains of increasing headaches and probable determining things. Nonenhanced head CT:There is a new interval area of extensive vasogenic edema in the left frontal lobe near the site of previously noted metastatic lesion on prior exam from 12 -- 13 -- 2010. This finding is associated with mass effect and effacement of adjacent cortical sulci as well as mass effect on the left frontal horn of the left lateral ventricle and midline shift of approximately 8 mm at the level of septum pellucidum. The finding is highly concerning for metastatic lesion and recommend follow with a dedicated enhanced MRI of brain. There are no additional foci of abnormal density of brain parenchyma. Ventricular system are within normal range of size.Above findings were discussed with the clinical service Dr. Postma Kelly at the time of interpretation of the exam.

Output: Large new focus of vasogenic edema in the left anterior frontal lobe with associated mass effect. Recommend follow up with enhanced CT or an enhanced MRI for evaluation of metastatic disease. Rightward midline shift of approximately 8 mm.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with known tonsillar cancer. Evaluate CT scan for staging. HEAD CT:There is an approximately 6-mm focus of enhancement in the left frontal lobe in the region of the corona radiata suspicious for metastatic lesion. No vasogenic edema is seen. An MRI may be obtained for further evaluation if clinically indicated. No additional areas of abnormal enhancement.The remaining cerebral hemispheres, cerebellum and brainstem are normal in structure and attenuation. No abnormal extra-axial fluid collections are identified. The ventricles are normal in volume and are midline.No osseous lesions are identified in the calvarium or skull base. The visualized paranasal sinuses and mastoid air cells are normally aerated.NECK CT:There is an approximately 3.9 x 2.6 cm (image) homogeneously enhancing mass involving the right tonsillar pillar reaching the midline as well as extending posteriorly abutting the oropharynx. There is surrounding lymphadenopathy within the right jugulodigastric region the largest of which appears to be a combination of two nodes measuring 12 x 23 mm (image 41/92) at the level of the angle of the right mandible. Additional suspicious nodes are seen at the level of the hyoid on the right. Subcentimeter nonpathologic nodes are seen on the left.The visualized osseous structures are normal.The visualized lung apices are normal. Please refer to the Chest CT performed on the same day for further details.

Output: 1. Right tonsillar mass with right neck lymphadenopathy.2. Enhancing focus in the left frontal corona radiata without evidence of vasogenic edema. A metastatic focus as the diagnosis of exclusion. An MRI may be considered if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: 37 years, Female, numbness in the thumb/finger on the left and ankle on the left. Evaluate for multiple sclerosis. Brain MRI appears within normal limits. No parenchymal lesions are seen to suggest demyelinating disease. Ventricles and sulci are within normal limits. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.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: Brain MRI is within normal limits. No findings to suggest demyelinating disease.


Instruction: Generate impression based on medical findings.

Input: Exaggerated cervical lordosis, similar to prior CT. Endplate degenerative changes, most severe at C3-C4. There is also degenerative changes at the C1-C2 articulation with thickening along the posterior aspect of the dens corresponding to calcifications seen on prior CT. Multilevel disc desiccation and disc space loss throughout the cervical spine. Vertebral body heights are intact. No abnormal signal within the cord.C2-C3: Mild posterior disc osteophyte complex without significant central or foraminal stenosisC3-C4: Moderate posterior disc osteophyte complex producing moderate central stenosis. Moderate right and mild left neural foraminal stenosis.C4-C5: Mild posterior disc osteophyte complex. Mild central canal stenosis and mild bilateral foraminal stenosisC5-C6: Mild posterior disc osteophyte complex without central canal stenosis. Moderate left and mild right neural foraminal stenosis.C6-C7: Mild posterior disc osteophyte complex. No central canal stenosis. Mild left neural foraminal stenosisC7-T1: No significant central or neural foraminal stenosis.

Output: Cervical spondylosis, most severe at C3-C4, where there is moderate spinal stenosis. No evidence of acute cord compression.


Instruction: Generate impression based on medical findings.

Input: Pituitary adenoma resection surveillance. There are stable postoperative findings related to pituitary tumor resection with an unchanged tumor in the sella that extends through the floor of the sella into the right sphenoid sinus and into the suprasellar cistern. The mass appears to protrude into the right cavernous sinus. Overall, the mass measures up to 24 mm. There is no significant mass effect upon the optic apparatus, which appears to be atrophic particularly on the left side.

Output: No significant interval change in the residual pituitary macroadenoma and optic apparatus atrophy.


Instruction: Generate impression based on medical findings.

Input: 27 years Male (DOB:6/25/1988)Reason: 3 T MRI seizure protocol History: Complex partial seizure since 2010PROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The hippocampi are symmetric and without signal hyperintensity.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No seizure focus identified on this exam. There is no convincing evidence for mesial temporal sclerosis.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old, with metastatic colorectal adenocarcinoma to the cerebellum, planning examination for resection of recurrent tumor. Postoperative findings are seen compatible with suboccipital craniectomy. Eight rim-enhancing tumor within the left superior cerebellum has increased in size from the prior examination now measuring at least 24 x 15 mm in the axial plane, previously 11 x 10 mm. The degree of surrounding T2 hyperintensity has also increased. Within this enhancing lesion, there is an 8 mm focus of apparent cystic degeneration. Minimal linear enhancement is seen along the prior surgical trajectory, likely postoperative in nature. No definite new enhancing lesions are seen.

Output: Interval increase in size of a left superior cerebellar tumor.


Instruction: Generate impression based on medical findings.

Input: 19-year-old female with left knee pain and instability, assess medial patellofemoral ligament, tibial tuberosity to trochlear groove distance, trochlear dysplasia, cartilage, loose bodies MENISCI: Lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema type signal within the medial aspect of the patella and associated lateral aspect of the lateral femoral condyle. Near fluid signal intensity within the medial patellofemoral ligament is suggestive of at least a partial tear. Patella alta is noted. The femoral trochlea appears shallow. Small ossicles measuring up to 5 mm are seen medial to the patella correlates with those seen on prior radiographs. Mild soft tissue swelling along the anterior soft tissues over the patella. The TT-TG distance measures approximately 8 mm. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patellar tendon is intact. The quadriceps tendon is intact.ADDITIONAL

Output: 1.At least partial tearing of the medial patellofemoral ligament with edema type signal along the medial aspect of the patella and lateral aspect of the femoral condyle consistent with a recent lateral dislocation and reduction. 2.Patella alta and findings suggestive of trochlear dysplasia. Findings are associated with predisposition to patellar instability.3.Small joint effusion.


Instruction: Generate impression based on medical findings.

Input: Evaluate for osteomyelitis Examination of the pelvis was performed before and after the intravenous administration of gadolinium. There is a large ulceration posterior to the distal sacrum and coccyx.. This ulceration abuts the coccyx and therefore osteomyelitis is highly suspected. There is also enhancement of the distal coccyx with the intravenous gadolinium.Note is made of metallic artifact involving the right hip.

Output: Ulceration reaching the coccyx and abnormal enhancement within the distal segments. Consistent with osteomyelitis


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old, with cervical radiculopathy. Spinal alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity. Cord morphology is discussed below.C2-3: Left greater than right facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Left greater than right facet hypertrophy. Mild disc osteophyte formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Left facet hypertrophy. Mild disc osteophyte formation. No significant spinal canal stenosis. Mild right and moderate left foraminal narrowing.C5-6: Facet hypertrophy. Mild disc osteophyte formation. Mild spinal canal stenosis without significant cord deformation. Moderate bilateral foraminal narrowing. C6-7: Facet hypertrophy. Moderate disc osteophyte formation and thickening of the PLL. Mild flattening of both the ventral and dorsal spinal cord with a moderate generalized canal stenosis. No significant foraminal narrowing. C7-T1: Facet hypertrophy. Mild disc osteophyte formation and thickening of the PLL. No significant spinal canal or neuroforaminal stenosis.

Output: Multilevel cervical spondylosis most severely affecting C5-6 where there is a mild generalized spinal canal stenosis, and C6-7 where there is a moderate generalized spinal canal stenosis and mild impingement of the spinal cord. No evidence of cord edema is seen.


Instruction: Generate impression based on medical findings.

Input: Male 78 years old Reason: rectal cancer History: rectal cancer Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Heterogeneous prostate gland which is enlarged and measures up to 4 x 5.5 cm (series 3/38).BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fat: Six which are suspicious due to restricted diffusion and enhancement, with the largest at the level of the rectosigmoid junction on the left measuring up to 1.4 x 0.9 cm (series 8/12).Lymph nodes outside the mesorectal fascia: None which are suspicious. Subcentimeter in short axis left pelvic sidewall and bilateral inguinal lymph nodes are not enlarged by size criteria and do not demonstrate restricted diffusion or enhancement.BOWEL, MESENTERY: Rectal Tumor:Size: 4.4 x 3 x 5.1 cm (AP x transverse x craniocaudal) (series 7/152 and series 4/18).Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensity.Tumor location: Lower-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 2.4-cm.Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 1-cm.Circumference of the rectum involved: 75 to 100% (series 3/33).Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): No abutment or invasion.MRI T-stage: T3a - Tumor invades < 0.5cm into perirectal fat or extramural (series 3/38).Tumor Distance to Mesorectal Fascia: Approximately 1.5-cm (series 3/35).BONES, SOFT TISSUES: Small fat-containing left inguinal hernia.OTHER: No significant abnormality noted.

Output: Rectal cancer with mesorectal fat invasion and metastatic perirectal lymphadenopathy seen.


Instruction: Generate impression based on medical findings.

Input: Restaging ovarian germ cell tumor.IMAGES: Submitted for interpretation are FDG PET/CT images from the skull base through the thighs, dated 7/17/2015. (The nonenhanced CT images were obtained solely for purposes of completing the PET scan, are not of diagnostic quality and are thus not interpreted or used to diagnose disease independently of the PET images.) Today's CT portion grossly demonstrates right chest Port-A-Cath with tip in the right atrium. The uterus is not well-visualized and may be surgically absent.Today's PET examination demonstrates no suspicious FDG avid lesion to indicate FDG avid tumor currently in the neck, chest, abdomen or pelvis. Note the known hepatic lesions on recent MRI are not demonstrated to be FDG avid. However, given their small size, they are not large enough to confidently characterize on PET. These could represent non-FDG avid tumor or treated tumor versus benign lesions.

Output: No FDG avid tumor identified currently in the neck, chest, abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: 74 years Female (DOB:8/28/1941)Reason: F/U MRI. H/O lumbar spinal stenosis s/p decompressive surgery in 2012. Please compare to MRI from 2014. History: low back pain, persistent bilateral lower extremity weaknessPROVIDER/ATTENDING NAME: HELENE G RUBEIZ HELENE G RUBEIZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post L3-4 hemilaminectomy. There is a mottled appearance to the lumbar marrow.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level. There is partial effacement of fat at the lateral recess at this level. This is stable compared to the prior exam.At L4-5 there is anterior subluxation of L4 on L5 by 7 mm. There is loss of disc space height this desiccation and diffuse disc bulge at this level associated with moderate bilateral facet hypertrophy and effacement of the fat at the lateral recess bilaterally. Overall there is a moderate degree of spinal stenosis at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. This is stable compared to the prior examAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height and disc desiccation as well as a disc bulge at this level associated with partial effacement of fat within the neural foramina. There is partial effacement of the fat at the lateral recess bilaterally at this level. Overall there is mild to moderate spinal stenosis at this level. There is a left far lateral disc protrusion present at this level This has been stable since prior exam. There are some endplate reactive changes present this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. Some minor endplate reactive changes at this level.

Output: There are multilevel degenerative changes present in the lumbar spine which overall appears stable compared to the previous exam. The worst levels at L4-5 where there is some mild subluxation of L4 on L5 associated with a moderate degree of spinal stenosis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with HCC status post TACE ABDOMEN:LIVER, BILIARY TRACT: Widening of the fissures consistent with cirrhotic morphology. Trace perihepatic fluid.Subcentimeter T2 hyperintense lesion in the right lobe of the liver likely reflects a cyst.Redemonstrated is a T2 hypointense treatment cavity in segment eight of the liver. There is a wedge-shaped arterially enhancing region adjacent to the treatment site. There is no definite focus of washout or persistent enhancement to suggest recurrent or residual disease. No new suspicious lesions are present.Hepatic steatosis is present. Mild intrahepatic biliary ductal prominence. Cholelithiasis is present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense cyst in the left interpolar kidney. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post TACE as described above without evidence of recurrent or residual disease.2.Wedge-shaped arterial enhancement adjacent to the treatment site likely perfusional changes related to treatment.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. There is a 6 mm presumed pineal cyst. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The midline structures and craniocervical junction are within normal limits without evidence of abnormal CSF flow dynamics at the level of the foramen magnum. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is minimal fluid within the left mastoid air cells.

Output: 1.Normal brain MRI without evidence for Chiari malformation.2.Minimal nonspecific fluid within the left mastoid air cells.


Instruction: Generate impression based on medical findings.

Input: Encounter for other preprocedural examination [Z01.818] / Hemangioma of intracranial structures [D18.02] / Unspecified convulsions [R56.9], Reason for Study: ^Reason: PRE-OP please do in CCD at 6:00am - PLEASE PAGE NEUROSURGERY RESIDENT TO PLACE FIDUCIALS Multiple fiducial markers attached on scalp for the preparation of stealth registration.There is a 13.2 mm x 14 mm x 12.7 mm sized cavernous malformation on the right side anterior inferior aspect of middle temporal gyrus with the peripheral hemosiderin deposition, unchanged since prior scan.There is a developmental venous anomaly at the right cerebellar hemisphere, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Right middle temporal gyrus cavernous malformation as described above.


Instruction: Generate impression based on medical findings.

Input: 22-year-old female with a history of neuroblastoma. Baseline pre-stem cell transplant. CHEST:LUNGS AND PLEURA: The innumerable bilateral pulmonary nodules have increased in size and number. No significant pleural effusion is identified. Many of the metastatic nodules are pleural based.MEDIASTINUM AND HILA: The heart size is normal. The pre-vascular, subcarinal and right hilar lymphadenopathy has increased in size in the interval. The lymph nodes are in a conglomeration are not amenable to reproducible measurement.CHEST WALL: The previously described right axillary lymph node now measures 4.4 x 2 cm (image 13/2 a one). On the most recent exam this measured 3.6 x 2 centimeters.There is new sclerosis of the T5 and T6 vertebral bodies. The T6 vertebral body shows a loss of height of approximately 50%. While no involvement of the spinal canal is identified on this examination, if there is clinical concern for involvement, an MRI may be obtained. Multiple sclerotic metastatic lesions are seen in the ribs.ABDOMEN:LIVER, BILIARY TRACT: There are multiple hypodense lesions in both lobes of the liver. The phase of enhancement is different on today's examination and therefore reproducible measurement is not possible. However, it appears to these lesions have all increased in size. No biliary ductal dilatation is present.SPLEEN: No significant abnormality noted.PANCREAS: Multiple hypodense lesions are identified within the body and tail of the pancreas. Lesions in the tail of pancreas have increased slightly in size. Lesions in the body of the pancreas are not as clearly seen on this examination. This may be due to phase of contrast enhancement rather than actual decrease in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is atrophic. No abnormalities are identified within the left kidney itself. However multiple nodules are identified surrounding the left kidney which likely represent metastatic nodules.RETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes are increased in number but not enlarged by CT criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subtle sclerotic lesions are identified within the thoracic and lumbar spine. These correlate with the areas of increased uptake on recent bone scan likely represent metastatic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The uterus is small for age.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See discussion of bones in the abdomen above.OTHER: No significant abnormality noted.

Output: Interval worsening of metastatic disease in the chest, abdomen and pelvis as described above. Specifically new collapse of the T6 vertebral body is identified.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma on Temodar. The intrinsically T1 hyperintense lesions in the bilateral cerebral hemispheres are stable to slightly decreased in size. For example, a lesion in the left occipital lobe measures 4 mm in diameter, previously also 4 mm, while a lesion in the right anterior cingulate gyrus measures 3 mm in diameter, previously 5 mm. There is no appreciable vasogenic edema associated with the lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stable to slight interval decrease in size of the brain metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old. Left shoulder pain ROTATOR CUFF: There is moderate tendinopathy of the supraspinatus tendon, without discrete tear evident. The supraspinatus muscle appears normal. The infraspinatus, teres minor, and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: There is mild acromioclavicular joint osteoarthritis. There is trace fluid within the subacromial bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is diffuse mild cartilage loss involving the glenohumeral joint as well as osteophyte formation. Within the limits of nonarthrographic exam, there is diffuse irregularity of the glenoid labrum, compatible with degeneration.BICEPS TENDON: The tendon of the long head of the biceps is normal in course and morphology. ADDITIONAL

Output: 1.Supraspinatus tendinopathy without rotator cuff tear identified.2.Osteoarthritis of the glenohumeral and acromioclavicular joints as above.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old, with left-sided back pain and left lower extremity radiculopathy. T1 hypointensity and heterogeneous T2 hyperintensity are seen affecting the superior aspect of the L4 vertebral body. These findings correlate with sclerosis and cystic changes demonstrated on prior CT from 2013. Only slight loss of vertebral body height is seen at this level which may reflect endplate degeneration and/or Schmorl's node formation. The remaining vertebral bodies are free of significant marrow signal abnormality and demonstrate preservation of height. Spinal alignment is anatomic. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.A large left renal cystic lesion is partially visualized.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Mild disc bulging. No spinal canal or foraminal stenosis. L3-4: Moderate facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Advanced facet arthropathy. Ligamentum flavum thickening. Disc bulging with perhaps a small superimposed right paracentral/foraminal protrusion. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. L5-S1: Moderate facet arthropathy. Ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Findings are seen compatible with sclerosis and endplate degeneration or Schmorl's node formation at L4. Accounting for differences in technique, this abnormality does not appear to have changed significantly when compared to a prior CT examination from 2013.2.No other definite acute vertebral body abnormalities are seen.3.Multilevel disc and posterior element degeneration are seen. At most, the spinal canal is mildly narrowed. Moderate right foraminal narrowing is seen at L4-5.


Instruction: Generate impression based on medical findings.

Input: Leg weakness, multiple sclerosis, evaluate for progression. There are numerous T2 hyperintense lesions in the periventricular white matter, cerebellum, and brainstem. Several of these lesions demonstrate corresponding low T1 signal. Overall, these lesions appear grossly similar to prior examination. There is mild prominence of the cortical sulci in proportion to the cerebral ventricles consistent with mild diffuse global volume loss. There is no evidence of acute infarction. There is no midline shift or mass effect appreciated. There is redemonstration of a 1.8 cm diameter T2 hyperintense nodule in the left cheek, which may represent a sebaceous or epidermal inclusion cyst.

Output: Numerous supratentorial and infratentorial demyelinating lesions related to multiple sclerosis, which do not appear to have significantly changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with elevated liver enzymes ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion is evident. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right breast implant is noted. Status post left mastectomy.

Output: 1.No focal liver lesion as clinically queried.


Instruction: Generate impression based on medical findings.

Input: Obsessive-compulsive disorder [F42], Reason for Study: ^Reason: surveillance History: ocd There is no evidence of acute ischemic or new hemorrhagic lesion on this scan.Redemonstration of prior laser ablation foci on bilateral internal capsule anterior limb just lateral aspect of lateral ventricle frontal horns. Those foci show central low signal intensity with surrounding high signal intensity rim, no change in terms of MR characteristics. The size of right side focus remains stable but that of the left appears to be slightly smaller than before and changed its shape from round to elliptical. Bilateral frontal lobes' laser ablation lead tracks are seen with some susceptibility artifacts indicating lead tract blood products, no change since prior scan.On post enhanced image, the left focus still shows evidence of enhancement, however, the extent of the enhancement appears to be much lessen than prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Interval decrease in size of left laser ablation focus as well as decrease extent of enhancement comparing to prior scan.3. Stable right side ablation focus in terms of size and MR characteristics.4. No change in bilateral lead track blood products.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female urothelial cancer. Restaging. CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules are predominantly peripheral and some are pleural based. Bibasilar dependent atelectatic changes. No nodule larger than 4 mm was found.MEDIASTINUM AND HILA: Diffuse calcified lymph nodes in the mediastinum. Small amount of coronary artery calcification. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 1 x 2.6 cm inferior right hepatic lobe cystic lesion appears uniloculated and benign. Subcentimeter hypodensities are bilobar and too small to characterize. SPLEEN: No significant abnormality noted.PANCREAS: 8 x 10 mm distal pancreatic parenchymal cystic focus (coronal image 43, axial image 82 of series 3). If indicated, obtain MRI/MRCP for further evaluation, if indicated. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic calcifications in the aorta. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral lung micronodules and subcentimeter liver hypodensities are too small to characterize.Pancreatic tail 1 cm cystic lesion. see above. No measurable metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Ms. Rubin is a 31-year-old female with known right breast cancer and metastatic lymph node in the right axilla. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the right upper outer breast, there is an irregular enhancing mass identified measuring 3.1 x 2.3 x 2.6 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this lesion, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement identified in the right breast.There are at least four abnormally enlarged right axillary lymph nodes identified, the largest of which measures approximately 1.7 cm in maximal dimension. This particular lymph node along with associated adjacent postbiopsy changes is compatible with history of biopsy-proven metastatic lymph node.No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: (1) Unifocal malignancy within the right upper outer breast with enlarged biopsy-proven metastatic axillary lymph nodes.(2) No MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Clinical question: 48-year-old male with history of SCLC with metastases to liver, brain, now with weakness. Signs and symptoms: Evaluate intracranial process versus metastases. Pre-and post-enhanced brain MRI:Examination demonstrates very significant interval progression of metastatic disease. There are numerous varying size nonhemorrhagic and enhancing metastatic lesions in bilateral cerebral and cerebellar hemispheres as well as the pons. Thickening and enhancement of the ependymal lining the lateral ventricles are also highly suggestive for additional metastatic lesions. There is a small amount of peritumoral edema with the lesions all were without appreciable mass effect on the lateral ventricles and with maintained midline.There is a slight interval increased size of lateral ventricles however with maintained midline. Calvarium is intact.Unremarkable images through the orbits including axial fat sat post contrast series.

Output: 1.Significant interval progression of metastatic disease with numerous supratentorial and infratentorial parenchymal nonhemorrhagic enhancing metastatic lesions. Diffuse metastatic lesions involving the ependymal lining of the lateral ventricles.2.There is no significant mass effect or midline shift.3.Unremarkable calvarium and orbits.


Instruction: Generate impression based on medical findings.

Input: Reason: Hx of peritoneal mesothelioma, eval disease progresion History: abdominal pain CHEST:LUNGS AND PLEURA: No gross abnormalities.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Tumor extending anteriorly within the cardiophrenic space is decreased since the prior exam.CHEST WALL: Subcentimeter axillary and internal mammary nodes are unchanged.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Multiple perihepatic subserosal and peritoneal nodular implants extending along the right paracolic gutter are not significantly changed.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 1.4 x 1.2 cm, minimally increased since the prior exam.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged lymph nodes at the porta hepatis which have increased since the prior exam with increased necrosis.BOWEL, MESENTERY: Numerous soft tissue implants throughout the peritoneum and mesentery. Reference measurements are unchanged.BONES, SOFT TISSUES: Complex cystic lesion along the ventral incision site has increased in size.OTHER: Moderate ascites is unchanged.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Soft tissue implants throughout the pelvis with an unchanged reference lesion. Rectosigmoid anastomosis.BONES, SOFT TISSUES: Cystic lesion within the right gluteus minimus measures 1.5 x 1.7 cm. Right-sided paralabral cystOTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 6/13/2016 08:23:50)PERITONEAL NODULAR ADJACENT TO LIVER: 3.7 x 1.9 cm (Image 274, Series 2204); 4.1 x 2.2 cm on prior (4/6/2016) (Image 33, Series 209).PERIPANCREATIC NODULE: 2.5 x 2.6 cm (Image 189, Series 2204); 2.1 x 1.9 cm on prior (4/6/2016) (Image 38, Series 209).VENTRAL BODY WALL COMPLEX CYSTIC LESION: 12.2 x 5.4 cm (Image 1, Series 1701); 7.9 x 3.6 cm on prior (4/6/2016) (Image 57, Series 209).POSTERIOR PELVIC SOFT TISSUE IMPLANT: 3.0 x 2.8 cm (Image 84, Series 3001); 2.9 x 2.9 cm on prior (4/6/2016) (Image 80, Series 209).

Output: 1.Soft tissue implants along the anterior mediastinum have slightly decreased since the prior exam.2.Extensive peritoneal and mesenteric soft tissue implants are not significantly changed accounting for differences in technique.3.Peripancreatic lymph nodes are slightly increased in size with increased central necrosis.4.Large cystic lesion along the anterior abdominal wall is increased in size.5.Small cystic foci in the right gluteus minimus is of uncertain etiology.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Benign neoplasm of meninges, unspecifiedClinical question: meningioma f/u, compare w/ priorComments: Meningioma resection 7/2012 | The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right-sided craniotomy. A small focus of encephalomalacia is present along the right frontal lobe along the lateral aspect of the right precentral gyrus extending to the subcentral lobule. No abnormal enhancing lesion is appreciated to suggest local recurrence.There is a T1 hyperintense mass present along the perivertebral musculature at the C1-2 level measuring 41 x 26 mm axial dimensions which is bright on T1-weighted imaging and suppresses on the fat suppressed images suggesting that this is a lipoma. It is unchanged since the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for local recurrence of meningioma status post right parietal bone craniotomy for removal of the meningioma.2.Lipoma in the left upper neck is stable.


Instruction: Generate impression based on medical findings.

Input: Generalized abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is full of numerous gallstones including the neck of the gallbladder. There is mild gallbladder wall thickening, pericholecystic fluid, wall hyperenhancement and adjacent reactive hepatic parenchymal hyperenhancement. No choledocholithiasis. No intrahepatic or extrahepatic biliary ductal dilatation.The liver is normal in morphology, signal intensity and enhancement. Stable segment 6 punctate lesion is too small to characterize. No suspicious focal liver lesion or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal lipid rich adenoma measuring 2.8 x 1.7 cm. Mild right adrenal nodularity.KIDNEYS, URETERS: Simple appearing left renal cortical cyst. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Large duodenal diverticulum. No evidence of bowel obstruction. Colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The gallbladder is distended with numerous gallstones, wall thickening, wall hyperenhancement and pericholecystic fluid suspicious for acute and/or chronic cholecystitis. No discrete enhancing mass to suggest gallbladder malignancy.


Instruction: Generate impression based on medical findings.

Input: Artifact from the shunt device limits evaluation in the left parietal and occipital lobes and posterior fossa. Shunt tubing enters through a left parietal burr hole and has its tip in the posterior horn of the left lateral ventricle. A small amount of increased T2 signal intensity is present anterior to the shunt tubing otherwise there is no abnormal parenchymal signal. A second catheter is seen along the left temporal lobe coursing through the sylvian fissure.There is prominent extra-axial fluid along the left frontal lobe with posterior displacement of the frontal lobe and mass effect on the left lateral ventricle which is asymmetrically smaller compared to the right. There is also prominence of CSF along the anterior left temporal lobe. The prepontine cistern is prominent. There may be a small ependymal cyst at the level of the atrium of the right lateral ventricle curving along the right lateral thalamus and into the temporal lobe.The superior vermis is small and slightly dysmorphic in appearance. The junction of the vein of Galen and straight sinus appears abnormally superiorly positioned which probably contributes to the appearance of a tall and thin superior vermian cistern. The contour of the roof of the fourth ventricle is also atypical in that the superior medullary vellum is relatively convex superiorly.No acute abnormal bodies are seen. No parenchymal edema is detected.

Output: 1.Asymmetric but nondilated ventricles.2.Areas of prominent extra-axial CSF and mass effect on the left cerebral hemisphere may be related to cysts.3.Mildly dysmorphic brain parenchyma is likely chronic.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Follow-up MRI guided laser ablation for intractable epilepsy. Signs and symptoms: Left temporal epilepsy. Nonenhanced brain MRI:Negative diffusion weighted images.Small well-demarcated focus of minimally hemorrhagic encephalomalacia in the left hippocampal head is detected and representing site of prior laser ablation. The finding measures approximately 20 x 7.7 mm in transaxial dimensions on sagittal T2-weighted series and 9 x 8 mm on coronal T2-weighted series 5 image 16.A thin hemosiderin laden linear signal abnormality extends from the site of laser ablation posteriorly to the left posterior temporal burr hole consistent with track of laser ablation device.Tiny focus of gliosis at the site of the left posterior temporal burr hole and left paramedian frontal burr hole is noted. There is prominence of cerebral cortical sulci and of cerebellar-vermian folia for patient's stated age of 42 consistent with parenchymal volume loss and do not significant change since prior studies.Ventricular system remain within normal size and maintained midline.

Output: 1.Focus of minimally hemorrhagic encephalomalacia in the left hippocampal head measuring at 20 x 7.7 mm on axial T2 and 9 x 8 mm on coronal T2-weighted images representing sites of prior laser ablation.2.Prominence of cortical sulci, cerebellar and vermian folia for stated age of 42 without change since multiple prior exams.3.Other expected findings of prior electrode placement as well as laser ablation device as detailed.4.No acute intracranial process and unremarkable exam otherwise. Please see above comments.


Instruction: Generate impression based on medical findings.

Input: History of hemoglobin SC with confusion, dizziness, failing grades. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening and hyperenhancement, suggestive of inflammation.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.