Instruction: Generate impression based on medical findings.

Input: Female, 36 years old. Reason: left thyroid nodules with left neck lymph node History: as above RIGHT LOBE MEASUREMENTS: 4.3 x 1.5 x 1.1 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.7 x 1.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Minimally heterogeneous echotexture, without focal lesion.LEFT LOBE: Minimal heterogeneous echotexture. A left superior pole nodule measures 0.4 by 0.3 x 0.2 cm, cystic with a small echogenic focus, unchanged from prior.ISTHMUS: Minimally heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 2 lymph node measures 0.9 x 0.8 x 0.3 cm. A left level 2 lymph node measures 1.0 x 0.5 x 2.1 cm. A left level 4 lymph node measures 0.8 x 0.4 x 1.3 cm, unchanged.OTHER: No significant abnormality noted.

Output: 1. Subcentimeter left colloid nodule, unchanged.2. Unchanged cervical lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post re-do untethering. Signs and symptoms: As above. Nonenhanced lumbar MRI:Examination demonstrates evidence of tethered cord without convincing evidence of interval change since prior exam. There is no detectable anterior movement of the cord on sagittal T2-weighted images when compared with supine series. This is a similar observation is prior exam. Similar to prior exam there is termination of the cord at S2 level. Visible central canal is again identified in the lower cord without interval change in size or extent. Signal intensity and alignment of vertebral column is within normal without evidence of spinal canal or neural foraminal compromise. Postoperative changes of recent surgery evidenced by postoperative fluid accumulation in the soft tissues over the lower back extending from mid L3-L5-S1 disc level. There is no evidence of mass effect on the spinal canal secondary to this expected postoperative finding. The fluid accumulation measures approximately at 40 x 30 mm in transaxial dimensions.

Output: 1.Postoperative changes of redo untethering of the cord evident by posterior lower spine soft tissue fluid accumulation extending from L3 to L5/S1 disc level without mass effect on the thecal sac.2.No convincing evidence of anterior movement of the cord on prone sagittal T2 weighted images compared to supine.3.Revisualization of termination of the cord at S2 level and central canal without change.


Instruction: Generate impression based on medical findings.

Input: 45 years, Female, Reason: cause of LFT abnormalities History: markedly elevated alk phos, elevated AST/ALT. Severely limited study due to patient motion and large body habitus.ABDOMEN:LUNG BASES: Cardiomegaly.LIVER, BILIARY TRACT: Gallbladder is contracted with wall thickening which is nonspecific. Hepatomegaly. No focal hepatic lesions. Common bile duct appears normal. SPLEEN: Borderline enlarged spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace perihepatic ascites.

Output: 1.Limited study due to motion and body habitus.2.Hepatomegaly without focal liver lesions.3.Contracted gallbladder with nonspecific wall thickening which is likely due to volume overload.4.Trace perihepatic ascites.


Instruction: Generate impression based on medical findings.

Input: CT NECK AND FACIAL BONES: There is a well-defined mildly enhancing 28 x 19 mm mass centered within the left masticator space abutting the medial pterygoid muscle and just anterior to the internal carotid artery. It is unchanged in size compared with the 11/14/2014 MRI and is not completely imaged on the 9/10/2014 CT making comparison with that exam difficult. There is no adjacent fat stranding or osseous destruction. There is no evidence of significant cervical lymphadenopathy. The major cervical vessels are patent. The thyroid and major salivary glands are unremarkable. There are tonsilloliths.The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There are nonspecific ground glass opacities within the lung apices. There is mild mucosal thickening within the maxillary sinuses.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.

Output: 1.Well-defined 28 mm left masticator space mass without evidence for lymphadenopathy or cervical metastasis. The appearance is non-specific but most compatible with a nerve sheath tumor such as neurofibroma with a pedunculated deep parotid lobe mass felt less likely. 2.No evidence of significant steno-occlusive lesion or vascular malformation within the neck.


Instruction: Generate impression based on medical findings.

Input: Images were obtained for surgical stereotactic localization purposes. Postoperative changes are seen from previous occipital craniectomy. There is redemonstration of a large cystic lesion in the midline posterior fossa, slightly greater to the left side, with areas of enhancing mural nodularity and small serpentine flow-voids. It measures 4.5 cm transverse x 5.0 cm AP x 3.9 cm CC. When allowing for differences in technique, it appears slightly increased in size compared to prior outside MRI. There is mild increased degree of mass effect upon the fourth ventricle, with persistent areas of T2 hyperintensity extending outward into the cerebellar parenchyma, slightly progressed and representing vasogenic edema. A linear area of T2 hyperintensity the right frontal lobe is likely postprocedural gliosis.Areas of solid nodular enhancement associated with the dominant lesion as well as other scattered foci of nodular enhancement elsewhere in the cerebellum bilaterally appear grossly similar. There is a rounded area of nodularity along the dorsal aspect of the right posterior body of the corpus callosum, measuring 7 x 7 mm in greatest axial dimensions.In addition, along the upper cervical spinal canal at the C1-C2 level, there is an irregular enhancing intradural extra medullary nodule along the left ventral thecal sac on 4/9 measuring 6 x 7 mm, with slight thickening of the adjacent dural margin just caudally. Coronal and axial T2-weighted images appear to suggest mild heterogeneous T2 hyperintense signal within the right greater than left atrophic cord along the visualized upper cervical spine. Previous spine imaging suggested myelomalacia at these levels with associated volume loss.The ventricles and sulci are otherwise within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal opacification of posterior ethmoid air cells.

Output: 1. Slight interval increased size of dominant cerebellar hemangioblastoma with increased mass effect although without significant interval ventricular size change.2. Similar pattern of other scattered smaller predominantly cerebellar enhancing nodules as well as one posterior to the posterior body of the corpus callosum on the right side, also likely hemangioblastomas.3. Findings suggestive of upper cervical cord myelomalacia of the incompletely assessed, with the possibility of intrinsic cord lesion entirely excluded on the basis of this exam. Small nodular area of enhancement along the left ventral thecal sac at the C1-C2 level, likely representing an additional hemangioblastoma perhaps along the cervical nerve root. Grossly, this appears similar to prior outside MRI of the spine from May 2012.


Instruction: Generate impression based on medical findings.

Input: Stroke workup: right sided weakness. Brain MRI: There is an area of high T2 signal and restricted diffusion as well as faint patchy enhancement in the posterior left basal ganglia and corona radiata. There also a a punctate focus of T2 signal and restricted diffusion as well as intrinsically high T1 signal in the left caudate nucleus. There is no associated susceptibility effect. 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.Brain and Neck MRA: There is no evidence of significant steno-occlusive lesions. There is no evidence of cerebral aneurysms.Brain MRV: The images are markedly degraded by patient motion. However, there is no evidence of venous sinus thrombosis based on the conventional brain MRI sequences.

Output: 1. Findings compatible with subacute left basal ganglia and coronal radiata infarction. A punctate focus of high T1 signal in the left caudate nucleus infarct is nonspecific and does not appear to represent hemorrhage due to the lack of corresponding susceptibility effect. A metastases is also an unlikely consideration. Nevertheless, follow up with a repeat brain MRI in one month or so may be useful.2. No evidence of significant steno-occlusive lesions in the head and neck arteries. 3. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on medical findings.

Input: 15-year-old female with persistent swelling and pain of left knee. Evaluate extent of synovial inflammation-synovectomy is a consideration. MENISCI: The medial and lateral meniscus are normal.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. The articular cartilage of the patellofemoral and tibiofemoral compartments is intact without of focal thinning or fissure.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. The popliteus muscle and tendon are intact.EXTENSOR MECHANISM: The extensor mechanism is normal. The patella appears normal.ADDITIONAL

Output: Synovitis with large joint effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old. Reason: complains of hoarseness and has had multinodular goiter History: rule out enlargement RIGHT LOBE MEASUREMENTS: 7.9 x 2.4 x 2.2 cmLEFT LOBE MEASUREMENTS: 8.3 x 3.2 x 3.2 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Heterogeneous echotexture, with multiple nodules. A right superior Palmetto measures 1.3 x 0.8 by 1.6 cm, heterogeneous and hypoechoic, predominantly solid, calcified, with mild internal vascularity. A right inferior pole nodule measures 1.1 x 0.6 x 2.1 cm, heterogeneous, solid, calcified, with minimal internal vascularity. A right mid thyroid nodule measures 2.2 x 1.8 x 2.2 centimeters, solid and heterogeneous, noncalcified, with mild internal vascularity.LEFT LOBE: Heterogeneous echotexture, with multiple nodules. A lower pole nodule measures 2.1 x 1.1 x 1 .9 cm, solid and heterogeneous, with internal calcification and moderate internal vascularity. A mid to superior pole nodule measures 2.3 by 1.9 x 1 .5 cm, isoechoic and mildly heterogeneous, noncalcified, with moderate internal vascularity.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 2 lymph node measures 0.7 x 0.4 x 1.4 cm, with a fatty hilum. A left level 3 lymph node measures 0.4 x 0.2 x 0.4 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: Multinodular goiter, not significantly changed from prior.


Instruction: Generate impression based on medical findings.

Input: 86 year old female with a repeat head CT secondary to worsened mental status change. There is no evidence of intracranial hemorrhage, mass or edema. Small lacunae in the right basal ganglia. Few diffuse hypodensities consistent with minimal small vessel disease, age indeterminate, essentially within normal limits for the patient's age. If there is clinical concern for acute ischemia an MRI may be considered. Overall, there is no change when compared to the previous study.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable exam.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of L4-5 spondylolisthesis with right lower extremity radiculopathy. There is approximately 5 mm of anterolisthesis of L4 on L5 and 6 mm of retrolisthesis of L5 on S1. There are chronic bilateral pars defects at L4. The vertebral body heights are intact. The conus medullaris is mildly low lying, terminating at the level of L2-3. The paraspinous soft tissues are grossly unremarkable. There are multilevel degenerative changes:L1-L2: No significant disc disease. No spinal canal or neuroforaminal stenosis.L2-L3: Mild disc bulge. No spinal canal or neuroforaminal stenosis.L3-L4: Mild disc bulge. No spinal canal or neuroforaminal stenosis.L4-L5: Disc uncovering and bulging with an extruded component extending cranially within the midline ventral epidural space. There is moderate to severe neuroforaminal canal stenosis at this level. No significant spinal canal stenosis. There is also facet arthropathy and a medial subcentimeter right synovial cyst that appears to impinge upon the adjacent nerve roots.L5-S1: There is a disc bulge resulting in moderate bilateral neuroforaminal stenosis. No significant spinal canal stenosis. Moderate facet arthropathy and bilateral facet joint effusions.

Output: 1. Bilateral L4 spondylolysis with grade 1 anterolisthesis of L4 on L5 and moderate to severe bilateral neuroforaminal stenosis. Advanced facet arthropathy is present at this level as well, with an associated subcentimeter right synovial cyst.2. An L5-S1 disc bulge results in moderate bilateral neuroforaminal narrowing. Advanced facet arthropathy is present at this level as well.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: Oligodendroglioma status post RT and now on PCV. There are post-treatment findings in the left temporal region with a persistent confluent, mildly expansile area of T2 hyperintensity and and susceptibility effect in the left temporal lobe with slightly increased patchy foci of enhancement, which may display corresponding slightly elevated perfusion. There is also an unchanged subcentimeter non-enhancing focus of T2 hyperintensity in the right superior cerebellar hemisphere. There is no evidence of acute 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 unchanged.

Output: 1. Slight interval increase in the patchy foci of enhancement associated with treated left temporal lobe tumor,, which may represent incipient tumor progression.2. Unchanged nonspecific subcentimeter right cerebellar hemisphere lesion.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Epidural abscess, diskitis. Signs and symptoms: Paraspinal pain, elevated WBC. Pre-and post-enhanced cervical spine MRI:Examination demonstrate normal anatomical alignment vertebral column however with mild reversal of cervical lordosis.The signal intensity of spine is unremarkable other than changes secondary to degenerative disease.There is no evidence of diskitis, osteomyelitis or epidural abscess as these questioned clinically.The signal intensity of the cord remains reading normal.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate a central and rightward broad based disk protrusion with resultant flattening and posterior displacement of the cord and moderate central spinal stenosis. Patent bilateral neural foramina and no detectable cord signal abnormality.C4 -- C5 demonstrate moderate disk disease, loss of disk height and a broad-based disk osteophyte complex. There is flattening and posterior displacement of the cord and moderate central spinal stenosis. There is mild bilateral neural foraminal compromise.C5 -- C6 demonstrate mild disk disease, a disk/osteophyte complex on the left results in flattening and posterior displacement of the cord and mild central spinal stenosis. Mild right neural foraminal compromise is also present.C6 -- C7 is unremarkable.C7 -- T1 is unremarkable.Pre-and post-enhanced thoracic MRI:There is normal anatomical alignment the vertebral column however with mild exaggerated kyphosis of thoracic spine. There is unremarkable signal intensity of thoracic spine.There is no evidence of diskitis, osteomyelitis or epidural abscess as clinically is questioned.There is normal signal intensity of the thoracic cord and without evidence of abnormal enhancement.There is no evidence of central spinal stenosis or significant neuroforaminal compromise at any level. Mild degenerative disk disease and hypertrophic changes of posterior elements are noted in the thoracic spine.Pre-and post-enhanced lumbar spine:Examination demonstrate no evidence of diskitis, osteomyelitis or epidural abscess as is questioned clinically.There is normal anatomical alignment the vertebral column. There is no evidence of spinal canal or neural foraminal compromise at any level. Incidentally note is made of an enlarged uterus with multiple well-demarcated foci of low-attenuation suspect that a fibroma. Recommend follow-up with the dictated imaging for better assessment and to exclude other pathology.

Output: 1.Pre-and post-enhanced MRI of the cervical spine demonstrate no evidence of diskitis/osteomyelitis or epidural abscess. There is evidence of extensive degenerative disk disease and with multilevel osteophytes and disk protrusion resulting in central spinal stenosis at C3 -- C4, C4 -- C5 and C5 -- C6 levels and multilevel neural foraminal compromise as detailed per level.2.Pre-and post-enhanced MRI of thoracic spine demonstrate no evidence of osteomyelitis, diskitis or epidural abscess. There is no redness on the spinal canal or neural foraminal compromise. Mild degenerative changes of thoracic spine and slight exaggeration of thoracic kyphosis is noted.3.Pre-and post-enhanced lumbar MRI demonstrate no evidence of diskitis, osteomyelitis or an epidural abscess. No spinal stenosis or neuroforaminal compromise at any level. 4.Incidental note is made of an enlarged uterus and highly suspected multiple fibromas. Recommend follow-up with dedicated imaging to exclude other pathologies.


Instruction: Generate impression based on medical findings.

Input: Most recent PSA 8/2016 was 5.5 ng/mL. Prior PSA from 9/2015 was 5.1 ng/mL. Prolaris score = 3.4. He currently has no urinary symptoms. Prostate biopsy from 2010 was benign. PELVIS:PROSTATE:Prostate Size: 4.9 x 2.6 x 3.7 cmPeripheral Zone: Left peripheral zone T2 low (series 601 image 88) and ADC low (series 708 image 324) focus with early arterial enhancement.Central Gland: Right prostate base at the junction of the transition zone, peripheral zone, and central zone with T2 low (series 601 image 97) and ADC low (series 708 image 364) focus. This may represent extension of hyperplastic nodule from transition zone, but cannot exclude malignancy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left peripheral zone T2 low and ADC low focus with early arterial enhancement, PIRADS 4.2.Right prostate base T2 low and ADC low focus, PIRADS 3.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on medical findings.

Input: Postmenopausal bleeding PELVIS:UTERUS, ADNEXA: Small amount of fluid in the endometrial canal, which is deviated by a low signal intensity broad-based submucosal mass along the posterior fundus with an enhancement pattern similar to the uterus. Overall, the mass measures 1.8 x 1.7 x 3.5 cm (series 7, image 25; series 6, image 21). There are no T2 cystic changes or T1 hyperintense foci to suggest adenomyosis.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Broad-based submucosal mass along the posterior fundus of the uterus; differential considerations include leiomyoma; adenomyoma is considered less likely.


Instruction: Generate impression based on medical findings.

Input: Female; 22 years old. Reason: PSC, IBD, eval for cholangiocarcinoma History: PSC, IBD ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. The portal and hepatic veins are patent.Mild beading of the left and right intrahepatic central ducts is similar similar to prior. However, there is increased narrowing of the confluence of the intrahepatic ducts and the common hepatic duct, which demonstrates new concentric biliary wall thickening. No associated increased enhancement or focal mass.Mild common bile duct dilation is slightly increased and now measures up to 10 mm, previously 8 mm, without evidence of obstructing mass.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: Increased narrowing of the biliary ducts at Klatskin point, particularly of the common hepatic duct, with new concentrate biliary wall thickening. Considering the patient's young age, cholangiocarcinoma is a possibility, and correlation with ERCP is recommended.


Instruction: Generate impression based on medical findings.

Input: Grade II astrocytoma treated with RT/TMZ+TMZ. Off all treatment currently. There are unchanged post-treatment findings in the posterior fossa and unchanged patchy T2 hyperintensity in the pontomedullary region. There is an unchanged punctate focus of susceptibility effect in the right posterior medulla, which may represent a microhemorrhage or cavernous malformation. There is unchanged confluent T2 hyperintensity in the right cuneus and mild scattered nonspecific foci of susceptibility effect in the cerebral white matter. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No evidence of tumor progression.


Instruction: Generate impression based on medical findings.

Input: Right arm weakness, spasms/fasciculation, tingling and numbness. There is asymmetric increased T2 signal and thickening involving the right C5-T1 roots which also extends throughout the remainder of the right brachial plexus, at least to the level of the cords. This is not associated with abnormal contrast enhancement. It is also not associated with surrounding mass or abnormal soft tissue signal. This is a nonspecific finding that could represents plexopathy. Only part of the shoulder girdle is included and there is no significant asymmetry or abnormal signal. Susceptibility artifact in the midshaft of left clavicle is probably related to previous clavicular fracture repair. The study is not optimized to assess the cervical spine, but there is no significant cervical spinal canal or right sided foraminal stenosis.

Output: 1. Asymmetrically increased STIR signal and mild thickening involving the roots of the right brachial plexus with its extension into the remainder of the right brachial plexus segments suggests brachial plexitis. Otherwise, no evidence of mass lesions or pseudomeningoceles.2. Findings related to left clavicular fracture and surgical repair.


Instruction: Generate impression based on medical findings.

Input: seizures, No evidence of acute ischemic or hemorrhagic lesion on this scan.There are patchy high signal intensity lesions on bilateral periventricular white matters indicate non specific small vessel ischemic lesion. Underlying brain shows minimal to mild brain atrophy which could be a bit more prominent than age.The ventricles appear to be a bit prominent but no evidence of occlusive lesion.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Sphenoid sinus as well as bilateral maxillary sinuses show mucosal thickening and fluid level indicating sinusitis.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. The right Pcom artery is patent and Acom artery is patent but the left Pcom artery is not seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery origin appears to be narrowed about 50%. The right vertebral artery is hypoplastic. Bilateral common carotid, carotid bifurcations, internal/external carotid show tortuous course but do not show any significant luminal narrowing. There is no evidence of intracranial arterial luminal narrowing or arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial and extracranial craniocervical arterial luminal narrowing.3. No evidence of intracranial aneurysm.4. Non specific white matter changes with mild brain atrophy as described above.


Instruction: Generate impression based on medical findings.

Input: Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: metastatic breast cancer - baseline screening for a clinical trial History: none There are multiple intra axial nodules demonstrating various degree of enhancement. The location of lesions include; right precentral gyrus (7mm), left superior temporal gyrus posterior aspect (9.8mm), left precuneus around the left parieto-occipital fissure (11mm), and left occipital lobe (14mm).There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Bilateral Staphylomas. There is no signal intensity of lens indicating post cataract surgery.

Output: Multifocal intra axial lesions indicating metastasis as described above. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on medical findings.

Input: History of poorly differentiated sinonasal carcinoma SNUC treated with CRT. There are postoperative findings related to sinonasal tumor excisional biopsy with resection of the left ostiomeatal complex and left middle and superior turbinates. There is no evidence of measurable sinonasal region tumor. There is persistent mucosal thickening and secretions that occupy the left sphenoid sinus. There is also persistent moderate mucosal thickening in the left maxillary sinus and mild mucosal thickening within the right maxillary, right sphenoid, left frontal, and right ethmoid sinuses. The parotid glands are unremarkable. There is encephalomalacia in the inferior right cerebellar hemisphere. There are also scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There are bilateral lens implants. There is multilevel degenerative cervical spondylosis.

Output: 1. Post-treatment findings in the sinonasal region with persistent diffuse mucosal inflammatory changes, but no evidence of measurable tumor recurrence. 2. Chronic right inferior cerebellar infarct.


Instruction: Generate impression based on medical findings.

Input: Cholangiocarcinoma status post chemotherapy. ABDOMEN:LIVER, BILIARY TRACT: A common bile duct stent is noted with mild surrounding susceptibility artifact which limits evaluation. There is moderate intrahepatic biliary ductal dilatation to the level of the stent/Klatskin's point, appearing similar to the prior. There is subtle post-contrast circumferential enhancement about the proximal aspect of the stent (series 1008, 264), likely corresponding to the patients periductal infiltrating cholangiocarcinoma. There is subtle soft tissue infiltration into the porta hepatis where there is at least partial encasement of the common hepatic artery, measuring approximately 1.3 x 1.0 cm (series 1008/254).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The patient's known cholangiocarcinoma at Klatskin's point is difficult to accurately measure with subtle circumferential enhancement about the proximal aspect of the stent and soft tissue infiltration into the porta hepatis with at least partial encasement of the common hepatic artery. The appearance is similar to the recent prior CT (peri-arterial soft tissue is seen in retrospect on series 11 of image 95).


Instruction: Generate impression based on medical findings.

Input: Left knee pain. Left knee patellar chondral defect? MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: Although I see no fluid-filled defects of the articular cartilage of the patella, focal low signal intensity within the articular cartilage of the medial facet of the patella may represent degeneration. The articular cartilage of the femoral trochlea appears normal. The remaining articular cartilage appears normal. Bone marrow signal intensity is within normal limits.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Small focus of low signal intensity within the articular cartilage of the medial facet of the patella may represent focal degeneration, but this is equivocal, and I see no fluid-filled articular cartilage defects.


Instruction: Generate impression based on medical findings.

Input: 47-year-old female with shoulder pain. Evaluate right shoulder. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. No intra-articular gadolinium is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe degenerative changes affect the glenohumeral joint. There is full-thickness articular cartilage degeneration along the central and inferior aspect of the glenoid with subchondral signal abnormality and subchondral cyst formation, which is likely degenerative. There is a 13 mm oval focus of low signal intensity within the inferior aspect of the axillary recess likely representing a loose body within the joint. There is an additional 12 mm focus of low signal abnormality along the posterior aspect of the glenohumeral joint also consistent with a loose body. The glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Severe degenerative changes affecting the glenohumeral joint with multiple loose bodies within the joint space as described above.


Instruction: Generate impression based on medical findings.

Input: 14-month-old female with newly diagnosed neuroblastoma. Neck CT:Due to the lack of body fat, the lesions seen on prior MRI study are more difficult to delineate on this CT study. Again noted are masses in bilateral neck, primarily at level 2 of the internal jugular chain, consistent with lymphadenopathy. There is also a mass measuring 16 x 12 mm in the right lower neck, probably in the carotid space at the level of the thyroid. These findings are compatible with history of neuroblastoma.The osseous structures and limited view of the upper lungs appear unremarkable.There is nonspecific opacification of the paranasal sinuses, left middle ear and mastoid air cells.

Output: 1. Right neck mass, and bilateral adenopathy, compatible with history of neuroblastoma. The findings are similar to recent MRI study, and are actually better visualized on the prior MRI due to the lack of body fat.2. Nonspecific paranasal sinus, left middle ear and mastoid air cells inflammatory changes.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old, with left shoulder arthritis. Evaluate the glenoid. No fracture is evident. Severe osteoarthritis affects the glenohumeral joint with bone on bone apposition. Multiple subcentimeter subchondral lucencies penetrate the articular surface of the humeral head and glenoid, representing erosions. A large joint effusion is also noted (better seen on the patient's prior MRI). These findings raise the possibility of an underlying chronic inflammatory arthritis. Fluid is also seen distending the biceps tendon sheath.Please note that rotator cuff tearing and tendinosis seen on the prior MRI are not well visualized on the current CT study.A large, normal variant os acromiale is again noted. Moderate osteoarthritis affects the acromioclavicular joint.Note is made of a patulous esophagus with a dependent fluid level. If there is clinical concern for a motility disorder, further evaluation with an esophagram may be considered.The remaining bony and soft tissue structures are within normal limits.

Output: Severe arthritic changes at the shoulder joint as described above with multiple small erosions and a large joint effusion suggesting osteoarthritis with an underlying chronic inflammatory arthritis.


Instruction: Generate impression based on medical findings.

Input: Metastatic embryonal rhabdomyosarcoma off therapy since May, 2013. Assess for recurrent disease. Brain: There is no evidence of intracranial mass. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There cerebellar tonsils appear to extend up to 7 mm inferior to the foramen magnum. The major cerebral flow voids are intact. The cerebellar tonsil remains low lying especially on the left. There is left parieto-occipital plagiocephaly. There is trace fluid in the left mastoid air cells. The orbits and scalp soft tissues are grossly unremarkable.Neck: There are post-treatment findings in the left parotid space region, but no evidence of underlying measurable mass lesions. The cervical lymph nodes are unchanged. The thyroid and major salivary glands are unchanged, including an asymmetrically small left submandibular gland. The major cervical flow voids are intact. The airways are patent. The osseous structures are unremarkable.

Output: 1. Post-treatment findings in the left parotid gland without discernible recurrent tumor.2. No significant change in the cervical lymph nodes.3. No evidence of intracranial mass.4. Findings suggestive of possible Chiari I malformation.


Instruction: Generate impression based on medical findings.

Input: There is no evidence of diffusion restriction. There are T2/FLAIR hyperintensities in the pons, midbrain, and in the subcortical and periventricular white matter representing chronic ischemic vascular changes.There is a low T1 and high T2 linear hyperintensity that is not seen in FLAIR in the pons representing linear encephalomalacia, likely due to prior hemorrhage.Cannot definitely exclude any chronic hemorrhage due to motion artifact in the susceptibility images.There is prominence of the ventricles and sulci due to age related volume loss. There is no midline shift. Basal cisterns are patent.Vascular flow voids are normal.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. No acute infarct.2. Subcortical and periventricular white matter, pons, and midbrain hyperintensities on T2/FLAIR representing chronic vascular ischemic changes.3. Linear encephalomalacia in the pons, likely due to prior hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Postsurgical changes of right L5 and S1 hemilaminotomies are seen for resection of osseous lesion at the S1 level on the right. There appears to be resection of at least majority of the lesion including component extending medially extradurally in the lateral aspect of the spinal canal at S1. Rind of bone at the S1 level is seen projecting into the spinal canal which may represent normal/reactive residual bone or possibly small residual medial component of the lesion. Edema within the right S1 pedicle has not significantly changed from the prior study and is likely postprocedural and/or related to previously noted S1 lesion. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. No areas of abnormal enhancement are present. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. No spinal canal or neural foraminal narrowing.

Output: Postsurgical changes at the right L5-S1 level for resection of right S1 lesion. There appears to be resection of at least majority of the lesion. Consider CT for better evaluation for residual bony lesion lesion.


Instruction: Generate impression based on medical findings.

Input: 42-year-old female with a history of a right mastectomy for IDC/DCIS in 2011. She has a family history of breast cancer in her paternal grandmother diagnosed in her 80s and paternal aunt diagnosed in her 60s. Screening MRI. Mild parenchymal enhancement is noted in the left breast. There is scattered fibroglandular tissue in the left breast. Stable post-surgical changes are noted with no suspicious enhancement in the right reconstruction. No suspicious enhancement is seen in the left breast. The left retroareolar focus is stable. No abnormal axillary lymph nodes are identified in either axillary region. Post-surgical change is again noted in the right axilla.

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


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is a right parietal lobe enhancing nodule again measuring 10 x 11 mm. No other enhancing lesions are present.Postsurgical findings consistent with right parietal craniotomy and tumor resection are redemonstrated. Minimal curvilinear enhancement in the surgical bed appears similar to prior examination. Edema involving the parietal lobe is stable.No intra-axial or extra-axial fluid collections are visualized. The ventricles are normal in size. The basal cisterns are visualized. Small retention cysts are visualized in the left maxilla sinus. Partial opacification of the left mastoid air cells is redemonstrated.

Output: Redemonstrated is a right parietal lobe enhancing nodule again measuring 10 x 11 mm. No other enhancing lesions are present.


Instruction: Generate impression based on medical findings.

Input: Significant decline in vision OD, concern for compressive/ischemic optic neuropathy OD: afferent pupillary defect and loss of color OD. Orbits: The bilateral globes, optic nerves, and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.Brain: There is high T2 signal and enhancement of the optic chiasm and prechiasmatic optic nerves, right more than left, with minimal swelling. There are a few punctate foci of non-enhancing white matter T2 hyperintensity in the bilateral frontal lobes. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, cerebellum, brainstem, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are left maxillary ans sphenoid sinus retention cysts.

Output: Enhancement of the optic chiasm and prechiasmatic optic nerves, right more than left is compatible optic neuritis and a few nonspecific punctate white matter lesion in the unilateral frontal lobes. An autoimmune demyelinating process is a possible etiology, but other considerations include a subacute ischemic event or toxic-metabolic exposure, or perhaps even a neoplastic process, such as lymphoma.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of end-stage renal disease with altered mental status. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Multiple, mild areas of patchy hypodensity in a periventricular and subcortical white matter distribution consistent with microangiopathic changes. If there is clinical concern for acute ischemia, an MRI may be considered. Dystrophic calcifications along the cerebellar tentorium.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Age indeterminate microangiopathic changes. No evidence of intracranial bleed. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: 26-year-old male with left knee pain, swelling and decreased range of motion. Evaluate for ligament injury. MENISCI: There is linear branching signal abnormality within the posterior horn of the medial meniscus which extends anteriorly into the body of the medial meniscus consistent with a complex tear with both vertical and horizontal components. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Complex tear of the medial meniscus and joint effusion as described above.


Instruction: Generate impression based on medical findings.

Input: Mild motion artifact and lack of IV contrast limits evaluation of more subtle abnormalities/metastases. However, there is low T1 and heterogeneous T2 signal abnormality in the C7 vertebral body extending into the left pedicle, facet and spinous process, which on the prior PET/CT was hypermetabolic, consistent with osseous metastasis. There is also similar low T1 and high T2 signal abnormality in the left facet of C6 which may be due to degenerative disease and/or a subtle metastasis. The cord caliber and signal are within normal limits.C2-3: Small central disk osteophyte complex with no spinal stenosis.C3-4: Disk osteophyte complex and uncovertebral hypertrophy with mild facet arthropathy causing ventral CSF attenuation with no significant spinal canal stenosis and moderate right neural foraminal stenosis.C4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing moderate spinal canal stenosis and no significant neural foraminal stenosis.C5-6: Disk osteophyte complex eccentric to the left causing focal indentation of the ventral cord surface on the left. There is mild spinal canal stenosis and no significant neural foraminal stenosis.C6-7: Disk osteophyte complex causing no significant spinal no stenosis. There is mild left uncovertebral causing mild left neural foraminal stenosis.C7-T1: Vertebral body metastasis extending into the left pedicle with expansion of the left pedicle (with possible epidural tumor) causing severe left neural foraminal stenosis.T1-2: No disk herniation or spinal stenosis.

Output: 1.Vertebral body metastasis at C7 extending into the left pedicle, facet and spinous process. There is expansion of the left pedicle (with possible epidural tumor) causing severe left foraminal stenosis at C7-T1.2.Multilevel cervical spondylosis with moderate spinal canal stenosis at C4-5.3.No definite cord signal abnormality, however the exam is mildly degraded by motion artifact.4.Lack of IV contrast limits evaluation for more subtle abnormalities including metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 10 years old, history of tuberous sclerosis and epilepsy. Image quality is degraded by motion artifact. Within this limitation, the following observations are made.Redemonstrated are numerous stigmata of tuberous sclerosis, including scattered areas of subcortical T2 hyperintensity and numerous ependymal nodules. Most of these lesions show no significant interval change. Some of the ependymal lesions seem to demonstrate minimal enhancement above their intrinsic T1 hyperintensity, but this has not appreciably changed.One lesion, however, within the left anterior temporal lobe, shows increased T2 signal and enhancement, now measuring up to 8 mm in diameter, previously 5 mm.No entirely new parenchymal lesions are seen. No evidence of significant mass effect is demonstrated. Ventricular size and morphology are unremarkable. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen.Since the prior examination, maxillary sinus inflammation has improved. However, progressive opacification of the mastoid air cells and the left petrous apex is noted.

Output: 1.Interval increase in size of an enhancing lesion within the anterior left temporal lobe, the nature of which is uncertain. Although this would be a very unusual location for a giant cell astrocytoma, the possibility of a neoplastic process cannot be entirely excluded. Correlation with clinical symptomatology and close interval follow-up is suggested.2.The remaining subcortical tubers and subependymal nodules show no significant interval change in size or imaging characteristics.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of right lumpectomy for invasive ductal carcinoma in 2007. Patient also has history of LCIS and atypical lobular hyperplasia in both breasts, from a needle biopsy the right breast in 2007 and an excisional biopsy of the left breast in 2007. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact is seen in the upper right breast, corresponding to the surgical clips from patient's prior lumpectomy.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Brain bleed. There is a heterogeneous intermediate to high T1 signal and mixed low and high T2 signal lesion centered in the left middle cerebellar peduncle with diffuse central and peripheral susceptibility effect, which measures up to 20 mm. There is surrounding vasogenic edema. There is mild effacement of the fourth ventricle, but the third and lateral ventricles are not particularly enlarged. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a retention cyst in the left maxillary sinus.

Output: Findings most suggestive of a recently hemorrhagic left middle cerebellar peduncle cavernous malformation with associated developmental venous anomaly.


Instruction: Generate impression based on medical findings.

Input: 58-year-old woman with history of multiple prior benign bilateral breast biopsies. History of breast cancer in mother diagnosed at age 50. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A stable 1 cm focal asymmetry in the right upper outer breast corresponds to a nonenhancing mass seen on prior T2 weighted MRI images.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.

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


Instruction: Generate impression based on medical findings.

Input: 66 year old female with left sided headaches for one month. History of colon cancer, MET to the brain status post resection 2006. Stable extensive areas of encephalomalacia within bilateral cerebral hemispheres, left greater than right. There is also stable left craniotomy. There is no evidence of acute intracranial hemorrhage, mass, or abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial hemorrhage, mass, or abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old, with focal headache, left parasagittal, ventral to the crown, assess for stroke, less likely mass or vascular lesion. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. MRA imaging shows no evidence of any significant intracranial vascular stenosis or occlusion. No aneurysms are detected within the limitations of technique.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

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


Instruction: Generate impression based on medical findings.

Input: 28 year-old female with headache and syncope. Please evaluate for bleed/mass. Family history of aneurysms. There is no evidence of intracranial hemorrhage, parenchymal, intra-axial mass or edema. Adjacent to the left parietal lobe, there is a small extra axial broad based soft tissue density mass with punctate areas of calcification which has associated hyperostosis of the adjacent skull and measures 8 x 15 mm, (coronal series 80232, image 40). This most likely represents a meningioma. Further evaluation with MRI is recommended as clinically indicated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormalities, specifically no bleed.2. Small left parietal region extra-axial mass with adjacent associated hyperostosis most likely representing a meningioma. Further evaluation with MRI is recommended as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Status post lumbar spine surgery. There are new postsurgical changes since the prior MRI study, with hardware related to posterior spinal fusion from L2 to S1 levels. Postsurgical changes of anterior L2 -- L3 to L4 -- L5 interbody fusion are also present. There is a surgical drainage catheter in the posterior surgical bed. The orthopedic hardware generous streak artifacts, causing obscuration of image details in the surrounding area. This is small fracture at the right inferolateral aspect of the L4 vertebra, extending from the right L4 pedicle screw placement. Again noted is widening of anterior L1 -- L2 intervertebral disk space, with sclerotic endplate changes and air within the intervertebral disk space. This is similar in appearance to the prior MRI study. This may be related to severe degenerative disk disease; diskitis is less likely given the lack of interval change compared to the prior MR study, but this cannot be excluded.

Output: 1. New postsurgical changes as described above. There is a fracture at the right inferolateral aspect of L4 vertebra, extending from the right L4 screw placement.2. Residual degenerative disease as described above. There remains sclerotic endplate changes with bone erosion at endplates of L1 -- L2 level, likely representing severe degenerative disk disease. Diskitis is less likely but is not completely excluded.


Instruction: Generate impression based on medical findings.

Input: Female 36 years old Reason: h/o Crohn's, s/p 2 resections with possible proximal to previous anastomosis. intermittent obstructions. History: elevated crp, intermittent obstructions with bloating ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Signal dropout on out of phase images consistent with diffuse hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 1.4 cm. It is unchanged in size compared to prior CT 11/27/13. It demonstrates signal dropout on out of phase images and is consistent with adenoma.KIDNEYS, URETERS: Subcentimeter T2 hyperintensity within the left kidney compatible with a renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post ileocecectomy. Second side-to-side small bowel anastomosis in the mid/distal ileum. In the distal ileum in the region of the anastomosis and in the neoterminal ileum there are segments of mild hyper enhancement of the wall of the bowel with minimal edema in this region. There is no significant wall thickening or increased signal high B value diffusion weighted images.There is focal narrowing of the rectum which persists on serial sequences with mild wall edema and hyperenhancement (series 22, image 69).Additionally there is tethering of the neoterminal ileum to rectum in this region suggestive of underlying adhesions (series 22, image 79; series 23, image 24). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral physiologic ovarian follicles. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid.

Output: 1. Mucosal hyperenhancement and mild edema involving the neoterminal ileum and a focal segment of rectum. Focal adhesions are identified between these two abnormal segments of bowel. 2. Hepatic steatosis.


Instruction: Generate impression based on medical findings.

Input: 74 year old with history hypertension, coronary artery disease and congestive heart failure presenting after a recent ventricular fibrillation arrest. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 143 ml/m2 (normal range: 65+/-11), the LVEDV is 284 ml (normal range 109+/-23), the LV end systolic volume index is 114 ml/m2 (normal range 18+/-5), the LVESV is 226 ml (normal range 31+/-10), the LV mass index is 65 g/m2 (normal range 67+/-11), and the LV mass is 129 g (normal range 114+/-24). There is global hypokinesis with additional thinning and akinesis of the basal to mid inferior and inferoseptal walls. There is transmural late gadolinium enhancement involving most of the inferior and inferoseptal walls in a pattern consistent with prior myocardial infarction. These segments are unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 127 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 80 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild protruding atheroma in the descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is mild bilateral atelectasis or consolidation at the base of the lungs. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 20%).2. There is a transmural myocardial infarction involving much of the usual territory of the right coronary artery. This territory is unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable. 3. Normal RV size with moderately reduced systolic function (RVEF 37%).4. Severe left atrial dilation. 5. Mild protruding atheroma in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Male 12 years old Reason: evaluate pineal cyst for growth History: HA Again seen is a cystic anterior pineal lesion with mild heterogeneity involving the posterior aspect of the pineal gland. The cystic lesion measures 8 x 5 x 6 mm (AP by CC by transverse), previously also 8 x 5 x 6. Remainder of the brain demonstrates no other intracranial mass or mass effect. No evidence of ischemia or hemorrhage. No extra-axial collections. No hydrocephalus. Calvarium and extracranial soft tissues are unremarkable.

Output: Unchanged size of slightly complex appearing pineal cyst dating back to 2/13/2014. Brain parenchyma is otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Blurry vision and numbness/tingling, rule out demyelinating diease. 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 a small left maxillary sinus retention cyst.

Output: No evidence of demyelinating lesions, acute intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on medical findings.

Input: 43-year-old with left breast invasive ductal carcinoma status post chemotherapy presents for bilateral breast MRI to assess treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: Redemonstrated is a rim-enhancing mass with irregular margins and associated clip artifact in the left breast 11:00 position, posterior depth, measuring 14 x 11 x 12 mm (previously 14 x 11 x 12 mm), consistent with the biopsy-proven cancer. There is a subcentimeter cyst in the left breast 12:00 position which demonstrates mild peripheral enhancement. This appearance was similarly seen in some of her cysts on the initial staging MRI and is benign. There is no additional suspicious enhancing mass or focus of enhancement in the left breast or left axilla region.RIGHT BREAST: No abnormal enhancement is seen in the right breast or right axillary region.

Output: No change in size of left breast cancer measuring 14 x 11 x 12 mm.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: MRI: The exam is performed without IV contrast. There is no acute infarct, mass, or cerebral edema. The ventricles and basal cisterns are prominent for patient age. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRV: The superior sagittal sinus, inferior sagittal sinus, proximal transverse sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. Both distal transverse and sigmoid sinuses are suboptimally visualized, especially on the right which is likely artifactual. The right internal jugular vein is markedly thinned which is likely due to anatomic variation.

Output: 1.Artifactual and anatomic variation in both distal transverse and sigmoid sinuses contributing to suboptimal visualization of these structures on the venogram portion of the exam. Diminutive right internal jugular vein which is likely anatomic variation. Given absence of findings in the brain parenchyma, an acute thrombosis is felt to be unlikely, however if there remains high clinical suspicion, confirmation with CT venogram with IV contrast and/or repeat MR venogram with IV contrast would be suggested.2.Stable noncontrast MRI of the brain with no acute infarct, hydrocephalus or mass effect.


Instruction: Generate impression based on medical findings.

Input: 46 year old with personal history of left breast cancer status post lumpectomy in 2014 and radiation therapy. Multiple benign biopsies in both breasts. No current breast related complaint. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted in the right breast, and marked parenchymal enhancement is noted in the left breast.Post-surgical seroma is present at posterior 12:00 position in the left breast. Diffuse skin thickening, trabecular engorgement and edema with diffuse parenchymal enhancement is seen in the left breast, due to recent radiation treatment.In the right breast, there are three marker clips. Parenchymal enhancing pattern is about the same as previous.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Post-radiation and surgical changes in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: There is redemonstration of postoperative changes from prior left posterior temporal parietal lobe mass resection. The resection cavity appears similar in configuration, with marginal susceptibility likely relating to chronic postoperative hemosiderin deposition. There is no associated pathological enhancement. T2/FLAIR hyperintensity surrounding the posterior and medial margins of the resection cavity is again noted, with similar appearance to more recent comparisons, although slightly more posteriorly extending compared back to the June 2013 exam. There is again mild ex vacuo dilatation of the left ventricular trigone.There is redemonstration of numerous punctate foci of susceptibility throughout the cerebral hemispheres especially posteriorly and along the brainstem margins, with slight interval progression. These are are nonspecific but favored to represent posttreatment changes.Ventricles and sulci are prominent, consistent with moderate global volume loss. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The right cerebellar tonsil is slightly more low lying than the left.

Output: Stable postoperative and posttreatment changes without evidence of recurrent tumor. Slight posterior progression of marginal FLAIR hyperintensity when compared to remote exams which may relate to evolving posttreatment changes.


Instruction: Generate impression based on medical findings.

Input: Acute disseminated encephalitis and encephalomyelitis, with worsening headache. There are postsurgical findings related to right frontal approach stereotactic biopsy of the pontine enhancing lesions. There is significant interval improvement in the foci of enhancement within the pons. There are no new enhancing foci are significant abnormality. There are unchanged mild scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval improvement of the pontine lesions, status post biopsy.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: 46-year-old male with history of primary sclerosing cholangitis. Patient presents for cholangiocarcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver without evidence of a suspicious mass. Unchanged regions of right hepatic lobe fibrosis. Irregular biliary ductal beading and intrahepatic strictures compatible with patient's known history of primary sclerosing cholangitis is again seen. The confluence of the hepatic ducts is diminutive in caliber. No dominant stricture is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst is again noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in biliary ductal irregularity compatible with known primary sclerosing cholangitis.2.Cirrhotic hepatic morphology without interval development of a dominant stricture, biliary ductal dilatation or suspicious hepatobiliary lesions.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Further evaluation for disc herniation. Signs and symptoms: Myelopathy, preop planning. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative disc disease with resultant moderate left and mild right neural foraminal compromise and no central spinal stenosis.C4-C5 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophic changes. Shallow mental hypertrophic spur on the left results in slight flattening and posterior displacement of the cord and moderate central spinal stenosis. Moderate bilateral neural foraminal compromise is also present.C5-C6 demonstrate a large disc extrusion extending superiorly to mid C5 level and inferiorly to mid C6. Although the prior exam was incomplete there is no significant change of this finding which results in significant central spinal stenosis. The extruded disc is more prominent to the left of midline. Significant bilateral neural foraminal compromise is also present. On sagittal T2 STIR there is evidence of increased T2/T2 STIR signal intensity of the cord at this level suggestive of myelitis.C6-C7 demonstrate moderate disc disease, loss of disc height, mild hypertrophic changes of facet and ligamentum flavum. There is a shallow bulging disc with resultant subtle flattening the ventral aspect of the cord and mild central spinal stenosis.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord to T3 level is unremarkable.

Output: 1.C5-C6 demonstrate a large disc extrusion with resultant significant central spinal stenosis and increased T2 signal intensity of the cord/myelitis.2.C4-C5 demonstrate degenerative changes with resultant moderate central spinal stenosis and neural foraminal compromise as detailed.3.C6-C7 demonstrate degenerative changes with resultant mild central spinal stenosis and neural foraminal compromise.4.See detailed report per level above.


Instruction: Generate impression based on medical findings.

Input: Reason: 52-year-old male followup PV thrombosis and SV thrombosis, HCC screening History: hepatitis B cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Superior mesenteric vein thrombosis is again seen near its confluence with the splenic vein. This thrombus is nonocclusive, appearing similar to the prior study. The portal vein is patent.Several subcentimeter liver cysts are again noted. Cirrhotic morphology of the liver is unchanged. Gastroesophageal varices are unchanged. No suspicious liver lesion is identified. Cholelithiasis without evidence of acute cholecystitis. Multiple prominent porta hepatis lymph nodes. SPLEEN: Splenomegaly is again noted with spleen measuring up to 17.5 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Nonocclusive thrombus of the SMV, unchanged from prior study.2.Cirrhotic liver morphology without suspicious masslesion.3.Gallstones without evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: Clinical question: MS evaluate disease burden, compared to 2013 study. Signs and symptoms: Myoclonus, right sided paresthesia cognitive issues, imbalance to the left. Pre-and post enhanced brain MRI:No diffusion weighted abnormalities.Examination redemonstrates chronic nonenhancing findings of multiple sclerosis in the periventricular and subcortical as well as the corpus callosum of mild degree. Minimal similar findings are also present in the pons. When compared with prior exam there is no convincing evidence of any change of findings in the supratentorial space however there is mild progression of disease in the pons with evidence of a new nonenhancing plaque.The cortical sulci and ventricular system as well as the CSF spaces remain within normal for patient stated age of 61 and is stable since prior exam.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.Under local images through the orbits, paranasal sinuses and mastoid air cells.Pre-and post enhanced cervical MRI:There are no prior exams for comparison.Examination demonstrates only questionable small foci of T2 hyperintensity in the left paramedian cord at C5 and C6 levels without detectable abnormal enhancement are caliber and signal intensity of the cord is otherwise within normal.There are mild to moderate degenerative disk disease in particular at C5 -- C6 and C6 -- C7 levels. The findings result in moderate left and mild right neural foraminal compromise at C5 -- C6 and significant bilateral neural foraminal compromise at C6 -- C7 levels. Mild central spinal stenosis at C6 -- C7.There is slight straightening of cervical lordosis likely secondary to degenerative disease.There is no detectable abnormal enhancement the vertebral column.Pre-and post enhanced thoracic MRI:There is normal signal intensity and caliber thoracic cord and without abnormal enhancement.There is normal signal intensity and alignment the vertebral column without abnormal enhancement.There is no evidence of spinal canal or significant neural foraminal compromise at any level. Hypertrophy changes of posterior elements at T8 -- T9 however results in mild to moderate left neural foraminal compromise.Three limited partial visualization of L1 -- 2 disk level demonstrates very extensive degenerative disk disease with significant loss of disk height and extensive spur formation. There are no prior lumbar spine imaging for comparison. Correlate with history and symptomatology and considered dedicated MRI of lumbar spine if clinically deemed necessary.

Output: 1.Pre-and post enhanced brain MRI demonstrate no evidence of an acute enhancing demyelinating plaque. Stable mild chronic multiple sclerosis in the supratentorial brain parenchyma since prior exam. Minimal findings of chronic demyelinating disease in the pons and with evidence of minute interval progression since prior outside institution MRI exam from 2013. 2.Pre-and post enhanced MRI of the cervical spine demonstrate only questionable tiny nonenhancing foci of T2 hyperintensity at C5 and C6 which could also be result of degenerative changes. Degenerative changes at C5 -- C6 and C6 -- C7 levels results in mild central spinal stenosis at C6 -- C7 level and with significant bilateral neural foraminal compromise.3.Unremarkable pre-and post enhanced MRI of the thoracic spine. At the very edge of the field of exam there is partial visualization of significant disk disease at the L1 -- L2 level and with extensive bony formation. Correlate with history neurological findings and considered follow-up with dedicated lumbar MRI if clinically deemed necessary.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval Index Finger MCP History: s/p dislocation LIGAMENTS: There is disruption of the proximal fibers of the ulnar collateral ligament of the MCP joint of the index finger (image 12; series 701). The radial collateral ligament appears intact.TENDONS: The flexor and extensor tendons appear intact. There is fluid within the tendon sheath of the flexor tendon of the index finger indicating a mild tenosynovitis. There is subcutaneous edema along the volar aspect of the tendon as well which may reflect a strain injury.BONES: No bone marrow signal abnormality is identified. The alignment is anatomic.ADDITIONAL

Output: Findings indicating disruption of the ulnar collateral ligament of the MCP joint of the index finger as well as a mild tenosynovitis of the flexor tendon of the index finger as described above.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with HCC, please evaluate for metastases LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.The prominent pericardial recess in the right paratracheal region.Probable tracheal diverticulum unchanged from the prior exam.CHEST WALL: Degenerative changes in the thoracic spineUPPER ABDOMEN: Hypodense lesions with internal calcification within the right lobe of liver compatible with treatedtumor (recent MRI dated 6/29/11).

Output: No evidence of metastatic disease within the chest.


Instruction: Generate impression based on medical findings.

Input: headache during sex No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.The left side sphenoid sinus shows opacification.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, MCAs and ACAs.Bilateral Pcom arteries were identified and patent. Acom artery is also patent.There is no evidence of intracranial arterial aneurysm, significant intracranial arterial luminal stenosis or occlusion.Smaller than 3mm sized intracranial arterial aneurysm cannot be identified on MR angiography. Therefore, if clinically indicated, diagnostic cerebral angiography can be considered for further evaluation.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Left sphenoid sinus opacification.3. No evidence of intracranial aneurysm on MRA.Rec: If clinically indicated, diagnostic cerebral angiography can be considered for further imaging evaluation.


Instruction: Generate impression based on medical findings.

Input: Dysarthria [784.51], Reason for Study: ^Reason: Stroke workup History: Dysarthria There are scattered restricted diffusion lesions on bilateral frontal lobes including the left precentral gyrus, bilateral frontal lobe deep white matter indicating acute ischemic stroke. There is no evidence of hemorrhagic transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. 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: Multifocal bifrontal acute ischemic infarction without hemorrhagic transformation as described above.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female patient with glioblastoma multiforme. Evaluate for GBM status post RT/TMZ/bev. 4 week Redemonstration of postsurgical changes related to a right parietotemporal craniotomy for partial tumor resection from the right temporal lobe. Again seen is extensive enhancement surrounding the resection cavity, with the area of thick enhancement appearing mildly increased particularly along the superior margins of the tumor within the right temporooccipital lobe and extending to the right splenium. However, there is significant interval decrease in surrounding abnormal T2 signal along with diffusion abnormality, predominantly within the superior aspect of the right temporal lobe and parietooccipital lobe. This results in decreased mass effect and midline shift which now measures approximately 4 mm, previously 13 mm. Right uncal herniation is improved. An additional satellite nodule along the lateral surface of the right lateral temporal lobe is unchanged. Prominent left temporal horn periventricular T2 signal is unchanged. Linear and nodular susceptibility artifact surrounding the resection cavity is not significantly changed.

Output: 1. Post-surgical changes in the right temporal lobe related to partial resection of known GBM. Compared to 5/1/2015, there is significant decrease in FLAIR hyperintensity/edema particularly superior to the enhancing lesion consistent with response to Avastin therapy. There is however some interval increase in thick enhancement particularly surrounding the trigone of the right lateral ventricle, which given recent radiation therapy may represent treatment change; close follow-up, however, is recommended. 2. Improvement in mass effect, midline shift, and right uncal herniation.3. Unchanged right lateral temporal lobe satellite lesion.


Instruction: Generate impression based on medical findings.

Input: History of bladder cancer status post cystectomy and ileal conduit. Surveillance examination. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Moderate diffuse pancreatic parenchymal atrophy. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable simple cystic lesions bilaterally. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No abdominal lymphadenopathy.BOWEL, MESENTERY: Postoperative changes from ileal conduit from aeration.BONES, SOFT TISSUES: No focal suspicious osseous lesion.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy and ileal conduit information.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small focus of enhancing subcutaneous tissue overlying the left rectus muscle (series 20 image 42) is not significant changed since 2013 and presumed postsurgical.OTHER: No significant abnormality noted.

Output: 1.Postoperative changes from cystoprostatectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: History of hepatitis C with lesion in segment 5 on outside MRI. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. The T2 weighted hyperintense segment 7 peripheral lesion measures 1.2 cm without evidence of arterial enhancement, restricted diffusion or intracellular fat. There may be a thin enhancing septa within the lesion. The subtraction images are not reliable given the degree of misregistration due to motion. Punctate probable cyst in the right hepatic dome (series 7/27).No biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The segment 7 1.2 cm lesion (likely corresponding to that reported on outside MR as segment 5 lesion) demonstrates no definite arterial enhancement or other suspicious imaging features. This may represent a septated cyst or fibrosed hemangioma (given the outside hospital ultrasound appearance of an echogenic lesion). Continued follow-up with ultrasound to document stability in 3-6 months is recommended.


Instruction: Generate impression based on medical findings.

Input: Ex-FT female with cardiac arrest on DOL 1 (was down 90 mins), vEEG shows activity concerning for a hypoxic ischemic episode. There are scattered areas of high T1 signal in the cerebral cortex, particularly involving the bilateral perirolandic regions, bilateral hippocampi, bilateral posterior cingulate gyri, and left insula. There is also prominent T1 signal in the bilateral basal ganglia. There is deficiency of white matter T1 hyperintensity in the posterior limbs of the internal capsules and perirolandic regions. There is a punctate focus of susceptibility effect in the left occipital horn. There is high T1 signal and restricted diffusion in the bilateral transverse sinuses. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings compatible with subacute hypoxic ischemic injury in a central and peripheral distribution with delayed myelination.2. Findings suggestive of dural venous thrombosis involving the bilateral transverse sinuses versus flow artifact. An MRV may be useful fir further evaluation.3. Punctate blood products in the left lateral ventricle.Discussed with Dr. Jaideep Singh at 4 PM on 9/28/15.


Instruction: Generate impression based on medical findings.

Input: 44 year old man with heart block and exercise intolerance referred to evaluate for infiltrative cardiomyopathy. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 214 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 99 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 152 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The measured native myocardial T1 relaxation time is 1036 msec (within normal limits). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 212ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is 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 FindingsHilar and mediastinal lymphadenopathy is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size with normal systolic function (LVEF 54%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size with mildly reduced systolic function (RVEF 47%).3. Mild biatrial dilation.4. See extra-cardiac findings. 5. When compared to 4/25/2016, no significant change is noted. 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: Ms. Igielski is a 54-year-old woman with a personal history of left breast lumpectomy 2003 for IDC followed by radiation therapy. She has a family history of breast cancer in her paternal grandfather, paternal aunt, and paternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Expected post surgical volume loss and distortion is present in the left breast and left axilla. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Carcinoid syndrome and seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific periventricular white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mucosal thickening and secretions within the right osteomeatal unit.

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


Instruction: Generate impression based on medical findings.

Input: 34 year old man with history of ALL s/p chemotherapy/radiation and stem cell transplant, elevated ferritin and recent diagnosis of LV dysfunction referred for cardiac MRI to evaluate the etiology for his cardiomyopathy. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 136 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 80 g (normal range 164+/-36). There is global hypokinesis. The native T1 time is normal (1050ms). The ECV fraction is normal (25%). Global relative enhancement is normal. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 121 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 65 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 no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is iron overload of the liver, as suggested by a significantly reduced T2* decay time (6.1) . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal sized left ventricle with mildly reduced systolic function (EF 45%). There is global hypokinesis. 2. No evidence of late gadolinium enhancement to suggest acute myocarditis or myocardial fibrosis, inflammation, or infiltration.3. Normal sized right ventricle with mildly reduced systolic function (EF 47%).4. Iron overload of the liver and spleen. 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: Is a large solid and cystic mass in the left cerebellar hemisphere, currently measuring 2.4 x 2.8 cm in greatest axial dimensions, x 1.7 cm CC. This appears similar to the prior outside MRI. It abuts the inferior margin of the distal left transverse sinus without definite invasion or narrowing. There is an additional ring-enhancing low central signal intensity lesion in the right posterior peripheral occipital lobe, measuring 1.4 x 1.2 cm in greatest axial dimensions, x 1.1 cm CC. This previously demonstrated more homogeneous central enhancement on the outside images. There is an additional nodular area of enhancement in the midline posterior inferior vermis measuring up to 5 mm in greatest axial dimensions (501/69, 502/174), which can be identified on the prior exam with a similar appearance.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is scattered foci of punctate T2 hyperintensity within the subcortical white matter bilaterally, although not as well delineated given lack of FLAIR images. There is also corresponding T2 hyperintensity to the above-described larger parenchymal lesions. 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.

Output: 1. Redemonstration of dominant left cerebellar and smaller right occipital lobe enhancing lesions, consistent with known areas of presumed metastatic disease. Interval decreased central enhancement of now ring-enhancing right occipital lesion.2. Additional small focus of nodular enhancement in the posterior inferior vermis, also suspicious for metastatic disease.3. Grossly stable scattered punctate foci of T2 hyperintensity in the subcortical white matter which are nonspecific.


Instruction: Generate impression based on medical findings.

Input: Left side weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multiple small nodular signal void lesion on bilateral hemispheres on gradient echo images. Diagnostic possibilities include amyloid angiopathy, multiple small hemorrhages, multiple cavernous malformations or calcifications.Multifocal patchy high signal intensities on bilateral periventricular white matter and centrum semiovale on FLAIR images indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs and ACAs.Acom artery and right Pcom artery are patent but the left Pcom artery is not seen.There is no evidence of intracranial aneurysm.There is no evidence of intracranial arterial luminal stenosis or occlusion.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Non specific small vessel ischemic disease as described above.3. Multifocal bi-hemispheric signal voids on gradient echo images indicating possible amyloid angiopathy, multiple small hemorrhages, multiple cavernous malformations or calcifications.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Quadriplegia, C5-C7 incompleteClinical question: s/p spinal cord bxSigns and Symptoms: weakness The cervical vertebral bodies are appropriate in overall alignment and height. The patient is status post recent multilevel laminectomies at C5, C6, C7. There is redemonstration of a T2 hyperintense mass extending from the C5-6 disc space level down to the T1 vertebral level. There is some heterogeneous enhancement associated with this lesion which is eccentric towards the right half of the spinal cord. The spinal cord is enlarged at the level of the tumor. There is no spinal fluid surrounding the spinal cord at the levels of the tumor.There are signal changes and contrast enhancement along the paravertebral musculature extending from approximately C1 down to T1 which are probably related to partial operative effects.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is loss of disc space height, endplate reactive change, central disc protrusion, endplate and uncovertebral osteophytes and narrowing of the neural foramina bilaterally and encroachment of exiting nerve roots. The endplate reactive changes are high signal on T2 and display enhancement following gadolinium administration.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There are endplate and uncovertebral osteophytes present at this level associated with a disc bulge associated with endplate reactive change.The vertebral artery flow voids appear to be intact.

Output: 1.The patient is status post recent laminectomies in the lower cervical spine. There are associated postoperative changes present.2.There is a mass redemonstrated which is centered in the lower cervical spinal cord and eccentric to the right side. Differential considerations include astrocytoma and ependymoma.3.There are multilevel degenerative changes present in the cervical spine associated with the encroachment of exiting nerve roots bilaterally at C5-6. Spinal stenosis at the C5-6 level has been alleviated compared to the prior exam.